Ethanol and fomepizole are used as antidotes for poisoning with ethylene glycol or methanol. Both ethylene glycol and methanol are metabolized by the enzyme alcohol dehydrogenase. Ethanol is a substrate for alcohol dehydrogenase and fomepizole is an inhibitor of this enzyme. This review pays attention to the differences between ethanol and fomepizole. The advantages and disadvantages of both antidotes are reviewed. Some authors claim fomepizole may prove able to eliminate the need for haemodialysis in certain patient groups. This may only hold true if fomepizole treatment is started shortly after the intake of a relatively low quantity of a toxic alcohol. Contrary to many authors, it is our opinion that fomepizole will prove unable to obviate the need for haemodialysis. The use of haemodialysis in addition to treatment with the antidotes is described. Haemodialysis not only removes the toxic alcohol and its metabolites, but is also helpful in correcting the metabolic imbalance. Taking account of the low availability, the side effects, high costs, and limited registration of fomepizole, we believe that ethanol still is the antidote of choice for poisoning with ethylene glycol and methanol. Copyright © 2009, Nederlandse Vereniging voor Intensive Care. All Rights Reserved.