Methanol Toxicity Medication

  • Author: Kalyani Korabathina, MD; Chief Editor: Tarakad S Ramachandran, MBBS, FRCP(C), FACP   more...
 
Updated: Feb 3, 2012
 

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.[5]

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Antidotes, Other

Class Summary

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

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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.

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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 and American Epilepsy Society

Disclosure: Nothing to disclose.

Coauthor(s)

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 Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

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, and American Heart Association

Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, FRCP(C), FACP  Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine

Disclosure: Abbott Labs None None; Teva Marion None None; Boeringer-Ingelheim Honoraria Speaking and teaching

Additional Contributors

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

References

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  17. LoVecchio F, Sawyers B, Thole D, et al. Outcomes following abuse of methanol-containing carburetor cleaners. Hum Exp Toxicol. Oct 2004;23(10):473-5. [Medline].

  18. Sharma R, Marasini S, Sharma AK, Shrestha JK, Nepal BP. Methanol Poisoning: Ocular and Neurological Manifestations. Optom Vis Sci. Nov 28 2011;[Medline].

 
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