Alcohol dehydrogenase inhibitor
Blocks the first step of toxic-alcohol metabolism
- Prevents methanol/ethylene glycol from being activated to their toxic acids — the antidote mechanism
- The parent alcohols are far less toxic than their metabolites
- 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
- Given early, dialysis may be avoided
- 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.
Self-check
- Why does alcohol dehydrogenase inhibition treat methanol or ethylene glycol poisoning?
Prevents formation of toxic acids. - What alternative is described when fomepizole is unavailable?
Ethanol.
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