American academy of clinical toxicology practice guidelines on the treatment of ethylene glycol poisoning

Fomepizole (4-methylpyrazole, 4-MP, Antizol(TM)) is a potent inhibitor of a lcohol dehydrogenase that was approved recently by the US Food and Drug Adm inistration (FDA) for the treatment of ethylene glycol poisoning, Although ethanol is the traditional antidote for ethylene glycol poisoning, it has n ot been studied prospectively, Furthermore, the FDA has not approved the us e of ethanol for this purpose, Case reports and a prospective case series i ndicate that the intravenous (IV) administration of fomepizole every 12 hou rs prevents renal damage and metabolic abnormalities associated with the co nversion of ethylene glycol to toxic metabolites, Currently, there are insu fficient data to define the relative role of fomepizole and ethanol in the treatment of ethylene glycol poisoning, Fomepizole has clear advantages ove r ethanol in terms of validated efficacy, predictable pharmacokinetics, eas e of administration, and lack of adverse effects, whereas ethanol has clear advantages over fomepizole in terms of longterm clinical experience and ac quisition cost, The overall comparative cost of medical treatment using eac h antidote requires further study.