- Competitively inhibits the enzyme
alcohol dehydrogenase. Alcohol dehydrogenase is needed to
oxidize ethanol alcohol (found in alcoholic bevridges) to
acetaldehyde and to carry out the initial steps in the metabolism
of ethylene glycol (found in antifreeze) and methanol (found
in windshield washer fluid).
- It is the metabolites
of methanol and ethylene glycol that are toxic. By preventing
the metabolism of methanol or alcohol, toxicity can be prevented.
fomepizole treatment immediately upon suspicion of ethylene
glycol or methanol ingestion based on patient history and/or
anion gap metabolic acidosis, increased osmolar gap, visual
disturbances, or oxalate crystals in the urine, or
a documented serum ethylene glycol >3.2 mmol/l or methanol
concentration >6.2 mmol/L.
dose 15 mg/kg followed by 10 mg/kg q12h X 4 doses, then 15
mg/kg q 12 h until ethylene glycol < 0.4 mmol/L or serum
methanol levels <0.06 mmol/L
next scheduled dose if >6 hours since the last dose.
dialysis: administer doses every 4 hours.
if time since last dose is <1 hour, then give the
next scheduled dose 12 hours from the last dose administered,
and then follow the normal dosing schedule
require increased dosing frequency after 30-40 hours of treatment
due to fomepizole inducing its own hepatic metabolism
Mix dose in a minibag
with a minimum volume of 100 ml NS or D5W and administer over
at least 30 minutes.
- Use with caution
in hepatic failure.
reduces the metabolism of ethanol.
administration reduces the metabolism of fomepizole. While ethanol infusion can be used instead of fomepizole to treat methanol or ethylene glycol overdose, these two treatments should not be used together.
in hepatic enzymes
glycol or methanol levels
to ethylene glycol or methanol intoxication parameters
- May be administered by a nurse.