Alcohol Toxicity Medication

Updated: Jan 26, 2023
  • Author: Michael D Levine, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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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.

B vitamins (ie, folic acid, pyridoxine, thiamine) may be useful in selected cases to reduce the toxicity of alcohol metabolites.


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.

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.


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.

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.


B Vitamins

Class Summary

In ethylene glycol poisoning, thiamine and pyridoxine shunt metabolism of glyoxylic acid away from oxalate and favor the formation of less toxic metabolites. In patients with ethanol-related hypoglycemia, especially those who are malnourished or alcoholics, pretreatment with thiamine may be necessary.

Thiamine (Vitamin B1)