To the Editor:
We read with great interest Megarbane et al.’s report of their series of patients treated successfully with oral fomepizole after ethylene glycol and methanol poisoning. Our results of nearly identical pharmacokinetics after both intravenous and oral routes of administration in volunteers is now augmented by demonstration of the effectiveness in mildly poisoned patients. This is encouraging news. We agree that further studies need to be undertaken in severely poisoned patients to evaluate the efficacy of oral administration. We also agree that oral fomepizole provides many advantages, especially in the pediatric population after questionable exposure to toxic alcohols or in other scenarios such as mass poisonings.
In our study, we noted reports of poor palatability. Megarbane et al. do not describe similar issues, and we propose that perhaps there is a difference either because of the type of salt form or perhaps there was an incompatibility with the fruit juice used in our study.
Megarbane et al. supply us with information demonstrating the efficacy of oral fomepizole for toxic alcohol-poisoned patients that correlates well with our experimental data and suggests that the oral route is an option for antidote administration when treating these patients. The positive potential beneficial utility of oral administration demonstrated by both of these reports underscores the urgent need for further study and the need to develop a more palatable dosage form.