Your Patients Need Mannitol — Here's How to Help Them Get It

The Mannitol shortage has been testing hospital supply chains since 2023, and it's not over. As a provider, you're in a unique position to advocate for your patients and ensure they receive effective treatment — whether that means finding Mannitol supply or pivoting to an evidence-based alternative.

This guide provides practical, actionable steps you can take to help your patients access Mannitol (or appropriate substitutes) in 2026.

Current Availability: Where Things Stand

As of February 2026, the Mannitol supply situation remains constrained:

• ICU Medical Mannitol 20% premixed bags (250 mL and 500 mL) are on allocation nationally
• Allocation is based on historical purchasing volume, so facilities that didn't previously use large quantities may receive proportionally less
• Alternative concentrations (5%, 10%, 15%, 25%) may have intermittent availability from secondary suppliers
• 503B outsourcing facilities can compound Mannitol, though availability and turnaround times vary

The shortage is tracked on the ASHP Drug Shortage list and is part of the broader IV fluid supply chain disruption that has affected multiple products.

Why Your Patients Can't Find Mannitol

Understanding the root causes helps you set realistic expectations with patients and families:

• Manufacturing concentration: ICU Medical dominates the U.S. supply with limited competition
• Sterile production complexity: IV solutions require dedicated facilities with extensive quality controls; new manufacturers can't enter the market quickly
• Allocation mechanics: Even when ICU Medical produces Mannitol, distribution is rationed, creating uneven availability across facilities
• No retail pathway: Unlike many medications, patients can't "shop around" at retail pharmacies — Mannitol IV is a facility-level product

For Bronchitol (inhaled Mannitol for cystic fibrosis), the barriers are different: it's a specialty pharmacy product with a cash price of approximately $3,826/month, which creates financial access barriers even when supply is adequate.

What Providers Can Do: 5 Actionable Steps

Step 1: Monitor Supply Proactively

Don't wait until you need Mannitol to check availability. Build supply monitoring into your workflow:

• Use Medfinder for Providers to track real-time Mannitol availability across suppliers
• Subscribe to ASHP shortage alerts for Mannitol injection
• Establish regular communication with your hospital pharmacy purchasing team — a weekly check-in during active shortages is ideal
• If your facility uses a group purchasing organization (GPO), check for contract alternatives or emergency supply options

Step 2: Develop and Maintain Alternative Protocols

Every facility that uses Mannitol should have a documented alternative protocol that's been reviewed by pharmacy and approved by the P&T committee. Key elements:

• Hypertonic Saline protocol — Include concentration options (3%, 7.5%, 23.4%), dosing guidelines, central vs. peripheral access requirements, and monitoring parameters (serum sodium, osmolality)
• Furosemide adjunct protocol — For fluid management when osmotic therapy is unavailable
• Acetazolamide protocol — For intraocular pressure reduction scenarios
• Clinical decision tree — When to use Mannitol vs. alternatives, including escalation criteria

Ensure all relevant staff (intensivists, neurosurgeons, emergency physicians, pharmacists, and nurses) are trained on these protocols.

Step 3: Communicate Early with Patients and Families

Proactive communication reduces anxiety and builds trust:

• Before scheduled procedures, inform patients that Mannitol may be substituted with an equally effective alternative
• Explain that Hypertonic Saline has comparable clinical evidence and is not a "lesser" treatment
• Provide written information — share links to patient-friendly resources like the Mannitol shortage update for patients
• Document the conversation in the medical record

Step 4: Explore All Supply Channels

When your primary wholesaler can't fill orders, consider these options:

• Secondary wholesalers: Companies like Cardinal Health, McKesson, and AmerisourceBergen may have different allocation pools
• 503B outsourcing facilities: Can compound Mannitol solutions; verify they meet USP <797> and <800> standards
• Health system transfers: If you're part of a multi-facility system, internal transfers from lower-utilization sites may be possible
• Direct manufacturer contact: In some cases, ICU Medical's customer service team can provide allocation adjustment requests for documented clinical need

Step 5: Support Financial Access for Bronchitol Patients

If your CF patients use Bronchitol, the financial burden can be significant:

• Connect patients with the Chiesi CareConnect patient assistance program
• Explore specialty pharmacy copay programs
• Consider whether nebulized Hypertonic Saline (7%) or Dornase Alfa (Pulmozyme) might be appropriate and more accessible alternatives
• Refer patients to the Mannitol savings guide for additional cost-reduction strategies

Alternative Agents: Quick Reference

Here's a concise clinical comparison for decision-making during the shortage:

• Hypertonic Saline (3–23.4%): First-line Mannitol alternative for ICP reduction. Non-inferior or superior in meta-analyses. Does not require intact renal function. Monitor serum sodium.
• Furosemide (Lasix): Adjunctive diuretic. Does not provide osmotic ICP reduction. Best used in combination or for fluid overload management.
• Acetazolamide (Diamox): Reduces CSF and aqueous humor production. Best suited for IOP reduction and idiopathic intracranial hypertension.
• Glycerol: Third-line osmotic agent. Oral or IV. Limited current use in U.S. practice.

For a detailed comparison, see our Mannitol alternatives guide.

Workflow Tips for Shortage Management

Incorporate these practices into your team's workflow to stay ahead of the shortage:

• Daily huddle mention: Include Mannitol availability in your daily ICU/ED huddles when supply is critical
• Order set updates: Ensure electronic order sets include shortage alternatives and pharmacist review triggers
• Pharmacy liaison: Designate a pharmacy point of contact for shortage communications
• Patient handouts: Keep printed or digital copies of patient-facing shortage information in your unit
• Documentation template: Create a standard note template for shortage-related medication substitutions

Final Thoughts

The Mannitol shortage requires provider engagement at every level — from bedside clinical decisions to institutional supply chain management. The good news is that evidence-based alternatives exist, and most patients can be effectively managed even without Mannitol.

Your role as a provider is to stay informed, have protocols ready, communicate openly with patients, and use every available tool to ensure access to appropriate therapy.

Visit Medfinder for Providers to track Mannitol availability in real time and access tools designed to help your clinical team navigate medication shortages.

Related resources:

• Mannitol Shortage: Provider Clinical Briefing
• How to Help Patients Save Money on Mannitol
• Mannitol Drug Interactions: What to Avoid