Friday May 7, 2010


Case: 25 year old male is admitted to ICU with severe ethylene glycol toxicity. Patient is intubated and in severe acidosis. Hemodialysis is initiated to enhance elimination of ethylene glycol. Pharmacy call you with info. that they have located Fomepizole and now its available for patient. What adjustment in dosing is required for Fomepizole in patients already on "HD"?



Answer: Fomepizole is significantly (50-70%) removed through hemodialysis. Standard dose is loading dose of 15 mg/kg followed by 10 mg/kg every 12 hours for 4 doses and then 15 mg/kg every 12 hours until ethylene glycol levels fall below 20 mg/dl. In patient already on dialysis, reduction of the interval between doses to 4-6 hours is recommended or to just start drip with infusion rate of 1-1.5 mg/kg/hour.

The cost of Fomepizole per vial is around $1000, and therefore is not widely stocked in most hospital pharmacy. One vial contains 1500 mg of fomepizole.