fomepizole (Rx)

Brand and Other Names:Antizol
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 1.5g/1.5mL
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Methanol & Ethylene Glycol Poisoning

Load 15 mg/kg IV infusion over 30 min, THEN 

10 mg/kg IV q12hr for 4 doses, THEN increase to 15 mg/kg q12hr

Maintain serum level of 8.6-24.6 mg/L

Treat until ethylene glycol or methanol levels are <20 mg/dL

Dialysis may also be required

Renal Impairment

Dialyzable: Yes

Follow dose recommendations for those not on hemodialysis (see above) at intervals appropriate for patients on hemodialysis schedule/duration

Dose at beginning of hemodialysis

  • If <6 hr since last fomepizole dose: Do not administer the next dose
  • If ≥6 hr since last fomepizole dose: Proceed with administering next fomepizole dose

Dose during hemodialysis

  • Administer q4hr or as continuous IV infusion (1-1.5 mg/kg/hr)

Dose when hemodialysis is completed

  • <1 hr: Do not administer
  • 1-3 hr: Give 50% of next scheduled dose
  • >3 hr: Administered next scheduled dose

Maintenance dose following hemodialysis

  • Administer next scheduled dose 12 hr following last administered dose

Dosage Forms & Strengths

injectable solution

  • 1.5g/1.5mL
more...

Methanol & Ethylene Glycol Poisoning (Off-label)

Loading dose: 15 mg/kg IV, THEN

10 mg/kg IV q12hr for 4 doses, THEN

15 mg/kg IV q12hr until ethylene glycol or methanol levels reduce to <20 mg/dL

Renal Impairment

Dialyzable: Yes

Follow dose recommendations for those not on hemodialysis (see above) at intervals appropriate for patients on hemodialysis schedule/duration

Dose at beginning of hemodialysis

  • If <6 hr since last fomepizole dose: Do not administer the next dose
  • If ≥6 hr since last fomepizole dose: Proceed with administering next fomepizole dose

Dose during hemodialysis

  • Administer q4hr or as continuous IV infusion (1-1.5 mg/kg/hr)

Dose when hemodialysis is completed

  • <1 hr: Do not administer
  • 1-3 hr: Give 50% of next scheduled dose
  • >3 hr: Administered next scheduled dose

Maintenance dose following hemodialysis

  • Administer next scheduled dose 12 hr following last administered dose
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Adverse Effects

>10%

Headache (14%)

Nausea (11%)

1-10%

Bad/metallic taste (6%)

Dizziness (6%)

Drowsiness (6%)

Venous irritation

Transient elevations in LFTs (AST)

Backache

Nystagmus

Fever

Abdominal pain

<1%

Rash

Eosinophilia

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Pregnancy & Lactation

Pregnancy Category: C

Lactation: excretion in milk unknown; use with caution

Pregnancy Categories

A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA:Information not available.

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Pharmacology

Mechanism of Action

Inhibits alcohol dehydrogenase, which catalyzes the metabolism of ethanol, methanol and ethylene glycol; has no effect upon CNS or need for monitoring levels (like EtOH currently)

Pharmacokinetics

Onset of action: 1.5-2 hr

Vd: 0.6-1.02 L/kg

Excretion: Urine

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Administration

IV Preparation

Dilute in at least 100 mL of NS or D5W

Use within 24 hr

Storage

Inj concentrate solidifies if kept <25°C. Solidification & rethawing (in hand or water bath) does not affect efficacy, safety or stability.

Diluted solution is stable for at least 24 hr when stored at 20-25°C or refrigerated at 2-8°C

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Formulary

FormularyPatient Discounts

Adding plans allows you to compare formulary status to other drugs in the same class.

To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

Adding plans allows you to:

  • View the formulary and any restrictions for each plan.
  • Manage and view all your plans together – even plans in different states.
  • Compare formulary status to other drugs in the same class.
  • Access your plan list on any device – mobile or desktop.

The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC NOT COVERED – Drugs that are not covered by the plan.
Code Definition
PA Prior Authorization
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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