Manganese

Dosage Forms & Strengths

tablet

• 10mg (elemental)
• 15mg (elemental)
• 93mg (aspartate; 25mg elemental)
• 50mg (gluconate; 5.7mg elemental)

capsule

• 16.67mg

injectable solution

• 0.1mg/mL

Adequate Intake

Male: 1.9-2.3 mg/day

Female: 1.6-1.8 mg/day

Pregnancy: 2 mg/day

Lactation: 2.6 mg/day

Prevention of Deficiency

Parenteral solution (TPN):150-800 mcg/day IV

Osteoporosis (Off-label)

5 mg PO qDay

Dosage Forms & Strengths

injectable solution: MnCl2

• 0.1mg/mL

Adequate Intake

<6 months: 0.3-0.6 mg/day

6-12 months: 0.6-1.0 mg/day

1-3 years: 1.0-1.5 mg/day

3-8 years: 1.5-2.0 mg/day

8-13 years: 1.9 mg/day (males); 1.6 mg/day (females)

13-18 years: 2.2 mg/day (males); 1.6 mg/day (females)

Prevention of Deficiency

Parenteral solution (TPN): 2-10 mcg/kg/day IV 

Manganese is an essential nutrient which serves as an activator for enzymes such as polysaccharide polymerase, liver arginase, cholinesterase and pyruvate carboxylase. Providing Manganese during TPN helps prevent development of deficiency symptoms such as nausea and vomiting, weight loss, dermatitis and changes in growth and color of hair.

Under conditions of minimal intake, 20 mcg Manganese/day is retained. Manganese is bound to a specific transport protein, transmanganin, a beta-l-globulin. Manganese is widely distributed but concentrates in the mitochondria rich tissues such as brain, kidney, pancreas, and liver. Assays for Manganese in whole blood result in concentrations ranging from 6 to 12 mcg/Manganese/liter.

Excretion of Manganese occurs mainly through the bile, but in the event of obstruction, ancillary excretion routes include pancreatic juice, or return into the lumen of the duodenum, jejunum, or ileum. Urinary excretion of Manganese is negligible.

Direct intramuscular or intravenous injection of Manganese 0.1 mg/mL (Manganese Chloride Injection, USP) is contraindicated as the acidic pH of the solution (pH 2.0) may cause considerable tissue irritation.

Liver and/or biliary tract dysfunction may require omission or reduction of copper and Manganese doses because these elements are primarily eliminated in the bile.

WARNING: This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.

Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.

Manganese 0.1 mg/mL (Manganese Chloride Injection, USP) contains 0.1 mg Manganese/mL and is administered intravenously only after dilution. The additive should be administered in a volume of fluid not less than 100 mL. For the adult receiving TPN, the suggested additive dosage for Manganese is 0.15 to 0.8 mg/day (1.5 to 8 mL/day). For pediatric patients, a dosage of 2 to 10 mcg Manganese/kg/day (0.02 to 0.1 mL/kg/day) is recommended.

Periodic monitoring of Manganese plasma levels is suggested as a guideline for subsequent administration.

Parenteral products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. (See PRECAUTIONS.)

Manganese 0.1 mg/mL (Manganese Chloride Injection, USP) is supplied in 10 mL Plastic Vials (NDC No. 0409-4091-01).

Store at 20 to 25°C (68 to 77°F) [See USP Controlled Room Temperature.]

Revised: November, 2009

Printed in USA                           EN-2320

Hospira, Inc., Lake Forest, IL 60045 USA

• Dietary Supplement
• Trace Element, Parenteral

Refer to adult dosing.

Adequate intake: Oral:

0-6 months: 0.003 mg/day

7-12 months: 0.6 mg/day

1-3 years: 1.2 mg/day

4-8 years: 1.5 mg/day

9-13 years: Males: 1.9 mg/day; Females: 1.6 mg/day

14-18 years: Males: 2.2 mg/day; Females: 1.6 mg/day

Deficiency prevention: IV: 2-10 mcg/kg/day usually administered in TPN solutions

Note: Use caution in premature neonates; manganese chloride solution for injection contains aluminum.

Use caution; dose may need to be decreased or withheld.

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.

Manganese 0.1 mg/mL (Manganese Chloride Injection, USP) is supplied in 10 mL Plastic Vials.

Store at 20 to 25°C (68 to 77°F) [See USP Controlled Room Temperature.]

Distributed by Hospira, Inc., Lake Forest, IL 60045 USA. Revised: Apr 2018