Mannitol, a natural product, is used as a diuretic to increase urine production in people with acute kidney failure (chemo side-effects). Clinical studies have shown that using mannitol along with Cisplatin chemotherapy reduces Cisplatin-induced kidney injury, an adverse side-effect seen in a third of the patients treated with Cisplatin. Mannitol use along with Cisplatin can be nephroprotective.
Cisplatin Chemotherapy Side Effects
Cisplatin is a chemotherapy used to treat many solid tumors and a standard of care for cancers of the bladder, head and neck, small cell and non-small cell lung cancers, ovarian, cervical and testicular cancers and many others. Cisplatin is effective in eliminating cancer cells through causing increased oxidative stress and DNA damage, thereby inducing cancer cell death. However, Cisplatin use is also linked with numerous undesirable side-effects including allergic reactions, lowered immunity, gastrointestinal disorders, cardiotoxicity and severe kidney problems. One third of the patients treated with Cisplatin experience kidney damage following initial treatment (Yao X, et al, Am J Med. Sci., 2007). Kidney damage or nephrotoxicity caused by Cisplatin has been recognized as a significant adverse event (Oh, Gi-Su, et al. Electrolyte Blood Press, 2014). One of the key reasons for the higher nephrotoxicity with Cisplatin is because there is a greater accumulation of the drug in the kidney thus causing more damage to the kidney.
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What is Mannitol?
Mannitol, also known as sugar alcohol, is found in many natural sources such as mushrooms, strawberries, celery, onions, pumpkins and marine algae. It is also recognized as a safe ingredient by FDA (Food and Drug Administration), and is a widely used component in medicinal products.
Benefits/Uses of Mannitol Supplements
Following are some of the common uses of mannitol:
- Mannitol is usually used as a diuretic to increase urine production in people with acute kidney failure.
- Mannitol is also used in prescription drugs to reduce pressure and swelling in the brain as well.
- Mannitol may help improve blood sugar regulation
Side-Effects of Mannitol Supplements
Following are some of the common side-effects of mannitol supplements:
- Frequent Urination
- Increased heart rate
Mannitol for Cisplatin Chemo Side Effect- Kidney Injury
One approach to reduce chemo side-effects like nephrotoxicity, when treated with Cisplatin, that has been clinically evaluated is using Mannitol along with Cisplatin chemotherapy.
There have been multiple studies where they have assessed the effect of Mannitol use along with Cisplatin chemotherapy on nephrotoxicity (chemo side-effect) markers such as serum creatinine levels:
- A retrospective study from the University of Minnesota Health-Fairview system analyzed 313 patients treated with Cisplatin (95 treated with mannitol and 218 without), found that the group that used Mannitol had lower average increase in serum creatinine levels than the group that did not use Mannitol. Nephrotoxicity occurred less frequently in patients who received Mannitol than those who did not – 6-8% with Mannitol vs. 17-23% without Mannitol (Williams RP Jr et al, J Oncol Pharm Pract., 2017).
- Another study from Emory University involved a retrospective chart review of all patients receiving cisplatin with concurrent radiation for squamous cell carcinoma of the head and neck. Analysis of data from 139 patients (88 with Mannitol and 51 with saline alone) showed that the Mannitol group had lower increases in serum creatinine indicating lower nephrotoxicity (McKibbin T et al, Support Care Cancer, 2016).
- A single center study from Rigshospitalet and Herlev hospital, Denmark, also confirmed the nephroprotective effects of Mannitol use in head and neck cancer patients receiving cisplatin therapy in a group of 78 patients (Hagerstrom E, et al, Clin Med Insights Oncol., 2019).
The above clinical evidence does support the use of a safe, natural substance like mannitol, to reduce cisplatin-induced significant and serious side-effect of nephrotoxicity in cancer patients.
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