Fomeprazole -- oral doses of fomeprazole via alcohol dehydrogenase inhibition significantly reduced
                elimination of fomeprazole

Ethanol- ethanol decreased elimination of fomeprazole

Ethylene Glycol or methanol poisoning

Adverse reactions -   headache 14%      nausea 11%   dizziness. increased drowsiness and
                                    bad taste/metallic taste 6%

Cardiovascular-       sinus bradycardia, bradycardia, tachycardia, phelebitis, shock,
                                    hypotension, phebosclerosis

CNS-                           seizure, vertigo, lightheadedness, nystagmus, agitation,  facial flush,
                                    anxiety, feeling of drunkeness, strange feeling, decreased enviromental
                                    awareness

GI-                              vomiting, diarrhea, dyspepsia, decreased appetite, transcient aminitis,
                                    heartburn

Hematologic/lymphatic -    lymphangitis,   eosinophillia, hyperesionophillia,
                                              disseminated  coagulated , anemia

Respiratory -               hiccups.  blurred vision

Special senses-          abnormal smell, speech /visual disturbances, roar in the ear,
                                     transcient  blurred vision.

Miscellaneous-          abdominal pain, fever, multiorgan system failure, pain during
                                    fomeprazole injection, inflammation at injection site,
                                    anuria,  lumbalgia/backache, hangover, rash, application site reaction.

Serious hypersensitivity reactions to fomepizole or other pyrazoles.

Special precautions-
Administration- do not give fomeprazole undiluted or by bolus injection .
Venous irritation and phlesclerosis occurred  in few patients

Allergic reactions- minor allergic reactions ( mild rash. eosinophillia) have been reported.
Monitor patients for allergic reactions

Pregnancy-  give to pregnant women only if clearly needed

Lactation-  exercise caution when fomepizole is administered to a breast feeding woman.

Children-  safety  and efficacy have not been established.

Elderly-  safety and effectiveness in elderly patients have not been established

Monitoring-  patients intoxicated with ethylene glycol and methanol must be managed for
metabolic acidosis, acute renal failure, ( ethylene glyol) adult respiratory distress syndrome,
visual disturbances ( methanol ) and hypocalcemia. fluid therapy and sodium bicarbonate
administration are  potential supportive therapies.

Potassium and calcium supplementation and oxygen administration are usually necessary.

Monitor serum methanol concentration in patients poisoned with methanol.

Indication-
Ethylene Glycol or methanol poisoning

Dosage-
Administer  a loading dose of 15mg/kg followed by doses of 10mg/kg  every 12 hours for 4 doses,
then 15mg/kg every 12 hours thereafter until ethylene  glycol or methanol concentrations are
indetectable or have reduced to less than 20mg/mg/dL and the patient is asymptomatic with
 normal pH.

Administer all doses as a slow IV infusion to over 30 minutes.  

Pharmacology-
Fomepizole is a competetive inhibitor of alcohlol dehydogenase that catalyses the oxidation
of ethanol to acetyaldehde. Alcohol dehydrogenase also catalyses the initial steps in the
metabolism of ethylene glycol and methanol and their toxic metabolites.

Pregnancy- 
Give to pregnant women only if clearly needed

Lactation- 
Exercise caution when fomepizole is administered to a breast feeding woman.

Children- 
Safety  and efficacy have not been established.

Elderly- 
Safety and effectiveness in elderly patients have not been established