Fomepizole (4 methylpyrazole)

Fomepizole Brand Name– Antizol

What is Fomepizole

Fomepizole is a synthetic parenteral alcohol dehydrogenase inhibitor. It is the first treatment for ethylene glycol poisoning approved in the United States. Ethylene glycol is a highly toxic component of antifreeze, brake fluids, and automotive coolants.

Based on clinical studies, fomepizole effectively blocks formation of toxic ethylene glycol metabolites responsible for metabolic acidosis and renal damage seen in ethylene glycol poisoning.

Final FDA approval was granted on December 8, 1997 for treatment of ethylene glycol poisoning.

A subsequent approval was granted by the FDA for treatment of methanol poisoning on December 11, 2000.

Indications

  • ethylene glycol poisoning
  • methanol poisoning

For the treatment of ethylene glycol poisoning or methanol poisoning, either alone or in combination with hemodialysis

Side Effects

  1. abdominal pain
  2. agitation
  3. anemia
  4. anorexia
  5. anuria
  6. anxiety
  7. back pain
  8. blurred vision
  9. bradycardia
  10. diarrhea
  11. disseminated intravascular coagulation (DIC)
  12. dizziness
  13. drowsiness
  14. dyspepsia
  15. eosinophilia
  16. fever
  17. flushing
  18. headache
  19. hiccups
  20. hypotension
  21. injection site reaction
  22. metallic taste
  23. nausea
  24. nystagmus
  25. pharyngitis
  26. phlebitis
  27. pyrosis (heartburn)
  28. rash
  29. seizures
  30. sinus tachycardia
  31. vertigo
  32. visual impairment
  33. vomiting

Monitoring Parameters

  • arterial blood gases (ABGs)
  • ECG
  • EEG
  • plasma ethylene glycol
  • serum creatinine/BUN
  • serum electrolytes
  • urinalysis
  • urinary ethylene glycol
  • urinary oxylate crystals
  • WBC

Contraindications

  • breast-feeding
  • children
  • geriatric
  • pregnancy
  • renal disease
  • renal impairment

Interactions

  • Carbamazepine
  • Cimetidine
  • Ethanol
  • Ketoconazole
  • Phenytoin
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