ArticleClinical and experimental emergency medicine2026
The role of fomepizole in acetaminophen-related poisoning: a narrative review.
Article in Clinical and experimental emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
N-acetylcysteine (NAC) as the gold standard antidote in cases of acetaminophen (APAP)-related poisoning might not be sufficient with delayed presentation or massive ingestion. Human reports published up to July 2021 suggest that fomepizole could play a role in APAP overdoses by inhibiting cytochrome P450 2E1 (CYP2E1)-mediated N-acetyl-p-benzoquinone imine (NAPQI) production and JNK-mediated oxidative damage. This narrative review builds on previous systematic and scoping reviews by adding the latest evidence about the use of fomepizole in APAP poisoning to better understand the hepatoprotective role and safety profile of this medication, as well as its practical place in therapy. A systematic search of MEDLINE and Embase was completed through November 2024. Studies involving human patients with APAP toxicity who received fomepizole treatment were included. Each case was summarized in tables to identify clinical trends, particularly the risk of hepatotoxicity, quantity of ingestion, time of presentation since ingestion, therapeutic and dosing regimens, and clinical outcomes. This review covers 28 studies and 45 patients across 18 case reports and 6 case series. When used with NAC, fomepizole seemed to result in favorable laboratory and clinical outcomes in most patients at high risk of hepatotoxicity because of late presentation or massive APAP ingestion. The available data suggest that fomepizole might complement NAC in treating severe APAP toxicity. Though they lack detailed clinical outcome analyses, case studies suggest that fomepizole could improve hepatotoxicity, survival, and transplant-free days.
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