Alcohol dehydrogenase inhibitor

Blocks the first step of toxic-alcohol metabolism

Competitive ADH inhibition stops methanol → formic acid and ethylene glycol → oxalate
The PARENT alcohols are barely toxic; the metabolites blind (formate) and destroy kidneys (oxalate)
➔ fomepizole (ANTIZOL) — 4-methylpyrazole; first-line antidote
Ethanol works the same way (ADH affinity), used when fomepizole is unavailable
Buy time for hemodialysis; give until osmolar gap and acidosis clear

Drugs with this mechanism (1)

Fomepizole — Alcohol-dehydrogenase inhibitor and preferred antidote for methanol or ethylene-glycol poisoning.

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