Dietary supplement: Oral: 1 capsule/tablet daily.
Parenteral nutrition, maintenance requirement:
Note: Parenteral nutrition ordering requires advanced knowledge of nutrient and other metabolic requirements and should only be prescribed by clinicians trained in assessment and order writing for parenteral nutrition (ASPEN [Guenter 2015]).
Standard daily manganese requirement : IV: Elemental manganese 55 mcg daily as component of parenteral nutrition; adjust daily dose based on serum manganese and clinical considerations (ASPEN 2019).
Use caution; manganese chloride solution for injection contains aluminum.
Use caution; dose may need to be decreased or withheld in patients with elevated bilirubin or confirmed cholestatic disease.
Parenteral nutrition, maintenance requirement: IV: 2 to 10 mcg/kg/day
Expert recommendations suggest decreasing the daily dose for infants and children to 1 mcg/kg/day (up to a maximum of 50 mcg/day). However, these recommendations are difficult to follow with the current sources of parenteral manganese (ASPEN [Vanek 2012]).
Note: Use caution in premature neonates; manganese chloride solution for injection contains aluminum.
Use caution; manganese chloride solution for injection contains aluminum.
Use caution; dose may need to be decreased or withheld in patients with elevated bilirubin or confirmed cholestatic disease.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, Oral, as chelated:
MN-50: Elemental manganese 16.67 mg
Solution, Intravenous, as chloride:
Generic: Elemental manganese 0.1 mg/mL (10 mL)
Solution, Intravenous, as sulfate [preservative free]:
Generic: Elemental manganese 0.1 mg/mL (10 mL [DSC])
Tablet, Oral, as chelated:
Mangimin: Elemental manganese 10 mg [DSC] [corn free, rye free, wheat free]
Generic: Elemental manganese 15 mg [DSC], Elemental manganese 50 mg
Tablet, Oral, as gluconate:
Generic: 50 mg [elemental manganese 5.7 mg]
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous, as sulfate:
Micro-Mn: Elemental manganese 0.1 mg/mL (10 mL)
Oral: May be administered with a meal.
IV: Do not administer IM or by direct IV injection; acidic pH of the solution may cause tissue irritations and it is hypotonic; administer after dilution in volume of fluid ≥100 mL.
Parenteral: Not for direct IV or IM injection; must be diluted in parenteral nutrition solution prior to administration; acidic pH of the solution may cause tissue irritation and it is hypotonic
Dietary supplementation: Trace element added to parenteral nutrition to prevent manganese deficiency; orally as a dietary supplement.
Manganese sulfate may be confused with magnesium sulfate
There are no adverse reactions listed in the manufacturer's labeling.
There are no contraindications listed within the manufacturer's US labeling.
Canadian labeling: Hypersensitivity to manganese or any component of the formulation.
Disease-related concerns:
• Biliary tract impairment: Use with caution in patients with biliary tract impairment; dose may need to be decreased or withheld.
• Hepatic impairment: Use with caution in patients with hepatic impairment; dose may need to be decreased or withheld.
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer's labeling.
Other warnings/precautions:
• Appropriate use: Due to its highly acidic pH (pH 2.0), direct IV or IM injection is contraindicated; may result in severe tissue damage.
None known.
There are no known significant interactions.
Animal reproduction studies have not been conducted. Manganese crosses the placenta and can be detected in placental tissue and cord blood (Osada 2002).
Manganese is found in breast milk. Normal concentrations of manganese in human milk are generally lower than cow's milk or those found in food sources, but absorption from human milk is higher (IOM 2004).
Dietary adequate intake (IOM 2001):
0 to 6 months: 0.003 mg/day
7 to 12 months: 0.6 mg/day
1 to 3 years: 1.2 mg/day
4 to 8 years: 1.5 mg/day
9 to 13 years: Males: 1.9 mg/day; Females: 1.6 mg/day
14 to 18 years: Males: 2.2 mg/day; Females: 1.6 mg/day
>18 years: Males: 2.3 mg/day; Females: 1.8 mg/day
Pregnancy: 2 mg/day
Lactation: 2.6 mg/day
Periodic manganese plasma level
Whole blood: 6 to 12 mcg/L.
Cofactor in many enzyme systems, stimulates synthesis of cholesterol and fatty acids in liver, and influences mucopolysaccharide synthesis
Absorption: Poor
Distribution: Concentrated in mitochondria of pituitary gland, pancreas, liver, kidney, and bone
Excretion: Bile (primarily); urine (negligible)
Solution (Manganese Chloride Intravenous)
0.1 mg/mL (per mL): $3.06
Tablets (Manganese Gluconate Oral)
50 mg (per each): $0.06
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