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Methanol Toxicity Medication

  • Author: Kalyani Korabathina, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
 
Updated: Mar 30, 2016
 

Medication Summary

Ethanol and fomepizole can be administered to delay methanol metabolism until the methanol is eliminated from the patient’s system (either naturally or with dialysis). These antidotes work via competitive inhibition; ethanol and fomepizole are metabolized by ADH, just as methanol is, but the enzyme has a higher affinity for both antidotes than it does for methanol. For example, the affinity of ADH for ethanol is 10-20 times greater than it is for methanol. The use of fomepizole is limited because of its high cost and lack of availability.[8]

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Antidotes, Other

Class Summary

These agents inhibit the toxic effects of methanol via competitive inhibition.

Ethanol

 

Ethanol is believed to compete with methanol for ADH, thus preventing metabolism of methanol to its toxic by-products. ADH has a 10- to 20-fold greater affinity for ethanol than for methanol. By slowing the degradation of methanol, ethanol is assumed to prevent the accumulation of high levels of formic acid.

The goal of ethanol therapy is to achieve an ethanol blood concentration of 100 mg/dL. At this level, ethanol is thought to become a competitive substrate for ADH and to be sufficient to block methanol metabolism.

Fomepizole/4-methylpyrazole (Antizol)

 

Fomepizole acts similarly to ethanol. It is a stronger competitive inhibitor of ADH and, in addition, does not cause hypoglycemia or sedation. Fomepizole is relatively easier to administer than ethanol. It does not require monitoring of serum concentrations.

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Contributor Information and Disclosures
Author

Kalyani Korabathina, MD Consulting Physician, North County Neurology Associates, Inc

Kalyani Korabathina, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society

Disclosure: Nothing to disclose.

Coauthor(s)

David Likosky, MD Director of Stroke Program, President of Medical Staff, Evergreen Hospital Medical Center

David Likosky, MD is a member of the following medical societies: American Academy of Neurology, American College of Physicians-American Society of Internal Medicine, American Heart Association

Disclosure: Nothing to disclose.

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cyberonics; Eisai; Lundbeck; Sunovion; UCB; Upsher-Smith<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cyberonics; Eisai; Glaxo Smith Kline; Lundbeck; Sunovion; UCB<br/>Received research grant from: Cyberonics; Lundbeck; Sepracor; Sunovion; UCB; Upsher-Smith.

Chief Editor

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS Professor Emeritus of Neurology and Psychiatry, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Neuroscience Director, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS is a member of the following medical societies: American College of International Physicians, American Heart Association, American Stroke Association, American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners Institute, National Association of Managed Care Physicians, American College of Physicians, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, Royal Society of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Nestor Galvez-Jimenez, MD, MSc, MHA Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida

Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society

Disclosure: Nothing to disclose.

Jonathan S Rutchik, MD, MPH Assistant Professor, Department of Occupational and Environmental Medicine, University of California at San Francisco

Jonathan S Rutchik, MD, MPH is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Occupational and Environmental Medicine, and Society of Toxicology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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