What is the drug of choice to reduce intracranial pressure (ICP)?

Mannitol is the drug of choice for reducing intracranial pressure (ICP) due to its osmotic diuretic properties. When administered, mannitol increases the osmolarity of the blood, drawing water out of the brain tissue and into the bloodstream. This process reduces cerebral edema and effectively lowers intracranial pressure. Mannitol's rapid onset of action and ability to maintain its effects for several hours make it particularly useful in acute situations, such as traumatic brain injury or other conditions causing elevated ICP.

Other medications may have roles in managing ICP but lack the same efficacy or rapid action as mannitol. For instance, furosemide is a loop diuretic that can help in fluid management but is not specifically indicated for ICP reduction. Acetazolamide acts primarily by inhibiting carbonic anhydrase and can assist in certain conditions but does not provide the same immediate osmotic effect. Hypertonic saline, while it can also raise serum osmolarity and reduce ICP, is often used in conjunction with other treatments rather than as a first-line monotherapy. Thus, mannitol stands out as the preferred and most effective initial choice for lowering ICP.