Sormantol (solution for infusion)
(Solutio Sormantoli)
International nonproprietary name
Sorbitol. Mannitol. Sodium chloride.
Pharmacotherapeutic group
Diuretics.
Composition
1000 ml of infusion solution contains D-sorbit — 75 g, D-mannitol — 75 g, sodium chloride — 8,5 g.
Pharmacology action
Pharmacodynamics
Sormantol is an osmotic diuretic. On intravenous administration it increases the volume of blood passing through the kidney and contributes to a rapid excretion of fluid from the vascular bed. The effectiveness of the preparation depends on its concentration and administration speed. Besides, sormantol contributes to the regeneration of peristalsis on intestine atony and paresis, increases biligenesis, reduces intracranial pressure and has a detoxification action. The preparation may have an energetic action (it metabolizes with formation of fructose).
Pharmacokinetics
Mannitol: the volume of distribution corresponds to the volume of extracellular fluid. Mannitol may be subject to metabolism in the liver with formation of glycogen. Thehalf-periodisabout 100 minutes. On kidney impairment the half-period may be increased up to 36 hours. Sorbit: after intravenous administration it is distributed in the tissues of the organism. In the liver it is converted into the fructose under the action of sorbitdehydrogenase. On intravenous administration sodium chloride is rapidly excreted from the vascular bed, passes into the interstitial sector and inside the cells. The half-period is about an hour. Sodium ions and water start are very rapidly eliminated by the kidney, increasing the diuresis.
Indication
Sormantol is used on acute kidney and liver-kidney impairment with maintained filtration function of the kidney; on operations with artificial blood circulation to prevent kidney ischemia and kidney impairment related to it; on dehydratation therapy (diseases accompanied by increased intracranial pressure and brain edema, acute congestive glaucoma, etc.); to enforce diuresis on intoxication with barbiturates and other substances; to eliminate post-transfusion complications; as an energetic additive to the solutions of amino acids and protein hydrolyzates on parenteral nutrition; on prophylaxis of post-operation intestine paresis and its treatment.
Route of administration and dosage
The preparation is administered intravenously (jet administration or drop-by-drop administration).
When diuretic effect is required, it is recommended to administer the preparation rapidly, and on the use of the preparation as an energy source – a slow introduction is recommended.
On infusion therapy of liver and biliary tracts diseases sormantol is administered in the dose of 1—2 g of dry substance per 1 kg of the body weight, once or several times, controlling diuresis and liver function parameters (transaminase, bilirubin, etc.).
On hepatic coma the preparation is administered in the combination with albumin or protein and other preparations. On pancreatic diabetes the preparation is used under monitoring of sugar in the blood. On liver-kidney impairment sormantol is used in combination with albumin, protein and crystalloid solutions in the quantity of 1—1,5 g of dry substance per 1 kg of the body weight from 1 to 3 times per day with the interval between two administrations of 8—12 hours during 3—5 days.
On intoxication with various substances the solution is administered in the quantity of 1—2 g of dry substance per 1 kg of the body weight by drop-by-drop administration. If a repeated infusion is required, it is carried out in the same dose in 8—12 hours.
In the conditions of artificial blood circulation and hemodilution the doses of the preparation are 0,3—1 g of dry substance per 1 kg of the body weight. Depending on the phase of operation the preparation is administered in the perfusate or intravenously.
The preparation may be used in the neurosurgery to eliminate the brain edema and reduce intracranial pressure in the quantity of 1—3 g of dry substance per 1 kg of the body weight.
To eliminate complications appeared after the transfusion of blood non compatible by group or Rhesus factor, the preparation is administered in the dose of 1—1,5 g/kg per the body weight via drop-by-drop administration.
On parenteral nutrition 6% solution is used (reference solution is diluted 2,5 times). The energy value of sorbit sormantol is equal to the energy value of glucose (4 kcal). Sormantol is administered intravenously drop-by-drop (60 drops per minute) 500—1000 ml in 1—2 days during 5—10 days or more in combination with amin acids solutions, protein hydrolizates, 5—10% ethyl alcohol, vitamins.
Special indications
On transfusion of the preparation it is recommended to control the water balance parameters.
Sideeffects
On excessive administration symptoms of dehydration can occur (impairment of consciousness, dyspeptic developments). Administration of the preparation on anuria induced by alterations in the kidney may lead to the development of the lungs edema.
Contraindications
Administration of sormantol is contraindicated on organic damages of the kidney accompanied by filtration impairment, cardio-vascular failure.
Precautions
In the period of pregnancy and lactation the preparation is administered only in cases when the assumed benefit for the mother is higher than an eventual risk for a fetus or infant.
The preparation is prescribed with caution to patients with hypovolemia, hyponatremia, hyperkalemia. In case of occurrence of such symptoms as headache, dizziness, vomiting, vision impairment, it is necessary to stop administering the preparation.
Interactionwithotherpreparations
Thepreparationshallbeprescribedincombinationwithaminoacidsolutions, proteinhydrolyzates, ethylalcoholsolutions, vitamins, albumin, proteinandcrystalloidsolutions.
Product form
Solution for infusion. 400 ml in a glass bottle for blood, transfusion and infusion preparations.
