What are the medicinal uses of DMSO (Dimethyl Sulfoxide)?

Medicinal Uses of DMSO (Dimethyl Sulfoxide)

DMSO is FDA-approved only for the symptomatic relief of patients with interstitial cystitis, but has several evidence-based off-label uses including treatment of chemotherapy extravasation, particularly for anthracyclines, mitomycin C, and platinum salts. 1, 2

FDA-Approved Use

• DMSO is marketed as RIMSO-50® (50% w/w aqueous solution) for intravesical instillation in the treatment of interstitial cystitis 1
• It is not approved for intramuscular or intravenous injection 1
• There is no clinical evidence supporting DMSO's effectiveness in treating bacterial urinary tract infections 2

Evidence-Based Off-Label Uses

Chemotherapy Extravasation Management

• DMSO is recommended as a topical treatment option for extravasations occurring during anthracyclines, mitomycin C, or platinum salts infusion [Level III, B evidence] 3
• Application protocol:
  • 99% DMSO applied at four drops per 10 cm² of skin surface over the affected area 3
  • Left to air dry without dressing 3
  • Repeated every 8 hours for 1 week 3
  • Should be administered within the first 10 minutes after extravasation for optimal effect 3
• Clinical evidence:
  • A series of 144 patients treated with DMSO after chemotherapy extravasation showed only 1 patient developed ulceration 3
  • In 84% of cases, DMSO was applied within 10 minutes of extravasation 3

Other Potential Medical Applications

• Skin conditions:

  • Cutaneous manifestations of scleroderma may resolve following topical applications of high concentrations of DMSO 4, 5
  • Shows promise in off-label treatment of pressure ulcers, herpes simplex, and cutaneous fungal infections 5

• Pain management:

  • Provides rapid, temporary relief of pain in patients with arthritis and connective tissue injuries when applied topically 4
  • Functions as a topical analgesic 6

• Other applications:

  • Used as a cryopreservative for stem cells 7
  • May have benefits in treatment of amyloidosis by mobilizing amyloid deposits from tissues 4, 5
  • Has shown anti-angiogenic effects by suppressing matrix metalloproteinase-2 production 8

Mechanism of Action

• DMSO is an amphipathic molecule with both polar and apolar domains, making it soluble in both aqueous and organic media 6
• It has several pharmacological properties:
  • Free-radical scavenging properties 3, 6
  • Penetrates tissue when applied topically 3
  • Speeds up removal of extravasated drugs from tissues 3
  • At low concentrations, exhibits anti-inflammatory, analgesic, vasodilator, and muscle-relaxing properties 5
  • Functions as a hydrogen-bond disrupter and cell-differentiating agent 6

Adverse Effects

• Adverse reactions are common but usually minor and concentration-dependent 4
• Most common adverse effects:
  • Gastrointestinal reactions (nausea, vomiting, diarrhea) 7, 6
  • Skin reactions (rash, pruritus) after dermal application 7, 4
  • Local erythema which may affect evaluation of tissue damage 3
  • Characteristic garlic-like breath odor 7
• More serious but rare adverse effects:
  • Intravascular hemolysis after intravenous infusion 4, 6
  • Cardiovascular effects (hypertension, bradycardia, heart block) 6
  • Respiratory issues (bronchospasm, pulmonary edema) 6

Important Considerations for Use

• DMSO should be used at the lowest effective concentration to minimize adverse effects 4
• When used as a solvent for laboratory or experimental purposes:
  • Should not exceed 5 ml/kg or 10% of injected volume 3
  • For animal studies, organic solvent portion should not exceed 10% 3
• Safety of DMSO in combination with other drugs has not been fully established; neurotoxic interactions with sulindac have been reported 4
• DMSO enhances diffusion of other chemicals through the skin, which can be beneficial for drug delivery but also increases risk of toxicity 4

Cautions

• DMSO at 99% concentration can cause local erythema which may affect proper evaluation of tissue damage 3
• There is no evidence that DMSO can alter progression of degenerative joint disease, so it should be considered for palliative treatment only 4
• Most clinical trials of DMSO have lacked rigorous experimental design necessary for objective evaluation of efficacy 4