Dimethyl sulfoxide: Difference between revisions

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{{Chembox new
{{DrugProjectFormSinglePage
|authorTag={{Ammu}}
|genericName=Dimethyl sulfoxide
|aOrAn=an
|drugClass=[[anti inflammatory]]
|indicationType=treatment
|indication=symptomatic relief of patients with [[interstitial cystitis]]
|adverseReactions=[[garlic breath]], [[garlic taste]], chemical [[cystitis]]
|blackBoxWarningTitle=<span style="color:#FF0000;">ConditionName: </span>
|blackBoxWarningBody=<i><span style="color:#FF0000;">ConditionName: </span></i>
 
* Content
 
<!--Adult Indications and Dosage-->
 
<!--FDA-Labeled Indications and Dosage (Adult)-->
|fdaLIADAdult=* Dimethyl sulfoxide is indicated for the symptomatic relief of patients with [[interstitial cystitis]]. Dimethyl sulfoxide has not been approved as being safe and effective for any other indication.
* There is no clinical evidence of effectiveness of dimethyl sulfoxide in the treatment of [[bacterial infections]] of the urinary tract.
* Instillation of 50 mL of dimethyl sulfoxide directly into the bladder may be accomplished by catheter or aseptic syringe and allow to remain for 15 minutes. Application of an analgesic lubricant gel such as [[lidocaine]] jelly to the [[urethra]] is suggested prior to insertion of the catheter to avoid spasm. The medication is expelled by spontaneous voiding. It is recommended that the treatment be repeated every two weeks until maximum symptomatic relief is obtained. Thereafter, time intervals between therapy may be increased appropriately.
* Administration of oral analgesic medication or suppositories containing belladonna and opium prior to the instillation of dimethyl sulfoxide can reduce bladder spasm.
* In patients with severe interstitial cystitis with very sensitive bladders, the initial treatment, and possibly the second and third (depending on patient response) should be done under [[anesthesia]]. (Saddle block has been suggested).
* Instillation of 50 mL of dimethyl sulfoxide directly into the bladder may be accomplished by catheter or asepto syringe and allow to remain for 15 minutes. Application of an analgesic lubricant gel such as lidocaine jelly to the [[urethra]] is suggested prior to insertion of the catheter to avoid spasm. The medication is expelled by spontaneous voiding. It is recommended that the treatment be repeated every two weeks until maximum symptomatic relief is obtained. Thereafter, time intervals between therapy may be increased appropriately.
|offLabelAdultGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of dimethyl sulfoxide in adult patients.
|offLabelAdultNoGuideSupport=* Injection site extravasation
|fdaLIADPed=There is limited information regarding <i>FDA-Labeled Use</i> of {{PAGENAME}} in pediatric patients.
|offLabelPedGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Non–Guideline-Supported Use (Pediatric)-->
|offLabelPedNoGuideSupport=There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Contraindications-->
|contraindications=* None known.
|warnings=* Dimethyl sulfoxide can initiate the liberation of histamine and there has been occasional hypersensitivity reaction with topical administration of dimethyl sulfoxide. This hypersensitivity has been reported in one patients receiving intravesical dimethyl sulfoxide. The physician should be cognizant of this possibility in prescribing . If anaphylactoid symptoms develop, appropriate therapy should be instituted.
|clinicalTrials=There is limited information regarding <i>Clinical Trial Experience</i> of {{PAGENAME}} in the drug label.
|postmarketing=* Dimethyl sulfoxide can initiate the liberation of histamine and there has been occasional hypersensitivity reaction with topical administration of dimethyl sulfoxide.
* This hypersensitivity has been reported in one patients receiving intravesical RIMSO-50®. The physician should be cognizant of this possibility in prescribing dimethyl sulfoxide. If anaphylactoid symptoms develop, appropriate therapy should be instituted.
|drugInteractions=
<!--Use in Specific Populations-->
|FDAPregCat=C
|useInPregnancyFDA=* '''Pregnancy Category'''
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''
 
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
|useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.
 
<!--Administration and Monitoring-->
|administration=* [[Intravesical instillation]]
|monitoring=There is limited information regarding <i>Monitoring</i> of {{PAGENAME}} in the drug label.
 
* Description
 
<!--IV Compatibility-->
|IVCompat=There is limited information regarding <i>IV Compatibility</i> of {{PAGENAME}} in the drug label.
 
<!--Overdosage-->
|overdose=* The oral LD50 of dimethyl sulfoxide in the dog is greater than 10 gm/kg. It is improbable that this dosage level could be obtained with intravesical instillation of dimethyl sulfoxide in the patient.
* In case of accidental oral ingestion, specific measures should be taken to induce emesis. Additional measures which may be considered are gastric lavage, activated charcoal and force diuresis.
|drugBox={{Chembox2
|  Name = Dimethyl sulfoxide
|  Name = Dimethyl sulfoxide
|  ImageFile = DMSO-2D-dimensions.png
|  ImageFile = DMSO-2D-dimensions.png
Line 47: Line 113:
   }}
   }}
}}
}}
{{SI}}
|mechAction=<!--Structure-->
|structure=RIMSO-50®(dimethyl sulfoxide) (DMSO) 50% w/w Aqueous Solution for intravesical instillation.


Each mL contains 0.54 gm dimethyl sulfoxide STERILE AND NON-PYROGENIC.


==Overview==
Intravesical instillation for the treatment of interstitial cystitis.
'''Dimethyl sulfoxide''' (DMSO) is the [[chemical compound]] with the [[chemical formula|formula]] (CH<sub>3</sub>)<sub>2</sub>SO. This colorless liquid is an important [[polar solvent|polar]] [[aprotic solvent]] that dissolves both polar and nonpolar compounds and is miscible in a wide range of organic solvents as well as water.  It has a distinctive property of penetrating the skin very readily, allowing the handler to taste it. Its taste has been described as [[oyster]]- or [[garlic]]-like.


==Production==
NOT FOR INTRAMUSCULAR OR INTRAVENOUS INJECTION.
Dimethyl sulfoxide is a by-product of [[wood pulp]]ing. One of the leading suppliers of DMSO is the [[Gaylord Chemical Corporation]] in the [[USA]].
* The active component of the compound is dimethyl sulfoxide which has the empirical formula C2H6OS, and is structurally represented as:
: [[File:Dimethylsulfoxide.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
* Dimethyl sulfoxide is a clear, colorless and essentially odorless liquid which is miscible with water and most organic solvents. Other physical characteristics include: molecular weight 78.13, melting point 18.3° C, and a specific gravity of 1.096.


==Applications==
<!--Pharmacodynamics-->
===Solvent===
|PD=There is limited information regarding <i>Pharmacodynamics</i> of {{PAGENAME}} in the drug label.
DMSO is an important [[polar aprotic solvent]].  It is less toxic than other members of this class such as [[dimethylformamide]], [[dimethylacetamide]], [[Methylpyrrolidone|''N''-methyl-2-pyrrolidone]], [[Hexamethylphosphoramide|HMPA]].  Because of its excellent solvating power, DMSO is frequently used as [[solvent]] for chemical reactions involving salts. Its polarity accelerates reactions with charged transition states, such as [[SN2|S<sub>N</sub>2]] alkylations of indoles and [[phenols]].  Because DMSO is only weakly acidic, it tolerates relatively strong bases.  A practical problem with DMSO as a solvent is its high boiling point, thus its solutions are not typically evaporated.  Instead, reactions conducted in DMSO are often diluted with water to isolate organic products.  DMSO is an effective [[paint stripper]], being safer than many of the others such as [[nitromethane]] and [[dichloromethane]].


In its [[deuterium|deuterated]] form, i.e. [[Deuterated DMSO|DMSO-d<sub>6</sub>]], it is a useful but expensive solvent for [[Nuclear magnetic resonance|NMR]] spectroscopy, again due to its ability to dissolve a wide range of  analytes and its own simple spectrum. Disadvantages to the use of DMSO-d<sub>6</sub> are its high viscosity, which broadens signals, and high boiling point, which interferes with sample recovery from the NMR solvent.  Often it is used with [[deuterated chloroform|deuterochloroform]], because the 1:1 mixture has a low viscosity.
<!--Pharmacokinetics-->
|PK=* Dimethyl sulfoxide is metabolised in man by oxidation to dimethyl sulfone or by reduction to dimethyl sulfide. Dimethyl sulfoxide and dimethyl sulfone are excreted in the urine and feces.  
* Dimethyl sulfide is eliminated through the breath and skin and is responsible for the characteristic odor from patients on dimethyl sulfoxide medication. Dimethyl sulfone can persist in serum for longer than two weeks after a single intravesical instillation. No residual accumulation of dimethyl sulfoxide has occurred in man or lower animals who have received treatment for protracted periods of time. Following topical application, dimethyl sulfoxide is absorbed and generally distributed in the tissues and body fluids.
|nonClinToxic=There is limited information regarding <i>Nonclinical Toxicology</i> of {{PAGENAME}} in the drug label.


===Reactions===
<!--Clinical Studies-->
The sulfur center in DMSO is nucleophilic toward soft electrophiles and the oxygen is nucleophilic toward hard electrophiles.  The methyl groups of DMSO are somewhat acidic in character (p''K''<sub>a</sub>=35) due to the stabilization of the resultant [[carbanion]] by the S(O)R group.
|clinicalStudies=There is limited information regarding <i>Clinical Studies</i> of {{PAGENAME}} in the drug label.


DMSO reacts with [[methyl iodide]] to form a sulfoxonium salt [(CH<sub>3</sub>)<sub>3</sub>SO]I, which can be deprotonated with [[sodium]] [[hydride]] to form the [[sulfur]] [[ylide]]:
<!--How Supplied-->
:(CH<sub>3</sub>)<sub>2</sub>SO  +  CH<sub>3</sub>I  &rarr;  [(CH<sub>3</sub>)<sub>3</sub>SO]I
|howSupplied=*Vials contain 50 mL of sterile and non-pyrogenic dimethyl sulfoxide (50% w/w dimethyl sulfoxide aqueous solution).
:[(CH<sub>3</sub>)<sub>3</sub>SO]I  +  NaH  &rarr; [(CH<sub>3</sub>)<sub>2</sub>CH<sub>2</sub>SO  +  NaI  +  H<sub>2</sub>
* Dimethyl sulfoxide is clear and colorless.
* NDC 67457-177-50
* Carton containing a 50 mL vial
|storage=* Store at 20° to 25°C (68° to 77°F)
|packLabel=<!--Patient Counseling Information-->
|fdaPatientInfo=* Dimethyl sulfoxide is a sterile solution of 50% dimethyl sulfoxide (DMSO) and 50% water that has been approved by the U.S. Food and Drug Administration for use in the symptomatic relief of patients with interstitial cystitis.
* Dimethyl sulfoxide will be instilled in the bladder on an inpatient or out-patient basis, which will be determined by your physician.
* Some data indicate that dimethyl sulfoxide could change the effectiveness of medication(s) that you may be presently receiving. Be sure to mention the name and dosage of all medicines you are taking to your physician before a dimethyl sulfoxide instillation.
* A garlic-like taste may be noted by the patient within a few minutes after instillation of dimethyl sulfoxide. This taste may last several hours. An odor on the breath and skin may be present and remain for up to 72 hours.
* Some patients may experience discomfort on administration of the drug. Usually this becomes less prominent with repeated administration.
* If you are pregnant or nursing, ask your physician about the advisability of using RIMSO-50®.
* Some eye changes have been observed in animals treated with DMSO in large doses for prolonged periods. Therefore your doctor may want you to have eye evaluations, including slit lamp examinations prior to and periodically during treatment.
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


In [[organic synthesis]], DMSO is used as an oxidant,<ref>{{cite journal|author= Epstein W.W., Sweat F.W.|title=Dimethyl Sulfoxide Oxidations|journal= [[Chemical Reviews]]|year= 1967| volume= 67|pages= 247-260|doi=10.1021/cr60247a001}}</ref> such as the [[Pfitzner-Moffatt oxidation]] and the [[Swern oxidation]].<ref>{{cite journal | author= Tidwell, T.T. | title=Oxidation of Alcohols by Activated Dimethyl Sulfoxide and Related Reactions: An Update | journal= Synthesis | year= 1990 | volume = 1990 | pages=857-870 | doi=10.1055/s-1990-27036}}</ref>
<!--Brand Names-->
|brandNames=* RIMSO-50®<ref>{{Cite web | title =RIMSO-50- dimethyl sulfoxide irrigant  | url =http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=58b25d79-78f2-4953-b0c6-61658dc4ef0d  }}</ref>


Products of [[ozonolysis]], [[trioxolane]]s, are quenched with [[dimethyl sulfide]] to produce [[aldehyde]]s and DMSO.
<!--Look-Alike Drug Names-->
 
|drugShortage=
===Biology===
}}
DMSO is used in the [[PCR reaction]] to inhibit [[Polymerase chain reaction#Hairpins|secondary structures]] in the DNA template or the DNA primers. It is added to the PCR mix before reacting, where it interferes with the self-complementarity of the DNA, allowing otherwise troublesome reactions to occur. However, use of DMSO in PCR increases the [[mutation]] rate.
{{LabelImage
 
|fileName=Dimethyl sulfoxide.jpg
DMSO also sees use as a [[cryoprotectant]], added to cell media in order to prevent the cells dying as they are frozen. Approximately 10% may be used with a slow-freeze method, and the cells may be frozen at -20°C or stored in [[liquid nitrogen]] safely.
}}
 
{{LabelImage
===Medicine===
|fileName=DailyMed - RIMSO-50- dimethyl sulfoxide irrigant  (1).png
In [[cryobiology]] DMSO has been used as a [[cryoprotectant]] and is still an important constituent of cryoprotectant [[vitrification]] mixtures used to preserve organs, tissues, and cell suspensions. Without it, up to 90 percent of frozen cells will become inactive. It is particularly important in the freezing and long-term storage of [[embryonic stem cells]] and [[hematopoietic stem cell]]s, which are often frozen in a mixture of 10% DMSO and 90% fetal calf [[blood plasma|serum]]. As part of an autologous [[bone marrow transplant]] the DMSO is re-infused along with the patient's own [[hematopoietic stem cell]]s.
}}
 
<!--Pill Image-->
Use of DMSO in medicine dates from around [[1963]], when a [[University of Oregon]] Medical School team, headed by [[Stanley Jacob]], discovered it could penetrate the skin and other membranes without damaging them and could carry other compounds into a biological system.


In a 1978 study at the [[Cleveland Clinic]] Foundation in [[Cleveland, Ohio]], researchers concluded that DMSO brought significant relief to the majority of the 213 patients with inflammatory [[genitourinary]] disorders that were studied. They recommended [[DMSO]] for all inflammatory conditions not caused by infection or tumor in which symptoms were severe or patients failed to respond to conventional therapy.


Some people report an onion- or garlic-like taste after touching DMSO. ([[Onion]] and [[garlic]] also derive their stinginess from sulfoxides [[syn-propanethial-S-oxide]] and [[allicin]].) In the medical field DMSO is predominantly used as a topical [[analgesic]], a vehicle for topical application of pharmaceuticals, as an [[anti-inflammatory]] and an [[antioxidant]]. It has been examined for the treatment of numerous conditions and ailments. The [[Food and Drug Administration]] (FDA) has approved DMSO usage only for the [[palliative]] treatment of [[interstitial cystitis]]. Also, DMSO is commonly used in the veterinary field as a [[liniment]] for horses.


Because DMSO increases the rate of absorption of some compounds through organic [[Biological tissue|tissues]] including [[skin]], it can be used as a drug delivery system.
<!--Label Display Image-->


Dimethyl sulfoxide dissolves a variety of organic substances, including [[carbohydrate]]s, [[polymer]]s, [[peptide]]s, as well as many inorganic salts and gases. Loading levels of 50-60 wt.% are often observed vs 10-20 wt.% with typical solvents.  For this reason DMSO plays a role in sample management and [[High-throughput screening]] operations in drug design.<ref>{{cite journal | author=Balakin, K. V., Savchuk, N. P., Tetko I. V. | journal=Current Medicinal Chemistry | year=2006 | volume= 13 | issue=2 | pages 223-41 | title=In silico approaches to prediction of aqueous and DMSO solubility of drug-like compounds: trends, problems and solutions) | doi=10.2174/092986706775197917}}</ref>


====History in Medicine====
On September 9, 1965, the ''Wall Street Journal'' reported the death of an Irish woman after undergoing DMSO treatment for a sprained wrist <ref> Carley W. DMSO May Have Caused Death of Woman, Makers of 'Wonder' Drug Warn Doctors.  Wall Street Journal. September 9, 1965:6.</ref> Clinical research using DMSO halted and did not begin again until the National Academy of Sciences (NAS) published findings in favor of DMSO in 1972. In 1978, the FDA approved DMSO for treating interstitial cystis.  In 1980, Congress held hearings on claims that the FDA was slow in approving DMSO for other medical uses.  In 2007, the FDA granted "fast track" designation on clinical studies of DMSO's use in reducing brain tissue swelling following traumatic brain injury.


==Safety==
MSDS recommends wearing safety glasses because DMSO can cause chronic damage to the eyes.<ref>{{cite web | publisher = [[Oxford University]] | title = Safety data for methyl sulfoxide | url = http://ptcl.chem.ox.ac.uk/MSDS/ME/methyl_sulfoxide.html}}</ref> Glove selection is also important when working with DMSO. Thick rubber gloves are recommended, and nitrile gloves, which are very commonly used in chemical laboratories, have been found to dissolve rapidly with exposure to DMSO.<ref>{{cite web | publisher = [[Cornell University]] | title = Chemical Hygiene Plan | url = http://www.ehs.cornell.edu/geneva/chp/11.glove.selec.htm | date = September 99}}</ref> Because DMSO easily penetrates the skin, substances dissolved in DMSO may be quickly absorbed.  For instance, a solution of [[sodium cyanide]] in DMSO can cause [[cyanide]] poisoning through skin contact. DMSO by itself has low toxicity.<ref>Vignes, Robert (August 2000). [http://www.gaylordchemical.com/bulletins/Vignes-ACS.pdf Dimethyl Sulfoxide (DMSO): A "new" clean, unique, superior solvent], American Chemical Society Annual Meeting</ref>  Dimethyl sulfoxide can produce an explosive reaction when exposed to acid chlorides; at a low temperature, this reaction produces the oxidant for [[Swern oxidation]].


Recently, it was found that DMSO waste disposal into [[sewers]] can cause environmental odor problems in cities: Waste water bacteria transform DMSO under [[hypoxic]] (anoxic) conditions into [[dimethyl sulfide]] (DMS) that is slightly toxic and has a strong disagreeable odor, similar to rotten cabbage.<ref>{{cite journal
|author= Glindemann, D., Novak, J., Witherspoon, J.
|title= Dimethyl Sulfoxide (DMSO) Waste Residues and Municipal Waste Water Odor by Dimethyl Sulfide (DMS): the North-East WPCP Plant of Philadelphia.
|journal= Environmental Science and  Technology
|year= 2006
| volume = 40
| issue = 1
|pages=202-207
|doi=10.1021/es051312a S0013-936X(05)01312-X }}
</ref>


==See also==
<!--Category-->
*[[Methylsulfonylmethane]] (MSM), a related chemical often used as a dietary supplement
* [[Dimethyl sulfate]] (DMS), a [[mutagenic]] [[alkylation|alkylating]] compound
 
==References==
{{Reflist|2}}
 
{{Urologicals}}
{{Topical products for joint and muscular pain}}


[[Category:Drug]]


[[Category:Solvents]]
[[Category:Solvents]]
[[Category:Sulfoxides]]
[[Category:Sulfoxides]]
[[de:Dimethylsulfoxid]]
[[es:Dimetil sulfóxido]]
[[fr:Diméthylsulfoxyde]]
[[it:Dimetilsolfossido]]
[[he:דימתיל סולפוקסיד]]
[[nl:Dimethylsulfoxide]]
[[ja:ジメチルスルホキシド]]
[[pl:Dimetylosulfotlenek]]
[[ru:Диметилсульфоксид]]
[[fi:Dimetyylisulfoksidi]]
[[sv:Dimetylsulfoxid]]
[[zh:二甲基亞碸]]
{{WH}}
{{WS}}
{{jb1}}

Latest revision as of 20:01, 18 August 2015

Dimethyl sulfoxide
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Disclaimer

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Overview

Dimethyl sulfoxide is an anti inflammatory that is FDA approved for the treatment of symptomatic relief of patients with interstitial cystitis. Common adverse reactions include garlic breath, garlic taste, chemical cystitis.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

  • Dimethyl sulfoxide is indicated for the symptomatic relief of patients with interstitial cystitis. Dimethyl sulfoxide has not been approved as being safe and effective for any other indication.
  • There is no clinical evidence of effectiveness of dimethyl sulfoxide in the treatment of bacterial infections of the urinary tract.
  • Instillation of 50 mL of dimethyl sulfoxide directly into the bladder may be accomplished by catheter or aseptic syringe and allow to remain for 15 minutes. Application of an analgesic lubricant gel such as lidocaine jelly to the urethra is suggested prior to insertion of the catheter to avoid spasm. The medication is expelled by spontaneous voiding. It is recommended that the treatment be repeated every two weeks until maximum symptomatic relief is obtained. Thereafter, time intervals between therapy may be increased appropriately.
  • Administration of oral analgesic medication or suppositories containing belladonna and opium prior to the instillation of dimethyl sulfoxide can reduce bladder spasm.
  • In patients with severe interstitial cystitis with very sensitive bladders, the initial treatment, and possibly the second and third (depending on patient response) should be done under anesthesia. (Saddle block has been suggested).
  • Instillation of 50 mL of dimethyl sulfoxide directly into the bladder may be accomplished by catheter or asepto syringe and allow to remain for 15 minutes. Application of an analgesic lubricant gel such as lidocaine jelly to the urethra is suggested prior to insertion of the catheter to avoid spasm. The medication is expelled by spontaneous voiding. It is recommended that the treatment be repeated every two weeks until maximum symptomatic relief is obtained. Thereafter, time intervals between therapy may be increased appropriately.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of dimethyl sulfoxide in adult patients.

Non–Guideline-Supported Use

  • Injection site extravasation

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

There is limited information regarding FDA-Labeled Use of Dimethyl sulfoxide in pediatric patients.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Dimethyl sulfoxide in pediatric patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Dimethyl sulfoxide in pediatric patients.

Contraindications

  • None known.

Warnings

  • Dimethyl sulfoxide can initiate the liberation of histamine and there has been occasional hypersensitivity reaction with topical administration of dimethyl sulfoxide. This hypersensitivity has been reported in one patients receiving intravesical dimethyl sulfoxide. The physician should be cognizant of this possibility in prescribing . If anaphylactoid symptoms develop, appropriate therapy should be instituted.

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Clinical Trial Experience of Dimethyl sulfoxide in the drug label.

Postmarketing Experience

  • Dimethyl sulfoxide can initiate the liberation of histamine and there has been occasional hypersensitivity reaction with topical administration of dimethyl sulfoxide.
  • This hypersensitivity has been reported in one patients receiving intravesical RIMSO-50®. The physician should be cognizant of this possibility in prescribing dimethyl sulfoxide. If anaphylactoid symptoms develop, appropriate therapy should be instituted.

Drug Interactions

There is limited information regarding Dimethyl sulfoxide Drug Interactions in the drug label.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): C

  • Pregnancy Category


Pregnancy Category (AUS):

  • Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Dimethyl sulfoxide in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Dimethyl sulfoxide during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Dimethyl sulfoxide with respect to nursing mothers.

Pediatric Use

There is no FDA guidance on the use of Dimethyl sulfoxide with respect to pediatric patients.

Geriatic Use

There is no FDA guidance on the use of Dimethyl sulfoxide with respect to geriatric patients.

Gender

There is no FDA guidance on the use of Dimethyl sulfoxide with respect to specific gender populations.

Race

There is no FDA guidance on the use of Dimethyl sulfoxide with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Dimethyl sulfoxide in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Dimethyl sulfoxide in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Dimethyl sulfoxide in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Dimethyl sulfoxide in patients who are immunocompromised.

Administration and Monitoring

Administration

Monitoring

There is limited information regarding Monitoring of Dimethyl sulfoxide in the drug label.

  • Description

IV Compatibility

There is limited information regarding IV Compatibility of Dimethyl sulfoxide in the drug label.

Overdosage

  • The oral LD50 of dimethyl sulfoxide in the dog is greater than 10 gm/kg. It is improbable that this dosage level could be obtained with intravesical instillation of dimethyl sulfoxide in the patient.
  • In case of accidental oral ingestion, specific measures should be taken to induce emesis. Additional measures which may be considered are gastric lavage, activated charcoal and force diuresis.

Pharmacology

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Template:Chembox header2 | Dimethyl sulfoxide
Identifiers
3D model (JSmol)
ECHA InfoCard Lua error in Module:Wikidata at line 879: attempt to index field 'wikibase' (a nil value). Lua error in Module:Wikidata at line 879: attempt to index field 'wikibase' (a nil value).
Properties
C2H6OS
Molar mass 78.13 g/mol
Hazards
Related compounds
Template:Chembox header2 | Except where noted otherwise, data are given for
materials in their standard state
(at 25 °C, 100 kPa)
Infobox disclaimer and references

Mechanism of Action

There is limited information regarding Dimethyl sulfoxide Mechanism of Action in the drug label.

Structure

RIMSO-50®(dimethyl sulfoxide) (DMSO) 50% w/w Aqueous Solution for intravesical instillation.

Each mL contains 0.54 gm dimethyl sulfoxide STERILE AND NON-PYROGENIC.

Intravesical instillation for the treatment of interstitial cystitis.

NOT FOR INTRAMUSCULAR OR INTRAVENOUS INJECTION.

  • The active component of the compound is dimethyl sulfoxide which has the empirical formula C2H6OS, and is structurally represented as:
This image is provided by the National Library of Medicine.
  • Dimethyl sulfoxide is a clear, colorless and essentially odorless liquid which is miscible with water and most organic solvents. Other physical characteristics include: molecular weight 78.13, melting point 18.3° C, and a specific gravity of 1.096.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Dimethyl sulfoxide in the drug label.

Pharmacokinetics

  • Dimethyl sulfoxide is metabolised in man by oxidation to dimethyl sulfone or by reduction to dimethyl sulfide. Dimethyl sulfoxide and dimethyl sulfone are excreted in the urine and feces.
  • Dimethyl sulfide is eliminated through the breath and skin and is responsible for the characteristic odor from patients on dimethyl sulfoxide medication. Dimethyl sulfone can persist in serum for longer than two weeks after a single intravesical instillation. No residual accumulation of dimethyl sulfoxide has occurred in man or lower animals who have received treatment for protracted periods of time. Following topical application, dimethyl sulfoxide is absorbed and generally distributed in the tissues and body fluids.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Dimethyl sulfoxide in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Dimethyl sulfoxide in the drug label.

How Supplied

  • Vials contain 50 mL of sterile and non-pyrogenic dimethyl sulfoxide (50% w/w dimethyl sulfoxide aqueous solution).
  • Dimethyl sulfoxide is clear and colorless.
  • NDC 67457-177-50
  • Carton containing a 50 mL vial

Storage

  • Store at 20° to 25°C (68° to 77°F)

Images

Drug Images

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Package and Label Display Panel

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Patient Counseling Information

  • Dimethyl sulfoxide is a sterile solution of 50% dimethyl sulfoxide (DMSO) and 50% water that has been approved by the U.S. Food and Drug Administration for use in the symptomatic relief of patients with interstitial cystitis.
  • Dimethyl sulfoxide will be instilled in the bladder on an inpatient or out-patient basis, which will be determined by your physician.
  • Some data indicate that dimethyl sulfoxide could change the effectiveness of medication(s) that you may be presently receiving. Be sure to mention the name and dosage of all medicines you are taking to your physician before a dimethyl sulfoxide instillation.
  • A garlic-like taste may be noted by the patient within a few minutes after instillation of dimethyl sulfoxide. This taste may last several hours. An odor on the breath and skin may be present and remain for up to 72 hours.
  • Some patients may experience discomfort on administration of the drug. Usually this becomes less prominent with repeated administration.
  • If you are pregnant or nursing, ask your physician about the advisability of using RIMSO-50®.
  • Some eye changes have been observed in animals treated with DMSO in large doses for prolonged periods. Therefore your doctor may want you to have eye evaluations, including slit lamp examinations prior to and periodically during treatment.

Precautions with Alcohol

  • Alcohol-Dimethyl sulfoxide interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

There is limited information regarding Dimethyl sulfoxide Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. ↑ "RIMSO-50- dimethyl sulfoxide irrigant".

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