Fomepizole

Fomepizole is an alcohol dehydrogenase inhibitor used in management of methanol and ethylene glycol poisoning. It is not currently available in either Australia or New Zealand. 

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.