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ESRU

Manganese

AEMPS

Trace cofactor mineral used in mineral supplements and parenteral nutrition

ATC code: A12CX-MANGANESE

Brand names: Solgar Chelated Manganese, NOW Manganese, Pure Encapsulations Manganese

Updated · Methodology

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

D

Osteoporosis

Not recommended

Manganese is a trace element involved in bone metabolism, which is why it is sometimes promoted as a supplement to prevent or treat osteoporosis. The evidence does not show a convincing benefit of manganese for osteoporosis: taking it on its own does not lower fracture risk or rebuild bone density. What does help with osteoporosis are confirmed approaches – enough calcium and vitamin D, weight-bearing and resistance exercise, quitting smoking, and, when indicated, medication prescribed by a doctor such as bisphosphonates. With a balanced diet, manganese deficiency is rare.

Sources

  1. EFSA: Scientific Opinion on Dietary Reference Values for manganese (2013)
  2. NIH ODS: Manganese – Health Professional Fact Sheet (2021)
  3. USPSTF: Vitamin, mineral and multivitamin supplementation to prevent CVD and cancer (2022)

ICD-10: M81 · ICD-11: FB83.1

F

Minerals for general health (supplement marketing)

Not recommended

Manganese is marketed in supplements for «bone and joint health», «antioxidant support» and «energy». In adults eating an ordinary diet, manganese deficiency is not described; in 2013 confirmed that grains, nuts, tea and leafy vegetables meet requirements. NIH ODS and EFSA systematic reviews found no clinical trials in healthy adults showing supplemental manganese improves bone density, joint outcomes or overall morbidity. Supplementation is risky because manganese accumulates in the basal ganglia and chronic excess causes manganism with tremor, rigidity and gait disturbance. If manganese was bought «just in case», consider seeking a second opinion and clarify whether there is an actual reason to take it.

Sources

  1. EFSA: Scientific Opinion on Dietary Reference Values for manganese (2013)
  2. NIH ODS: Manganese – Health Professional Fact Sheet (2021)
  3. USPSTF: Vitamin, mineral and multivitamin supplementation to prevent CVD and cancer (2022)
How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Manganese is a cofactor for many enzymes: manganese superoxide dismutase (MnSOD) protects mitochondria from reactive oxygen species, glutamine synthetase handles ammonia in the brain, arginase participates in the urea cycle, and glycosyltransferases shape cartilage and bone proteoglycans. Adequate intake in adults is 1.8–3 mg/day; with a balanced diet, human deficiency is practically not seen. Chronic accumulation through inhalation or chronic liver disease causes manganism, a Parkinson-like syndrome.

Safety

Contraindications

  • Chronic cholestatic liver disease (biliary excretion of manganese is impaired)
  • Liver cirrhosis of any aetiology
  • Occupational manganese-dust exposure (welders, miners)
  • Parenteral nutrition already containing manganese

Serious adverse effects

  • Manganism – Parkinson-like syndrome with tremor, rigidity, gait disturbance, apathy and psychotic symptoms
  • Cognitive decline and sleep disturbance after years of excess intake
  • Raised blood manganese in liver failure with risk of hepatic encephalopathy

Common adverse effects

  • Nausea at doses above 11 mg/day
  • Constipation or diarrhoea depending on the salt

Pregnancy: can you take Manganese?

Adequate manganese intake in pregnancy is 2.0 mg/day (NIH ODS) and is covered by ordinary diet. Stand-alone manganese supplements in pregnancy are not justified and potentially harmful because the mineral crosses the placenta. AESAN classifies manganese supplements as complementos alimenticios without therapeutic indication. Manganese as part of a standard prenatal multivitamin is safe.

Breastfeeding: can you take Manganese?

Manganese is present in human milk at very low concentration (3–10 mcg/L); infants get most of their manganese from complementary feeding or formula. Stand-alone manganese supplements during lactation are not justified.

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Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

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Frequently asked

What is Manganese used for?

Manganese is evaluated for the following indications with varying evidence strength: Osteoporosis (evidence tier D), Minerals for general health (supplement marketing) (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Manganese?

Common side effects of Manganese (≥ 1 in 100): Nausea at doses above 11 mg/day, Constipation or diarrhoea depending on the salt. See the Safety section for uncommon and serious reactions.

Is Manganese safe during pregnancy?

Adequate manganese intake in pregnancy is 2.0 mg/day (NIH ODS) and is covered by ordinary diet. Stand-alone manganese supplements in pregnancy are not justified and potentially harmful because the mineral crosses the placenta. AESAN classifies manganese supplements as complementos alimenticios without therapeutic indication. Manganese as part of a standard prenatal multivitamin is safe.

Is Manganese compatible with breastfeeding?

Manganese is present in human milk at very low concentration (3–10 mcg/L); infants get most of their manganese from complementary feeding or formula. Stand-alone manganese supplements during lactation are not justified.

Who should not take Manganese?

Manganese is contraindicated in: Chronic cholestatic liver disease (biliary excretion of manganese is impaired); Liver cirrhosis of any aetiology; Occupational manganese-dust exposure (welders, miners); Parenteral nutrition already containing manganese. Full list in the Safety section.

Official sources

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Other drugs in this group

Molybdenum, Phosphorus, Potassium citrate, Selenium (oral salts and chelates: selenomethionine, sodium selenite, selenium yeast), Boron, Calcium + Cholecalciferol, Copper, Zinc (oral salts: picolinate, citrate, gluconate, oxide, acetate)