Methanol poisoning antidote - Fomepizole or ethanol?

Report By: Margaret Maloba - Specialist Registrar
Institution: Manchester Royal Infirmary
Date Submitted: 17th September 2004
Last Modified: 17th September 2004
Status: Blue (submitted but not checked)

Three Part Question

In [patients with methanol poisoning] is [fomepizole better than ethanol] in the [reduction of toxic effects]?

Clinical Scenario

A 26 year old man presents to your department having injested methanol. He appears intoxicated, has vomited and has abdominal pain. You wonder if fomepizole would be a better antidote than ethanol at preventing further toxicity.

Search Strategy

Medline plus 1966-09/2004 using the Ovid interface.
[(formepizole.mp OR 4MP.mp OR antizol.mp OR 4-methylepyrazole.mp) AND (exp ethanol OR ethanol.mp OR ethyl alcohol.mp) AND (Antifreeze OR Methanol)] LIMIT to human AND English language.

Search Outcome

26 references were found of which two were clinical trials. Neither addressed the question.

Comment(s)

Methanol poisoning is relatively uncommon, therefore few studies have been done on this subject. Fomepizole has been claimed to have a longer duration of action and better reduction in toxicity than ethanol when used as an antidote in methanol poisoning.

Clinical Bottom Line

There is no evidence to date comparing effectiveness of fomepizole versus ethanol for treatment of methanol poisoning.