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a diuretic (trade name Osmitrol) used to promote the excretion of urine (同)Osmitrol

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/02/09 22:46:45」(JST)

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D-マンニトール

一般情報
IUPAC名	(2R,3R,4R,5R)-ヘキサン-1,2,3,4,5,6-ヘキサオール
別名	マンニット
分子式	C₆H₁₄O₆
分子量	182.17 g/mol
形状	無色斜方晶 from エタノール
CAS登録番号	[69-65-8]（D体） [643-01-6]（L体） [133-43-7]（ラセミ体）
性質
融点	166-168 °C（斜方晶 from エタノール）
沸点	290-295 °C/3.5 mmHg
比旋光度 [α]_D	+23.3 ～ +24.3 (20 ℃)

マンニトール (Mannitol) は糖アルコールの一種である。ヘキシトールに分類され、マンノースの還元体に相当する。マンニット (mannite) とも呼ばれる^[1]。光学活性物質であり、天然に多く存在するエナンチオマーは D-マンニトールである。ソルビトールの異性体である。

ヨーロッパから中近東にかけて自生するモクセイ科のマンナトネリコ（Manna Ash、Fraxinus ornus）の甘い樹液から発見・命名された。マンナトネリコの名はマナにちなむ。

浸透圧調製剤・利尿剤であり、弱い腎臓血管拡張剤でもある。

水溶液中ではプロトンを放出する性質を持つため、水溶液は酸性になる。このため、炭酸ナトリウムなど pH 調整剤を併用することが珍しくない。

用途

主に頭蓋内圧を減少させたり乏尿性腎不全の患者を治療するのに用いられる。点滴静脈注射で投与され、腎臓でろ過される。高張液として作用し、末端細環へのナトリウムイオンと水分の移動量を増加させることにより尿の生成を促進させる。

マンニトールは薬剤を脳に直接送り込む際にも用いられる。血液脳関門の動脈の物質の透過性は他の動脈よりも高選択的である。通常、物質は血管内皮細胞の隙間を潜り抜けて血管から組織中へ拡散するが、脳組織中へ拡散する物質はより厳密にコントロールされている。血液脳関門の内皮細胞は密着結合しており、通常はその隙間を抜けて拡散する事は出来ない。関門を通過するにはエネルギーを消費して能動輸送される必要が有り、受容体に結合出来る物質のみが通過可能である。マンニトールは血管内皮細胞を一時的に収縮させ、同時に密着結合を引き伸ばしてバリアを解く事が出来る^[2]。高モル濃度のマンニトール（1.4〜1.6M）を頸動脈内に注入すると、動脈血の浸透圧が上昇し、圧を平衡させる為に血管内皮細胞から水分が血液に移行して、細胞が縮み、細胞間の密着結合が剥がされる^[3]。この隙間はマンニトール動注後5分で最大となり、30分間持続する。この時間内に動脈内に注射された薬剤は、脳組織内に直接拡散する事が出来る^[4]。この効果はアルツハイマー型痴呆や脳腫瘍の化学療法等の治療において脳に直接薬剤を送り込む為に必要不可欠である^[3]。

また、糖尿病を患っている人々のための甘味料としても利用される。負の溶解熱を持つため、キャンディーなどにヒヤリとする爽快感を与えるためにも使われる。20グラム以上の量を摂取すると緩下薬としてはたらくことから、小児用の下剤として販売されることもある。

ヘロイン、メタンフェタミンなどの麻薬の混ぜ物として使われることもある。

心臓ペースメーカーのらせん状の導線など、尖ったものを体内に挿入する際の一時的な被覆材としても用いられる。血液に溶解しやすく静脈を透過するので、目的の位置に達したあと時間がたつと被覆された部分は再び露出する。

重篤なシガテラ中毒の場合に、重傷度軽減と神経学的症状・消化管症状の発現時間短縮を目的に投与されるという報告もある^[5]^[6]が、これを支持する論文は他には見あたらない^[要出典]。この用途にマンニトールを利用するに当たっては、充分な補水とともに、細心の注意が必要である。これはシガトキシンを原因とするいわゆる「熱帯魚中毒」で、脳卒中に似た症状を示すことがある。

マンニトールは非透過性の分子である。すなわち細胞膜を通り抜けることができない。

有機合成の分野においては、安価かつ各種の変換を行いやすい点を生かし、不斉点を持つ化合物の合成の際に出発原料としてよく用いられる。

効能・効果

D-マンニトールのフィッシャー投影式

術中・術後・外傷後及び薬物中毒時の急性腎不全の予防及び治療する場合

脳圧降下及び脳容積の縮小を必要とする場合

眼内圧降下を必要とする場合^[7]

副作用

重大な副作用として、急性腎不全（大量投与時）と電解質異常（代謝性アシドーシス、高カリウム血症、低ナトリウム血症）が知られている。0.1〜5％に脱水症状（口渇等）が発生する。

脚注

^ 内山充、寺尾允男、早川堯夫ら、2006年3月31日『第十五改正日本薬局方』厚生労働省告示第285号、1055頁目、2010年9月29日取得。
^ Best, B. Perfusion & Diffusion in Cryonics Protocol. benbest.com.
^ ^a ^b Ikeda M, Bhattacharjee AK, Kondoh T, Nagashima T, Tamaki N (2002). “Synergistic effect of cold mannitol and Na(+)/Ca(2+) exchange blocker on blood-brain barrier opening.”. Biochem Biophys Res Commun 291 (3): 669-74. doi:10.1006/bbrc.2002.6495. PMID 11855842.
^ Wang M, Etu J, Joshi S (2007). “Enhanced disruption of the blood brain barrier by intracarotid mannitol injection during transient cerebral hypoperfusion in rabbits.”. J Neurosurg Anesthesiol 19 (4): 249-56. doi:10.1097/ANA.0b013e3181453851. PMID 17893577.
^ Palafox NA, Jain LG, Pinano AZ, Gulick TM, Williams RK, Schatz IJ (1988). “Successful treatment of ciguatera fish poisoning with intravenous mannitol.”. JAMA 259 (18): 2740-2. doi:10.1001/jama.1988.03720180066035. PMID 3128666.
^ “Mannitol”. The American Society of Health-System Pharmacists. 2015年1月8日閲覧。
^ “マンニットＴ注15％ (500mL)” (2014年9月). 2016年7月18日閲覧。

この項目は、医学に関連した書きかけの項目です。この項目を加筆・訂正などしてくださる協力者を求めています（プロジェクト:医学／Portal:医学と医療）。

wiki en

[Wiki en表示]

Mannitol is a type of sugar which is also used as a medication.^[1]^[2] As a sugar it is often used as a sweetener in diabetic food as it is poorly absorbed from the intestines.^[1] As a medication it is used to decrease high pressures in the eyes such as are seen in glaucoma and to lower increased intracranial pressure.^[3]^[2] Medically it is given by injection. Effects typically begin within 15 minutes and last up to 8 hours.^[4]

Common side effects from medical use include electrolyte problems and dehydration.^[4] Other serious side effects may include worsening heart failure and kidney problems.^[4]^[2] It is unclear if use is safe in pregnancy. Mannitol is in the osmotic diuretic family of medications and works by pulling fluid from the brain and eyes.^[4]

The discovery of mannitol is attributed to Joseph Louis Proust in 1806.^[5] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.^[6] The wholesale cost in the developing world is about 1.12 to 5.80 USD a dose.^[7] In the United States a course of treatment costs 25 to 50 USD.^[8] It was originally made from the flowering ash and called manna after its supposed resemblance to the Biblical food.^[9]^[10]

Uses

Medical uses

Mannitol is used to reduce acutely raised intracranial pressure until more definitive treatment can be applied, e.g., after head trauma.

It may also be used for certain cases of kidney failure with low urine output, decreasing pressure in the eye, to increase the elimination of certain toxins, and to treat fluid build up.^[4]

Mannitol acts as an osmotic laxative^[11] in oral doses larger than 20 g^[12] and is sometimes sold as a laxative for children.^{[citation needed]}.

The use of mannitol, when inhaled, as a bronchial irritant as an alternative method of diagnosis of exercise induced asthma has been proposed. A 2013 systematic review concluded there is insufficient evidence to support its use for this purpose at this time.^[13]

Other

Mannitol is commonly used in the circuit prime of a heart lung machine during cardiopulmonary bypass. The presence of mannitol preserves renal function during the times of low blood flow and pressure, while the patient is on bypass. The solution prevents the swelling of endothelial cells in the kidney, which may have otherwise reduced blood flow to this area and resulted in cell damage.

Mannitol can also be used to temporarily encapsulate a sharp object (such as a helix on a lead for an artificial pacemaker) while it is passed through the venous system. Because the mannitol dissolves readily in blood, the sharp point will become exposed at its destination.

Mannitol is the primary ingredient of Mannitol Salt Agar, a bacterial growth medium, and is used in others.

Mannitol is also the first drug of choice for the treatment of acute glaucoma in veterinary medicine. It is administered as a 20% solution IV. It dehydrates the vitreous humor and, therefore, lowers the intraocular pressure. However, it requires an intact blood-ocular barrier to work.^[14]

Mannitol is popularly used as a cutting agent in cocaine.^[15]

Food

Mannitol increases blood glucose to a lesser extent than sucrose (thus having a relatively low glycemic index^[16]) and is therefore used as a sweetener for people with diabetes, and in chewing gums. Although mannitol has a higher heat of solution than most sugar alcohols, its comparatively low solubility reduces the cooling effect usually found in mint candies and gums. However, when mannitol is completely dissolved in a product, it induces a strong cooling effect.^[17] Also, it has a very low hygroscopicity – it does not pick up water from the air until the humidity level is 98%. This makes mannitol very useful as a coating for hard candies, dried fruits, and chewing gums, and it is often included as an ingredient in candies and chewing gum.^[18] The pleasant taste and mouthfeel of mannitol also makes it a popular excipient for chewable tablets.^[19]

Analytical chemistry

Mannitol can be used to form a complex with boric acid. This increases the acid strength of the boric acid, permitting better precision in volumetric analysis of this acid.^[20]

Contraindication

Mannitol is contraindicated in people with anuria, congestive heart failure and active cerebral haemorrhage (except during craniotomy).^{[citation needed]}

Production

Mannitol is classified as a sugar alcohol; that is, it can be derived from a sugar (mannose) by reduction. Other sugar alcohols include xylitol and sorbitol. Mannitol and sorbitol are isomers, the only difference being the orientation of the hydroxyl group on carbon 2.^[17]

Industrial synthesis

Mannitol is commonly produced via the hydrogenation of fructose, which is formed from either starch or sucrose (common table sugar). Although starch is a cheaper source than sucrose, the transformation of starch is much more complicated. Eventually, it yields a syrup containing about 42% fructose, 52% glucose, and 6% maltose. Sucrose is simply hydrolyzed into an invert sugar syrup, which contains about 50% fructose. In both cases, the syrups are chromatographically purified to contain 90–95% fructose. The fructose is then hydrogenated over a nickel catalyst into a mixture of isomers sorbitol and mannitol. Yield is typically 50%:50%, although slightly alkaline reaction conditions can slightly increase mannitol yields.^[17]

Biosyntheses

Mannitol is one of the most abundant energy and carbon storage molecules in nature, produced by a plethora of organisms, including bacteria, yeasts, fungi, algae, lichens, and many plants.^[21] Fermentation by microorganisms is an alternative to the traditional industrial synthesis. A fructose to mannitol metabolic pathway, known as the mannitol cycle in fungi, has been discovered in a type of red algae (Caloglossa leprieurii), and it is highly possible that other microorganisms employ similar such pathways.^[22] A class of lactic acid bacteria, labeled heterofermentive because of their multiple fermentation pathways, convert either three fructose molecules or two fructose and one glucose molecule into two mannitol molecules, and one molecule each of lactic acid, acetic acid, and carbon dioxide. Feedstock syrups containing medium to large concentrations of fructose (for example, cashew apple juice, containing 55% fructose: 45% glucose) can produce yields 200 g (7.1 oz) mannitol per liter of feedstock. Further research is being conducted, studying ways to engineer even more efficient mannitol pathways in lactic acid bacteria, as well as the use of other microorganisms such as yeast^[21] and E. coli in mannitol production. When food grade strains of any of the aforementioned microorganisms are used, the mannitol and the organism itself are directly applicable to food products, avoiding the need for careful separation of microorganism and mannitol crystals. Although this is a promising method, steps are needed to scale it up to industrially needed quantities.^[22]

Natural extraction

Since mannitol is found in a wide variety of natural products, including almost all plants, it can be directly extracted from natural products, rather than chemical or biological syntheses. In fact, in China, isolation from seaweed is the most common form of mannitol production.^[18] Mannitol concentrations of plant exudates can range from 20% in seaweeds to 90% in the plane tree. It is a constituent of saw palmetto (Serenoa).^[23] Traditionally, mannitol is extracted by the Soxhlet extraction, utilizing ethanol, water, and methanol to steam and then hydrolysis of the crude material. The mannitol is then recrystallized from the extract, generally resulting in yields of about 18% of the original natural product. Another up and coming method of extraction is by using supercritical and subcritical fluids. These fluids are at such a stage that there is no difference between the liquid and gas stages, and are therefore more diffusive than normal fluids. This is considered to make them much more effective mass transfer agents than normal liquids. The super-/sub-critical fluid is pumped through the natural product, and the mostly mannitol product is easily separated from the solvent and minute amount of byproduct. Supercritical carbon dioxide extraction of olive leaves has been shown to require less solvent per measure of leaf than a traditional extraction — 141.7 g (5.00 oz) CO₂ versus 194.4 g (6.86 oz) ethanol per 1 g (0.035 oz) olive leaf. Heated, pressurized, subcritical water is even cheaper, and is shown to have dramatically greater results than traditional extraction. It requires only 4.01 g (0.141 oz) water per 1 g (0.035 oz) of olive leaf, and gives a yield of 76.75% mannitol. Both super- and sub-critical extractions are cheaper, faster, purer, and more environmentally friendly than the traditional extraction. However, the required high operating temperatures and pressures are causes for hesitancy in the industrial use of this technique.^[22]

History

Julije Domac elucidated the structure of hexene and mannitol obtained from manna. He determined the place of the double bond in hexene obtained from mannitol and proved that it is a derivative of a normal hexene. This also solved the structure of mannitol which had been unknown until then.^[24]^[25]^[26]^[27]

Controversy

The three studies^[28]^[29]^[30] that initially found that high-dose mannitol was effective in cases of severe head injury have been the subject of a recent investigation.^[31] Although several authors are listed with Dr. Julio Cruz, it is unclear whether the authors had knowledge of how the patients were recruited. Further, the Federal University of São Paulo, which Dr. Cruz gave as his affiliation, has never employed him. As a result of doubt surrounding Cruz's work, an updated version of the Cochrane review excludes all studies by Julio Cruz, leaving only 4 studies.^[3] Due to differences in selection of control groups, a conclusion about the clinical use of mannitol could not be reached.

Compendial status

British Pharmacopoeia^[32]
Japanese Pharmacopoeia^[33]
United States Pharmacopeia^[34]

References

^ ^a ^b Varzakas, Theodoros; Labropoulos, Athanasios; Anestis, Stylianos (2012). Sweeteners: Nutritional Aspects, Applications, and Production Technology. CRC Press. pp. 59–60. ISBN 9781439876732.
^ ^a ^b ^c WHO Model Formulary 2008 (PDF). World Health Organization. 2009. p. 332. ISBN 9789241547659. Retrieved 8 December 2016.
^ ^a ^b Wakai, A; McCabe, A; Roberts, I; Schierhout, G (5 August 2013). "Mannitol for acute traumatic brain injury.". The Cochrane database of systematic reviews. 8: CD001049. doi:10.1002/14651858.CD001049.pub5. PMID 23918314.
^ ^a ^b ^c ^d ^e "Mannitol". The American Society of Health-System Pharmacists. Retrieved Jan 8, 2015.
^ Kremers, Edward; Sonnedecker, Glenn (1986). Kremers and Urdang's History of Pharmacy. Amer. Inst. History of Pharmacy. p. 360. ISBN 9780931292170.
^ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Retrieved 8 December 2016.
^ "Mannitol". International Drug Price Indicator Guide. Retrieved 8 December 2016.
^ Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 344. ISBN 9781284057560.
^ Cottrell, James E.; Patel, Piyush (2016). Cottrell and Patel’s Neuroanesthesia. Elsevier Health Sciences. p. 160. ISBN 9780323461122.
^ Bardal, Stan; Waechter, Jason; Martin, Doug (2010). Applied Pharmacology. Elsevier Health Sciences. p. 411. ISBN 1437735789.
^ "Select Committee on GRAS Substances (SCOGS) Opinion: Mannitol". FDA.gov. April 2013. Retrieved October 2014. Check date values in: |access-date= (help)
^ Ellis, F.W.; Krantz, J.C. Jr. (1941). "Sugar alcohols: XXII. Metabolism and toxicity studies with mannitol and sorbitol in man and animals". J. Biol. Chem. 141: 147–154.
^ Stickland, MK; Rowe, BH; Spooner, CH; Vandermeer, B; Dryden, DM (September 2011). "Accuracy of eucapnic hyperpnea or mannitol to diagnose exercise-induced bronchoconstriction: a systematic review.". Annals of Allergy, Asthma & Immunology. 107 (3): 229–34.e8. doi:10.1016/j.anai.2011.06.013. PMID 21875541.
^ Veterinary Class Notes, Ophthalmology, The Ohio State University, provided by David Wilkie, DVM, DACVO
^ http://www.vice.com/en_ca/read/cut-v12n4
^ Grenby, T.H (2011) Advances in Sweeteners. Springer. ISBN 1461285224. p. 66
^ ^a ^b ^c Kearsley, M. W.; Deis, R. C. (2006) "Sorbitol and Mannitol", pp. 249–261 in Sweeteners and Sugar Alternatives in Food Technology. Wiley-Blackwell. ISBN 0470659688
^ ^a ^b Lawson, P. (2007) Mannitol. Blackwell Publishing Ltd. pp 219–225.
^ Weiner, Myra L.; Lois A. Kotkoskie (1999). Excipient Toxicity and Safety. p. 370. ISBN 9780824782108.
^ Belcher, R.; Nutten, A. J. (1960). Quantitative Inorganic Analysis (2nd ed.). London, UK: Butterworths. p. 194.
^ ^a ^b Song, S. H.; Vieille, C. (2009). "Recent advances in the biological production of mannitol". Applied Microbiology and Biotechnology. 84 (1): 55–62. doi:10.1007/s00253-009-2086-5. PMID 19578847.
^ ^a ^b ^c Ghoreishi, S. M.; Shahrestani, R. G. (2009). "Innovative strategies for engineering mannitol production". Trends in Food Science & Technology. 20 (6–7): 263–270. doi:10.1016/j.tifs.2009.03.006.
^ Wagner, H; Flachsbarth, H; Vogel, G (Mar 1981). "[A New Antiphlogistic Principle from Sabal serrulata, II].". Planta Medica. 41 (3): 252–8. doi:10.1055/s-2007-971711. PMID 17401849.
^ Inić, S; Kujundžić, N (2011). "The first independent pharmacognosy institute in the world and its founder Julije Domac (1853–1928)". Pharmazie. 66 (6). pp. 720–726.
^ J. Domac (1881). "Über das Hexylen aus Mannit". Sitzungsberichte der Kaiserlichen Akademie der Wissenschaften, Mathematisch-Naturwissenschaftliche Classe. 23. pp. 1038–1051.
^ J. Domac (1881). "Über das Hexylen aus Mannit (Aus dem Universitätslaboratorium des Prof. A. Lieben)". Monat. Chem. (Wien). 2. p. 309.
^ J. Domac (1882). "Über die Einwirkung der Unterchlorsäure auf Hexylen". Justus Liebig’s Ann. Chem. (Wien). 213. pp. 124–132.
^ Cruz, J.; Minoja, G.; Okuchi, K. (2001). "Improving Clinical Outcomes from Acute Subdural Hematomas with the Emergency Preoperative Administration of High Doses of Mannitol: A Randomized Trial". Neurosurgery. 49 (4): 864–71. doi:10.1097/00006123-200110000-00016. PMID 11564247.
^ Cruz, J.; Minoja, G.; Okuchi, K. (2002). "Major Clinical and Physiological Benefits of Early High Doses of Mannitol for Intraparenchymal Temporal Lobe Hemorrhages with Abnormal Pupillary Widening: A Randomized Trial". Neurosurgery. 51 (3): 628–638. doi:10.1097/00006123-200209000-00006. PMID 12188940.
^ Cruz, J.; Minoja, G.; Okuchi, K.; Facco, E. (2004). "Successful use of the new high-dose mannitol treatment in patients with Glasgow Coma Scale scores of 3 and bilateral abnormal pupillary widening: A randomized trial". Journal of Neurosurgery. 100 (3): 376–83. doi:10.3171/jns.2004.100.3.0376. PMID 15035271.
^ Roberts, I.; Smith, R.; Evans, S. (2007). "Doubts over head injury studies". BMJ. 334 (7590): 392–4. doi:10.1136/bmj.39118.480023.BE. PMC 1804156. PMID 17322250.
^ British Pharmacopoeia Commission Secretariat (2009). "Index, BP 2009" (PDF). Retrieved 31 January 2010.
^ "Japanese Pharmacopoeia, Fifteenth Edition" (PDF). 2006. Retrieved 31 January 2010.
^ USP 32 (2008). "Mannitol Injection" (PDF). Retrieved 31 January 2010.

External links

RXList-osmitrol
1724907529 at GPnotebook

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. マンニトール治療の合併症 complications of mannitol therapy
2. 成人における頭蓋内圧亢進の評価およびマネージメント evaluation and management of elevated intracranial pressure in adults
3. 気管支誘発試験 bronchoprovocation testing
4. 利尿剤の作用機序 mechanism of action of diuretics
5. 小児における頭蓋内圧亢進（ICP） elevated intracranial pressure icp in children

English Journal

Reactive oxygen species (ROS) generated by cyanobacteria act as an electron acceptor in the biocathode of a bio-electrochemical system.

Cai PJ, Xiao X, He YR, Li WW, Zang GL, Sheng GP, Hon-Wah Lam M, Yu L, Yu HQ.SourceDepartment of Chemistry, University of Science & Technology of China, Hefei 230026, China; Advanced Laboratory for Environmental Research & Technology, USTC-CityU, Suzhou 215123, China; Department of Biology and Chemistry, City University of Hong Kong, Kowloon, Hong Kong.
Biosensors & bioelectronics.Biosens Bioelectron.2013 Jan 15;39(1):306-10. Epub 2012 Jul 10.
The enhanced electricity generation in a biocathode bio-electrochemical system (BES) with Microcystis aeruginosa IPP as the cathodic microorganism under illumination is investigated. The results show that this cyanobacterium is able to act as a potential cathodic microorganism under illumination. In
PMID 22819632

Strategies for multivariate modeling of moisture content in freeze-dried mannitol-containing products by near-infrared spectroscopy.

Yip WL, Gausemel I, Sande SA, Dyrstad K.SourceUniversity of Oslo, School of Pharmacy, Department of Pharmacy, P.O. Box 1068 Blindern, 0316 Oslo, Norway. Electronic address: w.l.yip@farmasi.uio.no.
Journal of pharmaceutical and biomedical analysis.J Pharm Biomed Anal.2012 Nov;70:202-11. doi: 10.1016/j.jpba.2012.06.043. Epub 2012 Jul 7.
Accurate determination of residual moisture content of a freeze-dried (FD) pharmaceutical product is critical for prediction of its quality. Near-infrared (NIR) spectroscopy is a fast and non-invasive method routinely used for quantification of moisture. However, several physicochemical properties o
PMID 22824636

Japanese Journal

Thermal glycosylation and degradation reactions occurring at the reducing ends of cellulose during low-temperature pyrolysis.

Matsuoka Seiji,Kawamoto Haruo,Saka Shiro
Carbohydrate research 346(2), 272-279, 2011-02-01
… Thermal glycosylation and degradation reactions of cellulose (Avicel PH-101) were studied in the presence or absence of alcohols (glycerol, mannitol, 1,2,6-hexanetriol, 3-phenoxy-1,2-propanediol, and 1-tetradecanol) under N(2) at 60-280°C. …
NAID 120002753574

Prospective study establishing a management plan for impacted third molar in patients undergoing hematopoietic stem cell transplantation

Yamagata Kenji,Onizawa Kojiro,Yanagawa Toru,Takeuchi Yasutoshi,Hasegawa Yuichi,Chiba Shigeru,Bukawa Hiroki,山縣憲司,鬼澤浩司郎,柳川徹,長谷川雄一,千葉滋,武川寛樹
Oral surgery, oral medicine, oral pathology, oral radiology, and endodontology 111(2), 146-152, 2011-02
ObjectiveAlthough dental treatment before hematopoietic stem cell transplantation (HSCT) is essential to prevent serious infections from oral sources, the best management plan for impacted third molar …
NAID 120002836972

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★リンクテーブル★

リンク元	「利尿薬」「マンニトール」「作用機序」
拡張検索	「mannitol dehydrogenase」「D-mannitol」「sucrose mannitol agar」

「利尿薬」

D-Mannitol
Clinical data
Trade names	Osmitrol, other
AHFS/Drugs.com	Monograph
Pregnancy; category	US: C (Risk not ruled out); ;
Routes of; administration	intravenous; by mouth
ATC code	A06AD16 (WHO) B05BC01 (WHO) B05CX04 (WHO) R05CB16 (WHO)
Pharmacokinetic data
Bioavailability	~7%
Metabolism	Liver, negligible.
Biological half-life	100 minutes
Excretion	Kidney: 90%
Identifiers
	IUPAC name (2R,3R,4R,5R)-Hexane-1,2,3,4,5,6-hexol;
Synonyms	D-Mannitol, mannite, manna sugar
CAS Number	69-65-8
PubChem (CID)	6251
DrugBank	DB00742
ChemSpider	6015
UNII	3OWL53L36A
KEGG	D00062
ChEBI	CHEBI:16899
ChEMBL	CHEMBL689
E number	E421 (thickeners, ...)
ECHA InfoCard	100.000.647
Chemical and physical data
Formula	C6H14O6
Molar mass	182.172
3D model (Jmol)	Interactive image
	SMILES O[C@H]([C@H](O)CO)[C@H](O)[C@H](O)CO ;
	InChI InChI=1S/C6H14O6/c7-1-3(9)5(11)6(12)4(10)2-8/h3-12H,1-2H2/t3-,4-,5-,6-/m1/s1 ; Key:FBPFZTCFMRRESA-KVTDHHQDSA-N ;
(verify)

D-マンニトール
IUPAC命名法による物質名
	IUPAC名 (2R,3R,4R,5R)-Hexane-1,2,3,4,5,6-hexol
臨床データ
販売名	Osmitrol
Drugs.com	monograph
胎児危険度分類	US: C; ;
投与方法	Intravenous; Oral
薬物動態データ
生物学的利用能	~7%
代謝	Hepatic, negligible.
半減期	100 minutes
排泄	Renal: 90%
識別
CAS番号; (MeSH)	69-65-8
ATCコード	A06AD16 (WHO) B05BC01 (WHO) B05CX04 (WHO) R05CB16 (WHO)
PubChem	CID: 6251
DrugBank	DB00742
ChemSpider	6015
UNII	3OWL53L36A
KEGG	D00062
ChEBI	CHEBI:16899
ChEMBL	CHEMBL689
化学的データ
化学式	C6H14O6
分子量	182.172
	SMILES O[C@H]([C@H](O)CO)[C@H](O)[C@H](O)CO ;
	InChI InChI=1S/C6H14O6/c7-1-3(9)5(11)6(12)4(10)2-8/h3-12H,1-2H2/t3-,4-,5-,6-/m1/s1 ; Key:FBPFZTCFMRRESA-KVTDHHQDSA-N ;

　　[★]

英: diuretic, diuretics
関: 尿細管

適応

心不全、腎不全、高血圧症、肝硬変による腹水貯留、妊娠中毒症

利尿薬の種類 (GOO.744)

CATIONS

ANIONS

尿酸

腎血液動態

Na⁺

K⁺

H⁺

Ca²⁺

Mg²⁺

Cl^-

HCO₃^-

H₂PO₄^-

急性

慢性

RBF

GFR

FF

TGF

炭酸脱水酵素阻害薬

炭酸脱水酵素阻害

近位尿細管
　

＋

＋＋

－

NC

V

(＋)

＋＋

I

－

NC

＋

浸透圧利尿薬

浸透圧

ヘンレループ
　

＋＋

＋

I

＋

＋＋

＋

I

＋

NC

－

I

ループ利尿薬

Na⁺-K⁺-2Cl^- symport阻害

太い上行脚
　

＋＋

＋

＋＋

＋⁽¹⁾

＋

－

V(＋)

NC

V(－)

－

チアジド系利尿薬

Na⁺-Cl^-symport阻害

遠位尿細管
　

＋

＋＋

＋

V(－)

V(＋)

＋

＋⁽¹⁾

＋

－

NC

V(－)

NC

カリウム保持性利尿薬

上皮性ナトリウムチャネル阻害

遠位尿細管後部と集合管
　

＋

－

＋

(＋)

NC

I

－

NC

アルドステロン受容体拮抗

遠位尿細管後部と集合管
　

＋

－

I

－

＋

(＋)

I

－

NC

利尿薬の例

浸透圧利尿薬

炭酸脱水酵素阻害薬

ループ利尿薬

チアジド系利尿薬

ヒドロクロロチアジド hydrochlorothiazide

カリウム保持性利尿薬

上皮性ナトリウムチャネル阻害薬

アルドステロン受容体阻害薬

スピロノラクトン spironolactone

利尿薬の作用部位

ホルモンと利尿薬の作用部位についての簡単なまとめは→尿細管

参照

http://hobab.fc2web.com/sub4-Diuretics.htm

「マンニトール」

　　[★]

英: mannitol
ラ: D-mannitolum
商: マンニゲン、マンニットT、マンニットール、(果糖合剤)フルクトマニト、(ソルビトール合剤)マンニットールS
関: D-マンニトール D-mannitol、D-マンニット D-mannit; その他の循環器官用薬

概念

自然界にはD-マンニトールが多く存在しており、治療薬でもD-マンニトールが用いられる。

浸透圧によって尿細管腔内に水を引き入れる
利尿剤

参考1より引用

マンニトール (mannitol) は糖アルコールの一種である。ヘキシトールに分類され、マンノースの還元体に相当する。マンニット (mannite) とも呼ばれる。光学活性物質であり、天然に多く存在するエナンチオマーは D-マンニトールである。ソルビトールの異性体である。

浸透圧調製剤・利尿剤であり、弱い腎臓血管拡張剤でもある。

水溶液中ではプロトンを放出する性質を持つため、水溶液は酸性になる。このため、炭酸ナトリウムなど pH 調整剤を併用することが珍しくない。

適応

1. 術中・術後・外傷後及び薬物中毒時の急性腎不全の予防及び治療　　←　　通常の利尿薬はhypovolemia+乏尿では良い適応ではないらしい。そのような場合にマンニトールが良い適応となる、らしい。
2. 脳圧降下および脳容積の縮小を必要とする場合
3. 眼内圧降下を必要とする場合

参考

1

http://wpedia.goo.ne.jp/wiki/%E3%83%9E%E3%83%B3%E3%83%8B%E3%83%88%E3%83%BC%E3%83%AB

「作用機序」

　　[★]

英: mechanism of action, mode of action, MOA
関: 薬理学

化学的機序

制酸剤、penicillamine, BAL

物理化学的機序

mannitol

生化学的機序

choline esterase阻害薬、monoamine oxidase阻害薬

angiotensin変換酵素阻害薬、alloprinol

強心配糖体、炭酸脱水酵素阻害剤

生理学的機序

Ca拮抗薬

生体内情報伝達系を介する機序

「mannitol dehydrogenase」

　　[★]

マンニトール脱水素酵素、マンニトールデヒドロゲナーゼ

「D-mannitol」

　　[★] D-マンニトール、マンニトール

「sucrose mannitol agar」

　　[★]

SM・地

関: SM medium

[1] 内山充、寺尾允男、早川堯夫ら、2006年3月31日『第十五改正日本薬局方』厚生労働省告示第285号、1055頁目、2010年9月29日取得。

[2] Best, B. Perfusion & Diffusion in Cryonics Protocol. benbest.com.

[pmid11855842-3] Ikeda M, Bhattacharjee AK, Kondoh T, Nagashima T, Tamaki N (2002). “Synergistic effect of cold mannitol and Na(+)/Ca(2+) exchange blocker on blood-brain barrier opening.”. Biochem Biophys Res Commun 291 (3): 669-74. doi:10.1006/bbrc.2002.6495. PMID 11855842.

[pmid17893577-4] Wang M, Etu J, Joshi S (2007). “Enhanced disruption of the blood brain barrier by intracarotid mannitol injection during transient cerebral hypoperfusion in rabbits.”. J Neurosurg Anesthesiol 19 (4): 249-56. doi:10.1097/ANA.0b013e3181453851. PMID 17893577.

[pmid3128666-5] Palafox NA, Jain LG, Pinano AZ, Gulick TM, Williams RK, Schatz IJ (1988). “Successful treatment of ciguatera fish poisoning with intravenous mannitol.”. JAMA 259 (18): 2740-2. doi:10.1001/jama.1988.03720180066035. PMID 3128666.

[AHFS2015-6] “Mannitol”. The American Society of Health-System Pharmacists. 2015年1月8日閲覧。

[man-7] “マンニットＴ注15％ (500mL)” (2014年9月). 2016年7月18日閲覧。

[Sugar2012-1] Varzakas, Theodoros; Labropoulos, Athanasios; Anestis, Stylianos (2012). Sweeteners: Nutritional Aspects, Applications, and Production Technology. CRC Press. pp. 59–60. ISBN 9781439876732.

[WHO2008-2] WHO Model Formulary 2008 (PDF). World Health Organization. 2009. p. 332. ISBN 9789241547659. Retrieved 8 December 2016.

[Wak2013-3] Wakai, A; McCabe, A; Roberts, I; Schierhout, G (5 August 2013). "Mannitol for acute traumatic brain injury.". The Cochrane database of systematic reviews. 8: CD001049. doi:10.1002/14651858.CD001049.pub5. PMID 23918314.

[AHFS2016-4] "Mannitol". The American Society of Health-System Pharmacists. Retrieved Jan 8, 2015.

[5] Kremers, Edward; Sonnedecker, Glenn (1986). Kremers and Urdang's History of Pharmacy. Amer. Inst. History of Pharmacy. p. 360. ISBN 9780931292170.

[WHO19th-6] "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Retrieved 8 December 2016.

[ERC2014-7] "Mannitol". International Drug Price Indicator Guide. Retrieved 8 December 2016.

[Ric2015-8] Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 344. ISBN 9781284057560.

[9] Cottrell, James E.; Patel, Piyush (2016). Cottrell and Patel’s Neuroanesthesia. Elsevier Health Sciences. p. 160. ISBN 9780323461122.

[10] Bardal, Stan; Waechter, Jason; Martin, Doug (2010). Applied Pharmacology. Elsevier Health Sciences. p. 411. ISBN 1437735789.

[11] "Select Committee on GRAS Substances (SCOGS) Opinion: Mannitol". FDA.gov. April 2013. Retrieved October 2014. Check date values in: |access-date= (help)

[12] Ellis, F.W.; Krantz, J.C. Jr. (1941). "Sugar alcohols: XXII. Metabolism and toxicity studies with mannitol and sorbitol in man and animals". J. Biol. Chem. 141: 147–154.

[13] Stickland, MK; Rowe, BH; Spooner, CH; Vandermeer, B; Dryden, DM (September 2011). "Accuracy of eucapnic hyperpnea or mannitol to diagnose exercise-induced bronchoconstriction: a systematic review.". Annals of Allergy, Asthma & Immunology. 107 (3): 229–34.e8. doi:10.1016/j.anai.2011.06.013. PMID 21875541.

[14] Veterinary Class Notes, Ophthalmology, The Ohio State University, provided by David Wilkie, DVM, DACVO

[15] ttp://www.vice.com/en_ca/read/cut-v12n4

[16] Grenby, T.H (2011) Advances in Sweeteners. Springer. ISBN 1461285224. p. 66

[Kearsley-17] Kearsley, M. W.; Deis, R. C. (2006) "Sorbitol and Mannitol", pp. 249–261 in Sweeteners and Sugar Alternatives in Food Technology. Wiley-Blackwell. ISBN 0470659688

[Lawson.2C_P_pp_219-225-18] Lawson, P. (2007) Mannitol. Blackwell Publishing Ltd. pp 219–225.

[19] Weiner, Myra L.; Lois A. Kotkoskie (1999). Excipient Toxicity and Safety. p. 370. ISBN 9780824782108.

[20] Belcher, R.; Nutten, A. J. (1960). Quantitative Inorganic Analysis (2nd ed.). London, UK: Butterworths. p. 194.

[Song.2C_S._H._2009-21] Song, S. H.; Vieille, C. (2009). "Recent advances in the biological production of mannitol". Applied Microbiology and Biotechnology. 84 (1): 55–62. doi:10.1007/s00253-009-2086-5. PMID 19578847.

[Ghoreishi.2C_S._M._2009-22] Ghoreishi, S. M.; Shahrestani, R. G. (2009). "Innovative strategies for engineering mannitol production". Trends in Food Science & Technology. 20 (6–7): 263–270. doi:10.1016/j.tifs.2009.03.006.

[23] Wagner, H; Flachsbarth, H; Vogel, G (Mar 1981). "[A New Antiphlogistic Principle from Sabal serrulata, II].". Planta Medica. 41 (3): 252–8. doi:10.1055/s-2007-971711. PMID 17401849.

[24] Inić, S; Kujundžić, N (2011). "The first independent pharmacognosy institute in the world and its founder Julije Domac (1853–1928)". Pharmazie. 66 (6). pp. 720–726.

[25] J. Domac (1881). "Über das Hexylen aus Mannit". Sitzungsberichte der Kaiserlichen Akademie der Wissenschaften, Mathematisch-Naturwissenschaftliche Classe. 23. pp. 1038–1051.

[26] J. Domac (1881). "Über das Hexylen aus Mannit (Aus dem Universitätslaboratorium des Prof. A. Lieben)". Monat. Chem. (Wien). 2. p. 309.

[27] J. Domac (1882). "Über die Einwirkung der Unterchlorsäure auf Hexylen". Justus Liebig’s Ann. Chem. (Wien). 213. pp. 124–132.

[28] Cruz, J.; Minoja, G.; Okuchi, K. (2001). "Improving Clinical Outcomes from Acute Subdural Hematomas with the Emergency Preoperative Administration of High Doses of Mannitol: A Randomized Trial". Neurosurgery. 49 (4): 864–71. doi:10.1097/00006123-200110000-00016. PMID 11564247.

[29] Cruz, J.; Minoja, G.; Okuchi, K. (2002). "Major Clinical and Physiological Benefits of Early High Doses of Mannitol for Intraparenchymal Temporal Lobe Hemorrhages with Abnormal Pupillary Widening: A Randomized Trial". Neurosurgery. 51 (3): 628–638. doi:10.1097/00006123-200209000-00006. PMID 12188940.

[30] Cruz, J.; Minoja, G.; Okuchi, K.; Facco, E. (2004). "Successful use of the new high-dose mannitol treatment in patients with Glasgow Coma Scale scores of 3 and bilateral abnormal pupillary widening: A randomized trial". Journal of Neurosurgery. 100 (3): 376–83. doi:10.3171/jns.2004.100.3.0376. PMID 15035271.

[31] Roberts, I.; Smith, R.; Evans, S. (2007). "Doubts over head injury studies". BMJ. 334 (7590): 392–4. doi:10.1136/bmj.39118.480023.BE. PMC 1804156. PMID 17322250.

[ib29-32] British Pharmacopoeia Commission Secretariat (2009). "Index, BP 2009" (PDF). Retrieved 31 January 2010.

[jp15-33] "Japanese Pharmacopoeia, Fifteenth Edition" (PDF). 2006. Retrieved 31 January 2010.

[mi-34] USP 32 (2008). "Mannitol Injection" (PDF). Retrieved 31 January 2010.

v t e Drugs for constipation (laxatives and cathartics) (A06)

Stool softeners	Docusate

Stimulant laxatives	Bisacodyl Bisoxatin Cascara Castor oil Dantron Oxyphenisatine Phenolphthalein Senna glycosides Sodium picosulfate

Bulk-forming laxatives	Dietary fiber Ethulose Ispaghula Linseed Methylcellulose Polycarbophil calcium Sterculia Triticum

Lubricant laxatives	Liquid paraffin Mineral oil White petrolatum (petroleum jelly)

Osmotic laxatives	Lactitol Lactulose Laminarid Magnesium carbonate Magnesium citrate Magnesium hydroxide (milk of magnesia) Magnesium oxide Magnesium peroxide Magnesium sulfate Mannitol Pentaerythritol Polyethylene glycol (macrogol) Sodium phosphate Sodium sulfate Sodium tartrate Sorbitol

Enemas	Bisacodyl Dantron Glycerol Oil Sodium laurilsulfate Sodium lauryl sulfoacetate Sodium phosphate Sorbitol

Opioid antagonists	Alvimopan Methylnaltrexone bromide Naloxegol Naloxone (Oxycodone/naloxone)

Others	Linaclotide Lubiprostone Oxyphenisatine Prucalopride Tegaserod Ulimorelin

v t e Sugar alcohols

2-carbon	Ethylene glycol^{[citation needed]}

3-carbon	Glycerol

4-carbon	Erythritol Threitol

5-carbon	Arabitol Ribitol Xylitol

6-carbon	Mannitol Sorbitol Galactitol Iditol

7-carbon	Volemitol

Deoxy sugar alcohols	Fucitol

Cyclic sugar alcohols	Inositol

Glycylglycitols	Maltitol Lactitol Isomalt Maltotriitol Maltotetraitol Polyglycitol

IUPAC命名法による物質名


IUPAC名 (2R,3R,4R,5R)-Hexane-1,2,3,4,5,6-hexol
臨床データ
販売名	Osmitrol
Drugs.com	monograph
胎児危険度分類	US: C
投与方法	Intravenous Oral
薬物動態データ
生物学的利用能	~7%
代謝	Hepatic, negligible.
半減期	100 minutes
排泄	Renal: 90%
識別
CAS番号 (MeSH)	69-65-8
ATCコード	A06AD16 (WHO) B05BC01 (WHO) B05CX04 (WHO) R05CB16 (WHO)
PubChem	CID: 6251
DrugBank	DB00742
ChemSpider	6015
UNII	3OWL53L36A
KEGG	D00062
ChEBI	CHEBI:16899
ChEMBL	CHEMBL689
化学的データ
化学式	C₆H₁₄O₆
分子量	182.172
SMILES O[C@H]([C@H](O)CO)[C@H](O)[C@H](O)CO
InChI InChI=1S/C6H14O6/c7-1-3(9)5(11)6(12)4(10)2-8/h3-12H,1-2H2/t3-,4-,5-,6-/m1/s1 Key:FBPFZTCFMRRESA-KVTDHHQDSA-N

匿名

検索

案内

mannitol

WordNet

Wikipedia preview

wiki ja

目次

用途

効能・効果

副作用

脚注

wiki en

Contents

Uses

Medical uses

Other

Food

Analytical chemistry

Contraindication

Production

Industrial synthesis

Biosyntheses

Natural extraction

History

Controversy

Compendial status

See also

References

External links

UpToDate Contents

English Journal

Japanese Journal

Related Links

Related Pictures

★リンクテーブル★

「利尿薬」

適応

利尿薬の種類 (GOO.744)

利尿薬の例

利尿薬の作用部位

参照

「マンニトール」

概念

適応

参考

「作用機序」

「mannitol dehydrogenase」

「D-mannitol」

「sucrose mannitol agar」