Alcohol Toxicity Medication

  • Author: Michael D Levine, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Mar 12, 2012
 

Medication Summary

Fomepizole (eg, 4-methylpyrizole, 4-MP, Antizol) has greater affinity for alcohol dehydrogenase than ethanol or methanol and has a considerably better safety profile than ethanol. Fomepizole has been approved by the US Food and Drug Administration (FDA) for ethylene glycol poisoning, but it is also useful for managing methanol poisoning.

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Pharmacologic antidotes

Class Summary

These agents prevent formation of toxic metabolites in methanol ingestions (not useful with isopropanol or ethanol ingestions). Therapy generally is maintained until methanol levels are less than 20 mg/dL.

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Fomepizole (4-MP, Antizol)

 

DOC for ethylene glycol and methanol poisoning because of ease of administration and better safety profile than ethanol. Inhibitor of alcohol dehydrogenase. In contrast to ethanol, 4-MP levels do not require monitoring during therapy.

Begin fomepizole treatment immediately upon suspicion of methanol/ethylene glycol ingestion based on the patient's history or anion gap metabolic acidosis, increased osmolar gap, oxalate crystals in the urine, or a documented serum methanol/ethylene glycol level. Adjust dosing during hemodialysis; see package insert.

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Ethanol

 

Has 10-20 times greater affinity for enzyme alcohol dehydrogenase than methanol does, blocking production of toxic metabolites.

Believed to inhibit ADH when serum levels exceed 0.05 g/dL (50 mg/dL). Titration to serum levels between 0.10 g/dL (100 mg/dL) and 0.15 g/dL (150 mg/dL) typically used.

Measure patient's initial blood level. May be administered PO/IV.

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Folic acid (Folvite)

 

Adjunctive agent in methanol ingestion. Member of vitamin B-complex that may enhance elimination of toxic metabolite formic acid produced when methanol is metabolized. Useful in methanol and possibly ethylene glycol toxicity. Leucovorin (folinic acid) is active form of folate and may be substituted for folic acid.

Folic acid should be administered for several days to enhance folate-dependent metabolism of formic acid to carbon dioxide and water.

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Contributor Information and Disclosures
Author

Michael D Levine, MD  Physician, Department of Medical Toxicology, Banner Good Samaritan Medical Center; Physician, Department of Emergency Medicine, Banner Thunderbird Medical Center

Michael D Levine, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, Emergency Medicine Residents Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Tobias D Barker, MD  Attending Physician, Department of Emergency Medicine; Director, Harvard Medical School Dubai Center Simulation Center

Tobias D Barker, MD is a member of the following medical societies: American College of Emergency Physicians, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey Glenn Bowman, MD, MS  Consulting Staff, Highfield MRI

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD  Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

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  18. Lepik KJ, Levy AR, Sobolev BG, Purssell RA, DeWitt CR, Erhardt GD. Adverse drug events associated with the antidotes for methanol and ethylene glycol poisoning: a comparison of ethanol and fomepizole. Ann Emerg Med. Apr 2009;53(4):439-450.e10. [Medline].

 
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