Fomepizol for APAP

CRITICALCARENOW

FOMEPIZOLE: NOT JUST FOR TOXIC ALCOHOL TOXICITY

CriticalCareNow- By Ruben Santiago - March 25, 2021

“The Debrief:

• Acetaminophen overdose is a common presentation to the emergency department
• NAC is the only FDA approved agent for APAP overdose and works primarily by providing GSH stores to detoxify NAPQI
• There are instances when, despite therapy with NAC, hepatotoxicity still occurs
• Fomepizole inhibits NAPQI through CYP2E1 inhibition and prevents further hepatotoxicity through JNK inhibition
• For massive APAP overdoses, fomepizole may be considered as an adjunct to NAC to combat hepatotoxicity 
• Always consult your poison control center at 1-800-222-1222 when these patients present”