Fomepizole

Fomepizole is an alcohol dehydrogenase inhibitor used in management of methanol and ethylene glycol poisoning. It is largely unavailable in Australia or New Zealand but if you are lucky enough to have a supply the details are below: 

Administration:

• Loading dose = 15 mg/kg in 100ml of 0.9% saline or 5% dextrose IV over 30 minutes.
• Maintenance dose = 10 mg/kg in 100ml of 0.9% saline or 5% dextrose IV over 30 minutes every 12 hours for 48 hours.
• If given for >48 hours you will need to increase the dose to 15 mg/kg to compensate for induction of metabolism.
• If the patient undergoes dialysis, fomepizole should be given every 4 hours or as a continuous infusion at 1 mg/kg/hour for the entire duration of the haemodialysis

References

• Barceloux DG, Krenzelok EK, Olson K et al. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. Journal of Toxicology – Clinical Toxicology 1999; 37:537-560.
• Brent J, McMartin K, Phillips SP et al.  Fomepizole for the treatment of ethylene glycol poisoning.  New England Journal of Medicine 1999; 340:832-838.x
• Brent J, McMartin K, Phillips SP et al.  Fomepizole for the treatment of methanol poisoning.  New England Journal of Medicine 2001; 344:424-429.
• Brent J. Fomepizole for ethylene glycol and methanol poisoning. New England Journal of Medicine 2009; 360:2216-2223.
• Lepik KJ, Levy AR, Sobolev BG et al. Adverse drug events associated with the antidotes for methanol and ethylene glycol poisoning: a comparison of ethanol and fomepizole. Annals of Emergency Medicine 2009; 53:439-450.

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Neil Long

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.