D-Mannose 500 mg by NOW

LIKELY EFFECTIVE

• Carbohydrate-deficient glycoprotein syndrome type 1b. Oral d-mannose prevents certain hematologic and gastrointestinal complications in patients with this condition. However, it's unclear if it helps to prevent liver complications. Details: Carbohydrate-deficient glycoprotein syndrome type 1b is a rare and often lethal congenital disorder of glycosylation (CDG). It is characterized by protein loss in the digestive tract, gastrointestinal symptoms, hypoglycemia, liver disease, and failure to thrive. The disorder is also called phosphomannose isomerase (PMI) deficiency or mannose-phosphate-isomerase CDG (MPI-CDG). Taking d-mannose 300-1020 mg/kg daily in 3-6 divided doses long-term can reduce protein loss, hypoglycemia, coagulation disorders, and gastrointestinal symptoms in patients, usually infants and children, with this disorder (13344,13345,13346,13348,100978,100979,100980,100981). While d-mannose seems to be effective for stabilizing the signs and symptoms of this condition, it is not clear whether it can prevent liver complications. In two cases, d-mannose reduced hepatomegaly after 6 months or 2 years of therapy (13348,100980). In other cases, however, hepatic fibrosis developed despite d-mannose treatment for up to 6 years (13345,100978). These discrepant finding are thought to be due to the variable levels of liver disease severity at the time of d-mannose treatment initiation (100977).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Urinary tract infections (UTIs). Small clinical studies suggest that oral d-mannose might reduce UTI recurrence, when used alone or in combination with other ingredients. It is unclear if d-mannose improves symptoms in patients with existing UTIs. Details: A systematic review of the available research concluded that there is no strong evidence for or against the use of d-mannose for UTI prevention or treatment and higher quality research is needed (110013). A meta-analysis of low-quality studies suggests that d-mannose may have a protective effect against UTI recurrence when compared with no prophylaxis and may be similarly effective to prophylactic antibiotics. However, it is difficult to draw strong conclusions from the meta-analysis because it included only 3 small studies, one of which was a prospective cohort study (104209). Two of these studies compared d-mannose powder 2 grams daily for 6 months to prophylactic antibiotics. In one study, d-mannose demonstrated comparable effectiveness to nitrofurantoin 50 mg daily (91141). However, the other study compared d-mannose to trimethoprim/sulfamethoxazole 160/800 mg twice daily for 5 days, followed by one dose daily at bedtime for one week of each month (99656). Although trimethoprim/sulfamethoxazole is commonly used to prevent UTI recurrence, the specific regimen studied here is not typically used for prophylaxis, limiting the validity of the findings from this meta-analysis. Additionally, a small clinical study of postmenopausal females with a history of recurrent UTI was halted early due to likely futility to show a reduction in recurrent UTI with taking 2 grams of d-mannose powder (Organic & Pure Powder D-Mannose Powder, NOW Foods Inc.) daily for 90 days in addition to using vaginal estrogen (111756). A small clinical study in older adults post-cystoscopy for suspected bladder cancer or post-transurethral resection of the bladder shows that taking D-mannose 500 mg plus Saccharomyces boulardii daily for 1 week reduces the incidence of positive urine cultures (0% vs. 19%) when compared with no treatment (112363). However, it is unclear if these effects are due to D-mannose, Saccharomyces boulardii, or the combination. Low-quality research also suggests that taking specific combination products containing d-mannose with other ingredients may be beneficial for UTI prevention. These products have combined d-mannose 250 mg with cranberry extract, tara gum, and probiotic bacteria (1-2.5 billion live cells of L. plantarum LP01, L. paracasei LPC09, and Streptococcus thermophilus ST10) (93884); d-mannose (dose unspecified) with cranberry, and L. paracasei (Lactoflorene Cist, Montefarmaco) (104210); and d-mannose 500 mg with noni fruit extract 200 mg and N-acetylcysteine 100 mg (97360). D-mannose has also been studied as a treatment for existing UTI alone and in combination with other ingredients. A small clinical study in females with an acute UTI shows that taking a specific d-mannose product (Mannocist, Laboratori Farmaceutici Krymi) 1.5 grams twice daily for 3 days, and then once daily for 10 days, improves some symptoms of UTI when compared to baseline (93883). The validity of this finding is limited by the lack of a comparator group. A moderate-size clinical study in females aged 18-45 with uncomplicated UTIs shows that taking a supplement containing d-mannose 2 grams, astragalus, citric acid, dandelion, and prebiotics as a sachet dissolved in water twice daily for 5 days improves complete resolution of UTI symptoms and clearance of bacteriuria at days 6 and 35 when compared with placebo (111757). However, it is unclear if these effects are due to d-mannose, other ingredients, or the combination. More evidence is needed to rate d-mannose for this use.

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POSSIBLY SAFE ...when used orally and appropriately, short-term. D-mannose 3 grams daily for up to 2 weeks or 2 grams daily for up to 6 months has been used with apparent safety in clinical research (91141,93883,99656). There is insufficient reliable information available about the safety of taking d-mannose long-term.

CHILDREN: POSSIBLY SAFE
when used orally and appropriately in children with carbohydrate-deficient glycoprotein syndrome type 1b. D-mannose 300-1020 mg/kg daily, taken in 3-6 divided doses, has been used with apparent safety, long-term (13345,13346,13348,100978,100979,100980,100981). While total daily doses up to 1020 mg/kg have been used safely when taken in divided doses, single doses greater than 200 mg/kg are more likely to cause osmotic diarrhea (100977). There is insufficient reliable information available about the safety of using d-mannose in children with other conditions.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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General ...Orally, d-mannose seems to be well tolerated.
Most Common Adverse Effects:
Orally: Bloating, diarrhea, and nausea.

Gastrointestinal ...Orally, d-mannose can cause loose stools, diarrhea, abdominal bloating, and nausea (13344,91141,100979,100981,104209). In children, loose stools and abdominal bloating have been reported at d-mannose doses ranging from 100 mg/kg three times daily to 150 mg/kg five times daily (13344,100979). Diarrhea has been reported in adults taking d-mannose 2 grams daily for 6 months (91141). While diarrhea and loose stools have been reported at lower doses, taking a single d-mannose dose greater than 200 mg/kg is more likely to cause osmotic diarrhea (100977).

Renal ...Orally, there is concern that excessive doses (toxic amounts unspecified) of d-mannose might be toxic to the kidneys (13348).

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