Fomepizole Is Safe and Effective for Methanol Poisoning

Fomepizole (4-methylpyrazole) has been advocated as the treatment of choice for methanol poisoning, but there have been few published trials evaluating its clinical effectiveness. Fomepizole inhibits alcohol dehydrogenase, preventing metabolism of methanol into the toxic metabolite, formic acid. Ethanol is traditionally used, but side effects, a narrow therapeutic range, and the need for close patient monitoring make it suboptimal. This observational, manufacturer-supported study describes 11 consecutive patients who were treated with fomepizole.

All patients had a serum methanol concentration above 20 mg/dL or a strong suspicion of methanol ingestion and 2 of the following: arterial pH below 7.3, serum bicarbonate less than 20 mm/L, or seru…