NEUROTOL contains Mannitol and Glycerin, two sugars with good osmotic diuretic properties which is a unique balance combination of efficacy and safety for the specific care of cerebral oedema
Mannitol when used in dose of 1.5 – 2 g/kg body with in 30 – 60 minutes is used to reduce raised ICP and to treat cerebral oedema
Glycerin when used in 1.2 g / kg body weight reduce cerebral oedema. Either Glycerin or mannitol can be administered individually which are readily availaible in market.
However the addition of Glycerin to mannitol avoids rebound oedema likely t o be observed with plain mannitol when administered. This provides strong rationale for a combination of mannitol with Glycerin in management of increased intracranial pressure and cerebral oedema
Neurotol is able to enhance the diffusion of water from cerebrospinal back into plasma by elevating the osmolarity of the plasma , may result in reduction of elevated intracranial pressure and cerebrospinal fluid volume and pressure.
Each 100ml contains:
Mannitol I.P. 10 gm
Glycerin I.P. 10 gm
Water for injection I.P qs
MODE OF ACTION
Neurotol may also become an alternate source of energy either by being directly metabolized by brain or indirectly by enhancing lipogenesis or by both processes.
Neurotol can be administered to patients with diabetic ketoacidosis with observed cerebral oedema. Glycerin may act as a free radical scavenger , antioxidant and activator of plasma prostaglandins ( PG12)resulting in vasodilatation and further Glycerin may improve ischaemic brain energy metabolism.
- Cerebral oedema
- Cerebral infraction
- Intracerebral Hemorrhage
- Head Injury
- Subdural hematoma
- Brain tumor
NEUROTOL is contraindicated in patients with:
- Congestive heart failure as it increases extracellular fluid thereby increasing the load on already decompensated heart
- Pulmonary congestion
- Electroluyte Depletion
- Severe Dehydration
- Well established Anuria
- Acute intracranial bleeding except during craniotomy.
- Progressive renal damage
The cardiovascular status of the patient should be carefully evaluated before rapidly administering NEUROTOL since with mannitol sudden expansion of extracellular fluid may lead to culminating congestive heart failure.
NEUROTOL should not be administered simultaneously with blood as it may cause pseudo agglutination due to presence of mannitol in the preparation. If at all it is essential that blood is to be given simuyltaneusly , atleast 20mEq of sodium chloride should be added per litre to the preparation Rapid infusion of NEUROTOL should be carefully monitored as glycerol is not to be infused rapidly. There are no clinical evidences of use of NEUROTOL in pregnant or lactating women The dosing in elderly requires careful monitoring but no dose adjustment may be required.
DOSAGE AND ADMINISTRATION:
cerebral oedema: 50 gm to 200 gm (250-1000 ml) over a period of 24 hrs adjusted to maintain urinary output of 30 to 50 ml per hour.Glaucoma: 1.5 – 2 g per kg body weight over period of 30 – 60 minutes.
RATE OF ADMINISTRATION :
Cerebral oedema: rate of infusion should not exceed 40 drops per minute. Other indications: Rate of infusion may be adjusted according to the patients need
NEUROTOL is available with single cartons 100 ml and 350 ml glass bottles.