Generic Name:

Fomepizole

Trade Name:

Antizol

Action:

Competitively inhibits alcohol dehydrogenase anenzyme that catalyzes metabolism of ethanol, ethylene glycol, methanol to their toxic metabolites.

Indication:

Treatment of methanol, propylene glycol or ethylene glycol poisoning alone or in combination with hemodialysis; begin fomepizole therapy immediately upon suspicion of ingestion.

Administrative Guidelines:

DO NOT BOLUS! MUST DILUTE PRIOR TO USE to prevent phlebosclerosis, vein irritation.  All doses should be administered IV over 30 minutes

Usual dose and route:

1. Load: 15mg/kg in 100mL D5W or NS administer IV over 30 minutes,
2. Then: 10mg/kg in 250mL D5W or NS administer IV every 12 hours over 30 minutes x 4 doses.
3. Then: 15 mg/kg in 250 mL D5W or NS IV every 12 hours until ethylene glycol plasma, or methanol, level is <20mg/dL, or until pt asymptomatic with normal pH

Patients requiring hemodialysis page unit pharmacist for dosing.

Standard Concentration

Loading dose: mix in 100mL of D5W or NS

10mg/kg doses place in 250 mL D5W or NS

15 mg/kg doses place in 250 mL D5W or NS

*******MAX CONCENTRATION 25MG/ML*************

Critical Elements/ Special Considerations:

•  Page toxicology resident on call, beeper number 21827

•  If drug solidifies in vial, carefully warm vial under warm water or hold in hand.

•  Fomepizole and ethanol should NOT be used concurrently; ethanol decreases rate of fomepizole elimination by ~50%; fomepizole decreases ethanol rate of elimination by ~40%.

•  Monitor: fomepizole levels, ethylene glycol or methanol levels, osmolality, renal/hepatic function, serum electrolytes, anion/osmolar gaps, arterial blood gases

Precaution and Side Effects

•  Use with caution in patients with renal and/or hepatic impairment

•  Bradycardia, tachycardia, hypotension

•  Venous irritation/phlebosclerosis

•  Seizure

•  Minor allergic reactions-rash

•  Eosinophilia, lymphangitis, anemia,

•  Headache, nausea, diarrhea, hiccups, pharyngitis

•  Dizziness, feeling of drunkenness

Revised 05-09