Mannitol & Nutrient Depletion
Also searched as Osmitrol, Bronchitol. What the clinical evidence reports, what it may mean, and what to discuss with your pharmacist.
Mannitol has been associated with depletion of POTASSIUM, VITAMIN C, MAGNESIUM and THIAMINE and 3 more. This does not mean a deficiency will occur — it means these are worth knowing about and, if you take Mannitol long-term, worth raising with your pharmacist or healthcare provider.
Take more than one medication? Open the checker with Mannitol pre-loaded and add the rest to see overlapping nutrient signals.
Reported nutrient depletions with Mannitol
Each record below is shown as published in our licensed clinical database, with its evidence rating and citations. Expand a section for food sources and talking points.
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POTASSIUM
Major DepletionDIURETIC DRUGS
Potassium keeps your heart rhythm steady and your muscles working properly, so keeping levels in a healthy range really matters. Mannitol is an osmotic diuretic, meaning it pulls fluid through your kidneys very quickly, and that rapid fluid flush carries potassium out in the urine along with it. Because this loss is considered major, most people receiving mannitol will need their potassium levels watched closely and may require a supplement. Please talk with your doctor or pharmacist about monitoring and whether you need extra potassium.
What Potassium does & food sources
Potassium keeps nerve signals, muscle contractions, and heart rhythm working normally.
Common food sources:
- Bananas and citrus fruits
- Potatoes and sweet potatoes
- Beans and lentils
- Tomatoes and leafy greens
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Potassium is routinely checked with basic blood work. If you take a medication associated with potassium loss (like some diuretics), ask your provider how often your electrolytes should be monitored.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Do not start potassium supplements on your own. Both low and high potassium can affect heart rhythm, and several common medications (ACE inhibitors, ARBs, potassium-sparing diuretics) raise potassium.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Potassium supplementation can be dangerous in kidney disease or alongside potassium-raising medications — this is a decision for your prescriber, guided by lab results.
Learn more about this nutrient: Potassium — uses, safety & interactions
References (3)
- Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
- Garabedian-Ruffalo SM, Ruffalo RL. Drug and nutrient interactions. Am Fam Physician 1986;33:165-74.
- Robertson JI. Diuretics, potassium depletion and risk of arrhythmias. Eur Heart J 1984;5(Suppl A):25-8.
VITAMIN C
Insignificant DepletionDIURETIC DRUGS
In people with chronic renal failure, a 20 mg intravenous dose of furosemide (Lasix) increases urinary losses of vitamin C, probably due to increased water excretion. Significant vitamin C depletion hasn't been reported with long-term oral use of furosemide or other diuretics.
Vitamin C is something your immune system, skin, and wound healing all depend on, so it is worth knowing that mannitol, a diuretic given intravenously in hospital settings, could theoretically carry a little extra vitamin C out through the urine simply because it pulls so much water through the kidneys. That said, any such loss is considered insignificant, and meaningful vitamin C depletion has not been reported with diuretics like this. For most patients receiving mannitol, no special supplementation is needed, though if you have questions about your own situation, a quick word with your pharmacist or doctor is always a reasonable step.
What Vitamin C does & food sources
Vitamin C is an antioxidant that supports the immune system, collagen formation, and iron absorption.
Common food sources:
- Citrus fruits
- Bell peppers
- Strawberries and kiwi
- Broccoli and Brussels sprouts
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Frank vitamin C deficiency is uncommon with a varied diet. If your diet is limited and you take an associated medication, ask your provider whether your intake is adequate.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Vitamin C is water-soluble and generally low-risk at food-level intakes; very high supplemental doses can cause stomach upset and may not add benefit.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Learn more about this nutrient: Vitamin C — uses, safety & interactions
References (1)
- Mydlik M, Derzsiova K, Zemberova E. Influence of water and sodium diuresis and furosemide on urinary excretion of vitamin B6, oxalic acid and vitamin C in chronic renal failure. Miner Electrolyte Metab 1999;25:352-6..
MAGNESIUM
Moderate DepletionDIURETIC DRUGS
Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Magnesium helps keep your muscles, heart rhythm, and nerves working properly, so it is worth paying attention to. Mannitol is an osmotic diuretic, meaning it pulls water out of your tissues and sends it through your kidneys, and extra magnesium gets swept out in that urine flow. Because the rating here is moderate, this is not just a theoretical concern, and some people on mannitol do need a supplement. If you are using mannitol regularly, it is worth asking your pharmacist or doctor whether your magnesium levels should be checked.
What Magnesium does & food sources
Magnesium is involved in muscle and nerve function, heart rhythm, blood sugar control, and bone health.
Common food sources:
- Nuts and seeds (almonds, pumpkin seeds)
- Whole grains
- Leafy green vegetables
- Beans and legumes
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Ask whether a magnesium level is worth checking if you take an associated medication long-term — particularly with symptoms like muscle cramps, twitching, or palpitations. Blood levels do not always reflect total body stores, which is worth discussing too.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Magnesium supplements come in many forms and can cause loose stools at higher doses. They can also bind some medications in the gut (certain antibiotics, thyroid medication), so timing matters — check with your pharmacist.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Magnesium supplementation can be risky in kidney disease, where magnesium can accumulate — always check with a clinician first if your kidney function is reduced.
Learn more about this nutrient: Magnesium — uses, safety & interactions
References (4)
- Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
- Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
- Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
- Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..
THIAMINE
Moderate DepletionDIURETIC DRUGS
Increased urinary thiamine excretion and thiamine deficiency may occur in some people treated with diuretics, especially in high doses (e.g., more than 80 mg furosemide daily) for several months. Although most case reports involve furosemide, animal data suggest that the effect may occur with any diuretic. Diuretic-induced thiamine deficiency appears to be most common in elderly people with inadequate dietary intake and to be rare in people less than 60 years of age. Thiamine deficiency in people taking diuretics is a concern because it might worsen heart failure. Limited research suggests that supplementation with thiamine 200 mg daily may improve left ventricular ejection fraction and functional capacity in some thiamine-deficient people treated with high doses of furosemide for heart failure. However, other studies have found no improvement. It's too soon to recommend routine thiamine supplementation for people on prolonged, high-dose diuretic therapy. Monitor for thiamine deficiency.
Thiamine is a B vitamin your heart, nerves, and muscles depend on for energy. Mannitol is a diuretic, meaning it pulls extra fluid out through the kidneys, and that process can carry thiamine out in the urine along with it. The concern is rated moderate, so it is not a trivial footnote, especially for older adults or anyone on high doses for a long stretch of time. If you have been using mannitol regularly, it is worth asking your pharmacist or doctor whether your thiamine levels should be checked.
What Vitamin B1 (thiamine) does & food sources
Thiamine helps convert food into energy and is essential for nerve and heart function.
Common food sources:
- Whole grains and fortified cereals
- Pork
- Beans and lentils
- Nuts and seeds
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Ask about thiamine if you take an associated medication (for example, a long-term loop diuretic in heart failure) and have symptoms like fatigue or worsening heart failure control — this is an area your care team can weigh.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Thiamine is water-soluble and generally low-risk, but supplementing to treat a suspected problem should still be clinician-guided so the real cause is not missed.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Learn more about this nutrient: Thiamine — uses, safety & interactions
References (9)
- Brady JA, Rock CL, Horneffer MR. Thiamin status, diuretic medications, and the management of congestive heart failure. J Am Diet Assoc 1995;95:541-4. PubMed
- Shimon I, Almog S, Vered Z, et al. Improved left ventricular function after thiamine supplementation in patients with congestive heart failure receiving long-term furosemide therapy. Am J Med 1995;98:485-90. PubMed
- Seligmann H, Halkin H, Rauchfleisch S, et al. Thiamine deficiency in patients with congestive heart failure receiving long-term furosemide therapy: a pilot study. Am J Med 1991;91:151-5. PubMed
- Leslie D, Gheorghiade M. Is there a role for thiamine supplementation in the management of heart failure? Am Heart J 1996;131:1248-50. PubMed
- Saif MW. Is there a role for thiamine in the management of congestive heart failure? (letter) South Med J 2003;96:114-5. PubMed
- Schoenenberger AW, Schoenenberger -Berzins R, der Maur CA, et al. Thiamine supplementation in symptomatic chronic heart failure: a randomized, double-blind, placebo-controlled, cross-over pilot study. Clin Res Cardiol. 2012 Mar;101(3):159-64. PubMed
- Lubetsky A, Winaver J, Seligmann H, et al. Urinary thiamine excretion in the rat: effects of furosemide, other diuretics, and volume load. J Lab Clin Med 1999;134:232-7.. PubMed
- Levy WC, Soine LA, Huth MM, Fishbein DP. Thiamine deficiency in congestive heart failure (letter). Am J Med 1992;93:705-6. PubMed
- Pfitzenmeyer P, Guilland JC, d'Athis P, et al. Thiamine status of elderly patients with cardiac failure including the effects of supplementattion. Int J Vitam Nutr Res 1994;64:113-8.
COENZYME Q10
Insufficient EvidenceANTIHYPERTENSIVE DRUGS
Some antihypertensive drugs, including beta blockers, diazoxide, hydralazine, and others, appear to inhibit coenzyme Q10 enzyme activity and may decrease endogenous levels of coenzyme Q10. However, it is not clear if this reduction is clinically significant. There is no reliable evidence that coenzyme Q10 depletion contributes to antihypertensive drug side effects.
Coenzyme Q10 is a natural compound your cells use to produce energy, and it also acts as an antioxidant. Mannitol is primarily used as an osmotic agent rather than a classic antihypertensive, so the concern here really stems from a broader observation that some blood-pressure drugs may interfere with enzymes the body needs to make coenzyme Q10. Right now the evidence is simply too thin to know whether this matters for mannitol users specifically. If you have questions about your levels or whether a supplement makes sense, a quick conversation with your pharmacist or doctor is the right place to start.
What Coenzyme Q10 (CoQ10) does & food sources
CoQ10 helps cells produce energy and acts as an antioxidant; heart and muscle tissue use it heavily.
Common food sources:
- Organ meats and fatty fish
- Whole grains
- Nuts and seeds
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
There is no routine blood test for CoQ10 in everyday practice. If you have new, unexplained muscle symptoms on a medication linked to CoQ10 (statins are the best-known example), talk to your prescriber before changing anything — symptoms have many possible causes and your prescriber has several options.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
CoQ10 is generally well tolerated, but evidence for supplementing (for example, for statin muscle symptoms) is mixed. It may also modestly affect warfarin — check with your pharmacist before combining.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Do not stop a prescribed medication because of this association — discuss any symptoms with your prescriber first.
Learn more about this nutrient: Coenzyme Q10 — uses, safety & interactions
References (1)
- Kishi T, Kishi H, Watanabe T, et al. Bioenergetics in clinical medicine. XI. Studies on coenzyme Q and diabetes mellitus. J Med 1976;7:307-21.
FOLIC ACID
Insufficient EvidenceDIURETIC DRUGS
Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in balance. Because mannitol works as a diuretic, pulling extra fluid out through the kidneys, there is some thought that it could carry folate out in the urine along with it. That said, the evidence here is genuinely thin, so this is more of an open question than a proven concern. Eating folate-rich foods is a reasonable, low-effort step, and if you have questions about whether your levels are worth checking, your pharmacist or doctor is a good place to start.
What Folic acid (folate) does & food sources
Folate is needed for cell division, red blood cell formation, and healthy fetal development.
Common food sources:
- Leafy green vegetables
- Beans, lentils, and peas
- Fortified grains and cereals
- Citrus fruits
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Ask your provider whether folate monitoring or supplementation is appropriate for you — this matters most before and during pregnancy, and with long-term use of certain seizure or arthritis medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Folate needs are individual. With some medications (for example, methotrexate), folic acid is often prescribed deliberately on a specific schedule — follow your prescriber's instructions rather than adding your own.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: High-dose folic acid can mask vitamin B12 deficiency, so the two are often evaluated together.
Learn more about this nutrient: Folic Acid — uses, safety & interactions
References (1)
- Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed
SODIUM
Insufficient EvidenceDIURETIC DRUGS
Loop and thiazide diuretics increase sodium excretion by preventing sodium from being reabsorbed by the kidneys. Although uncommon, loop or thiazide diuretics can cause severe hyponatremia in some patients.
Sodium helps control fluid balance, nerve signals, and muscle function throughout your body. Mannitol is an osmotic diuretic, meaning it pulls water through your kidneys in a way that can also carry some sodium out with it. Right now, the evidence for this specific effect with mannitol is too limited to know how much it really matters in practice, so most people do not need to worry, but if you are on mannitol for any length of time, it is worth asking your doctor or pharmacist whether your sodium levels should be checked.
What Sodium does & food sources
Sodium maintains fluid balance, blood pressure, and nerve/muscle function.
Common food sources:
- Table salt and most processed foods — dietary shortage is rare; medication-related loss is about balance, not intake
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Sodium is part of routine blood work. If you take an associated medication (like certain diuretics or antidepressants), ask how often your electrolytes should be checked — especially if you feel confused, weak, or unusually tired.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Low sodium from a medication is managed by your care team (often by adjusting the medication or fluids) — not by eating more salt on your own.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Significant symptoms of low sodium (confusion, severe weakness) warrant prompt medical attention.
Learn more about this nutrient: Sodium — uses, safety & interactions
References (2)
- Sardar GK, Eilbert WP. Severe Hyponatremia Associated with Thiazide Diuretic Use. J Emerg Med 2015;48(3):305-9. PubMed
- Diaconu CC, Balaceanu A, Bartos D. Diuretics, first-line antihypertensive agents: are they always safe in the elderly? Rom J Intern Med 2014;52(2):87-90.
This tool is educational and is not a substitute for professional medical advice. An association is not a diagnosis and does not mean a deficiency will occur. Always talk to your pharmacist or healthcare provider before starting, stopping, or changing any medication or supplement.
Disclaimer: This checker finds which nutrients might be depleted by prescription or over-the-counter medications. Each nutrient depletion issue is rated based on clinical significance. Use your own professional judgment prior to making clinical decisions.© 2026 Therapeutic Research Center Licensed records refresh weekly · last updated July 3, 2026.
More about Mannitol
What drug-induced nutrient depletion means
Some medications can, over time, lower the levels of certain vitamins, minerals, or other nutrients — through reduced absorption, increased loss, or changes in how the body uses them.
Association is not deficiency
An entry here means a depletion has been reported or studied — not that it happens to everyone, or that you are deficient. Dose, duration, diet, and your own health all matter.
Evidence varies by pair
Some drug–nutrient links (like metformin and vitamin B12) are well studied; others rest on limited or preliminary research. Each entry shows the evidence rating from our licensed clinical database.
When to ask about labs
If you take an associated medication long-term, ask your healthcare provider whether monitoring is appropriate for you. Not everyone needs testing — your provider can weigh your dose, duration, and symptoms.
Don't self-supplement blindly
Supplements are not risk-free: some can interact with medications, and some (like potassium or magnesium) can be risky with kidney disease. Talk to your pharmacist before adding anything.
Never stop a medication over this
These medications are prescribed for good reasons, and the benefit usually far outweighs a manageable nutrient consideration. Any change belongs in a conversation with your prescriber.
Food first, usually
For many nutrients, a varied diet covers the gap. Each entry lists common food sources; a supplement is a decision to make with your pharmacist or provider, not a default.
Mannitol & nutrients: FAQs
Does Mannitol deplete POTASSIUM?
Should I take a supplement because I take Mannitol?
Should I stop taking Mannitol?
Where does this information come from?
Questions about Mannitol and your nutrition?
Ask a licensed pharmacist — free, no appointment needed.
Sources & How We Checked
Nutrient depletion records for Mannitol are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for drug-induced nutrient depletions, supplements, and interactions — the basis for this page.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for medication overviews across the site.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.