What is the role of fomepizole (Antizol) in the treatment of ethylene glycol (EG) toxicity?

Updated: Dec 05, 2017
  • Author: Daniel C Keyes, MD, MPH; Chief Editor: Sage W Wiener, MD  more...
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Answer

Fomepizole (Antizol) is a convenient antidotal therapy for treatment of ethylene glycol or methanol intoxication. Fomepizole received US Food and Drug Administration (FDA) approval for use in ethylene glycol intoxication in December 1997, and it appears to have largely supplanted ethanol as the antidote of choice in toxic alcohol exposures in the US. [13] Fomepizole is administered with a loading dose and twice-daily intravenous dosing. [14]

Fomepizole is equally efficacious for the treatment of methanol intoxication but does not cause any alteration in mental status, hypoglycemia, or respiratory depression.

Fomepizole is advantageous because it does not depress the patient's mental status or airway and needs to be administered only every 12 hours. The main drawback of fomepizole is the cost, which can total thousands of dollars. Because this agent is so expensive, clinicians should check its availability at their institution and discuss the plan for use of this antidote, especially for empiric treatment of cases in which the cause of acidosis is unknown.

The availability of timely results of laboratory tests can be a problem. Weigh the benefits, risks, and costs of each therapeutic intervention at the treating institution.


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