Table 5.

Comparison of fomepizole and ethanol in treatment of toxic alcohol ingestionsa

CompoundAdvantagesDisadvantages
Fomepizole
  1. High affinity for alcohol dehydrogenase (approximately 500 to 1000 times more than ethanol)

  2. Effective at relatively low serum concentrations

  3. Minimal adverse effects

  4. No effect of mentation that could confuse interpretation of clinical course

  5. Constant monitoring of blood levels not necessary

  6. Hospitalization in intensive care unit not necessary

  7. No increase in serum osmolality, allowing this to be used as surrogate for toxic alcohol levels in following response to treatment

  1. Not available in all clinical settings

  2. Expensive, approximately $5000 per 48-h course of therapy

  3. Intravenous preparation only available in United States

  4. Only formally approved by FDA for treatment of methanol and ethylene glycol intoxication

Ethanol
  1. Inexpensive

  2. Available in most clinical settings

  3. Can be given intravenously or orally

  1. Lower affinity for alcohol dehydrogenase than fomepizole

  2. Needs relatively high serum concentrations, approximately 100 mg/dl, to completely saturate the enzyme

  3. Requires constant monitoring of blood levels and possibly that of toxic alcohol

  4. Hospitalization in ICU necessary during treatment

  5. Increases serum osmolality, which can prevent effective use of serum osmolality to monitor response to therapy

  6. Impairs mentation, which can confuse interpretation of response to therapy

  • a FDA, Food and Drug Administration.