Hypersensitivity to fomepizole, other pyrazoles, or any component of the formulation Dosage and Administration Dosing: Adult

Ethanol as an antidote is effective in the management of methanol and ethylene glycol poisoning (Thanacoody 2016 Zakharov 2015) however, ethanol is associated with a higher incidence of adverse events and medication errors (Bestic 2009 Lepik 2009 Lepik 2011). If fomepizole is unavailable or if the patient is intolerant to fomepizole, ethanol therapy may be considered. Note: Fomepizole is the preferred antidote for known or suspected ethylene glycol poisoning or methanol poisoning. Has not been calculated varies with dose Protein BindingĮthylene glycol or methanol poisoning: Treatment of methanol or ethylene glycol poisoning alone or in combination with hemodialysis Peak effect: Maximum: 1.5-2 hours Half-Life Elimination Urine (1% to 3.5% as unchanged drug and metabolites) Onset of Action Hepatic to 4-carboxypyrazole (80% to 85% of dose), 4-hydroxymethylpyrazole, and their N-glucuronide conjugates following multiple doses, induces its own metabolism via CYP oxidases after 30-40 hours Excretion V d: 0.6-1.02 L/kg rapidly distributes into total body water Metabolism Pharmacokinetics/Pharmacodynamics Absorption

Formic acid is responsible for metabolic acidosis and visual disturbances. Methanol is metabolized to formaldehyde, then oxidized to formic acid. Glycolate and oxalate are responsible for metabolic acidosis and renal damage. Ethylene glycol is metabolized to glycoaldehyde, then oxidized to glycolate, glyoxylate, and oxalate.

Fomepizole competitively inhibits alcohol dehydrogenase, an enzyme which catalyzes the metabolism of ethanol, ethylene glycol, and methanol to their toxic metabolites.