Brent J, McMartin K, Phillips S, Aaron C, Kulig K, Fomepizole for the Treatment of Methanol Poisoning. New England Journal of Medicine 2001; 344:424-429

This prospective, multicenter clinical trial examined the effectiveness of fomepizole for the treatment of methanol poisoning in 11 consecutive patients with serum methanol concentrations greater than 20 mg/dL. Eight patients had measurable plasma formic acid concentrations on presentation, which were inversely related to serum pH. Seven patients had visual abnormalities. Following initiation of fomepizole treatment, formic acid concentrations fell with simultaneous improvement in plasma pH, visual disturbances and other symptoms related to the ingestion. Seven patients also underwent hemodialysis. The authors suggested that hemodialysis may not be necessary in cases where patients are not acidotic and are receiving fomepizole, but may be warranted in patients with high serum methanol concentrations to prevent lengthy hospital stays. The investigators concluded fomepizole is safe and effective for the treatment of methanol poisoning.

Baud F, Barron S. An Open-label Study for Patients Treated with Fomepizole for Methanol Poisoning in France (unpublished).

In this French trial, five patients were evaluated for acute methanol poisoning. On presentation, plasma methanol concentrations ranged from 10-425.6 mg/dL. The patient with the highest methanol concentration presented 12-24 hours post-ingestion with a pH of 7.26. He was treated with fomepizole as well as hemodialysis but, because of the severity of the intoxication and the length of time which elapsed prior to seeking help, the patient suffered bilateral blindness. The remaining patients presented with normal pH, received fomepizole therapy only and survived without sequellae. These investigators concluded that fomepizole is a safe and effective antidote for the treatment of methanol poisoning.