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    Fomepizole Dosing

    Doses fomepizole for methanol and ethylene glycol reversal.
    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients suspected of toxic alcohol ingestion, to prevent formation of toxic metabolites.
    • Indications include ingestions of methanol, ethylene glycol, and diethylene glycol to stop metabolism of formic acid, oxalic acid, and diglycolic acid, respectively.
    • Fomepizole is not indicated for known isopropyl alcohol ingestions.
    • Fomepizole is safe in adults and children, and is a Category C drug in pregnancy (adverse fetal effects have been observed in animal studies but no adequate studies have been performed in humans, and potential benefits may warrant use).
    • Patients should be on telemetry and BP monitoring during infusion, as fomepizole can cause bradycardia and hypotension.  
    • After 48 hours, dose should be increased to 15 mg/kg every 12 hours as fomepizole induces its own metabolism.
    • If fomepizole is not available, ethanol can be given to block alcohol dehydrogenase.
    • While Anion Gap and Serum Osmolality/Osmolarity may help with decision making, normal anion gap and osmol gap do not exclude toxic alcohol ingestion.  
    • Patients with signs of end-organ damage from toxic alcohol should be referred for immediate hemodialysis in addition to fomepizole.
    • Lack of clinical intoxication cannot exclude toxic alcohol ingestion.

    Fomepizole is an alcohol dehydrogenase inhibitor used to prevent the formation of toxic metabolites formed after the ingestion of toxic alcohols.

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    Creator Insights
    Dr. Lewis Goldfrank

    About the Creator

    Lewis Goldfrank, MD, FACEP, FAAEM, FAACT, FACMT, FACP, is the Herbert W. Adams Professor of Emergency Medicine at New York University. He is also the medical director of the New York City Poison Control Center. Dr. Goldfrank is perhaps best known as author and editor of the primary toxicology reference Goldfrank's Toxicologic Emergencies.

    To view Dr. Lewis Goldfrank's publications, visit PubMed

    Are you Dr. Lewis Goldfrank? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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    About the Creator
    Dr. Lewis Goldfrank
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