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Fomepizole

Classification

Antidote

Indications

CCP: Anion gap acidosis in the setting of either a toxic alcohol ingestion or ethylene glycol poisoning

Contraindications

Hypersensitivity
Breast feeding during treatment and 24 hours after discontinuation.

Caution

Renal failure
Hepatic impairment
Should not be given undiluted or as a bolus.
Avoid polycarbonate syringes or polycarbonate-containing needles.

Adult dosages

CCP: Ethylene glycol toxicity

15 mg/kg/dose IV
- Infuse over 30 minutes
- Avoid polycarbonate syringes or polycarbonate-containing needles.
Followed by 10 mg/kg/dose IV q12 hr
Continue until ethylene glycol level is < 20 mg/dL or asymptomatic with a normal pH.

CCP: Methanol toxicity

15 mg/kg/dose IV
- Infuse over 30 minutes
- Avoid polycarbonate syringes or polycarbonate-containing needles.
Followed by 10 mg/kg/dose IV q12 hr
Continue until methanol level is < 20 mg/dL or asymptomatic with a normal pH.

Pediatric Considerations And Dosing

CCP: Ethylene glycol toxicity

15 mg/kg/dose IV
- Infuse over 30 minutes
- Avoid polycarbonate syringes or polycarbonate-containing needles.
Followed by 10 mg/kg/dose IV q12 hr
Continue until ethylene glycol level is < 20 mg/dL or asymptomatic with a normal pH.

CCP: Methanol toxicity

15 mg/kg/dose IV
- Infuse over 30 minutes
- Avoid polycarbonate syringes or polycarbonate-containing needles.
Followed by 10 mg/kg/dose IV q12 hr
Continue until methanol level is < 20 mg/dL or asymptomatic with a normal pH.

Mechanism Of Action

Competitively inhibits alcohol dehydrogenase. Alcohol dehydrogenase is an enzyme that catalyzes the metabolism of ethanol, methanol, and ethylene glycol to their toxic metabolites.

Pharmacokinetics

Onset: 1.5-2 hours

Half-life: unknown as half-life varies with dose.

Adverse Effects

Headache
Nausea
Metallic taste
Dizziness
Drowsiness
Agitation
Transient increase in LFT’s
Backache
Nystagmus
Fever
Abdominal pain
Anemia
Anuria
DIC
Bradycardia
Tachycardia
Shock
Hypotension
Multi-organ failure

Warning And Precautions

Not to be given undiluted or by bolus injection.
Do not use polycarbonate syringes or polycarbonate needles.

Drug Interactions

Ethanol