DIMETHYL SULFOXIDE

DIMETHYL SULFOXIDE
(dye-meth'il sul-fox'ide)
DMSO, Rimso-50
Classifications: antiinflammatory, local;
Therapeutic: topical antiinflammatory

Pregnancy Category: C

Availability

50% solution

Action

Reported effects include antiinflammatory effects, membrane penetration, collagen dissolution, vasodilation, muscle relaxation, diuresis, initiation of histamine release at administration site, cholinesterase inhibition.

Therapeutic Effect

Has symptomatic relief of interstitial cystitis with local antiinflammatory properties.

Uses

Symptomatic treatment of interstitial cystitis.

Unlabeled Uses

Topical treatment of a variety of musculoskeletal disorders, arthritis, scleroderma, tendinitis, breast and prostate malignancies, retinitis pigmentosa, herpesvirus infections, head and spinal cord injuries, shock, and as a carrier to enhance penetration and absorption of other drugs. Also used to protect living cells and tissues during cold storage (cryo-protection). Widely used as an industrial solvent and in veterinary medicine for treatment of musculoskeletal injuries.

Contraindications

Urinary tract malignancy; pregnancy (category C), lactation. Safe use in children is not established.

Cautious Use

Hepatic or renal dysfunction.

Route & Dosage

Interstitial Cystitis
Adult: Instillation 50 mL of 50% solution instilled slowly into urinary bladder and retained for 15 min; may repeat q2wk until maximum relief obtained, then increase intervals between treatments

Administration

Instillation
  • Apply analgesic lubricant such as lidocaine jelly to urethra to facilitate insertion of catheter.
  • Instruct patient to retain instillation for 15 min and then expel it by spontaneous voiding.
  • Note: Discomfort associated with instillation usually lessens with repeated administration. Physician may prescribe an oral analgesic or suppository containing belladonna and an opiate prior to instillation to reduce bladder spasm.
  • Store at 15°–30° C (59°–86° F) unless otherwise directed. Protect from strong light. Avoid contact with plastics.

Adverse Effects (≥1%)

Special Senses: Transient disturbances in color vision, photophobia. GI: Nausea, diarrhea. Hypersensitivity: Local or generalized rash, erythema, pruritus, urticaria, swelling of face, dyspnea (anaphylactoid reaction). Other: Nasal congestion, headache, sedation, drowsiness. Following instillation: Garlic-like odor on breath and skin; garlic-like taste; discomfort during administration; transient cystitis. Following topical application: Vesicle formation.

Interactions

Drug: Decreases effectiveness of sulindac, possibly causing severe peripheral neuropathy.

Pharmacokinetics

Absorption: Readily absorbed systemically. Peak: 4–8 h. Distribution: Widely distributed in tissues and body fluids; penetrates blood–brain barrier; distributed into breast milk. Metabolism: Metabolized to dimethyl sulfide (garlic breath) and dimethyl sulfone. Elimination: Dimethyl sulfide excreted through lungs and skin; dimethyl sulfone may remain in serum >2 wk and is excreted in urine and feces.

Nursing Implications

Assessment & Drug Effects

  • Lab tests: Do CBC and liver and renal function tests initially and at 6-mo intervals.
  • Do complete eye evaluation including slit-lamp examination prior to and at regular intervals during therapy.

Patient & Family Education

  • Note: Garlic-like taste may be experienced within minutes after drug instillation and may last for several hours. Garlic-like odor on breath and skin may last as long as 72 h.
  • Do not use OTC topical medications without consulting physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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