Internal DMSO Use: Approved Applications and Physiological Effects
The only FDA-approved internal use of DMSO is for interstitial cystitis/bladder pain syndrome via intravesical instillation, where it provides anti-inflammatory and analgesic effects through multiple mechanisms including hydroxyl radical scavenging and membrane penetration. 1
FDA-Approved Internal Applications
Interstitial Cystitis Treatment
- DMSO is administered via bladder instillation specifically for interstitial cystitis/bladder pain syndrome and should not be confused with intravesical chemotherapy for bladder cancer 2
- The drug is metabolized through oxidation to dimethyl sulfone or reduction to dimethyl sulfide, with excretion occurring through urine, feces, breath, and skin 1
- Dimethyl sulfone can persist in serum for longer than two weeks after a single intravesical instillation, though no residual accumulation occurs with protracted treatment 1
Stem Cell Cryopreservation
- DMSO serves as a cryoprotective agent for stem cell preservation, representing a critical internal medical application 3, 4
Mechanisms of Physiological Action
Anti-Inflammatory Properties
- At low concentrations, DMSO suppresses pro-inflammatory cytokines, chemokines, and prostaglandin E2 production 5
- The drug inhibits ERK1/2, p38, JNK, and Akt phosphorylation pathways, which are central to inflammatory cytokine production 5
- DMSO acts as a vigorous hydroxyl free radical scavenger, contributing to its anti-inflammatory effects 6, 4
Membrane Penetration and Drug Potentiation
- DMSO readily penetrates and diffuses through biological membranes due to its amphipathic molecular structure with both polar and apolar domains 4
- When mixed with other drugs, DMSO potentiates their physiologic effects, allowing smaller doses and reduced toxicity—particularly valuable in cancer chemotherapy 7
- As a hydrogen-bond disrupter, DMSO facilitates the movement of other drugs through membranes 4
Additional Pharmacological Effects
- The drug exhibits analgesic, diuretic, vasodilator, anti-platelet aggregation, radioprotective, and muscle-relaxing properties at therapeutic concentrations 6
- DMSO functions as a cell-differentiating agent and intracellular cholesterol mobilizing agent 4
Critical Safety Considerations and Monitoring
Mandatory Surveillance Requirements
- Full eye evaluations including slit lamp examinations are required prior to treatment and every six months during therapy, as lens changes and opacities have been documented in animal studies 1
- Biochemical screening every six months must include liver function tests, renal function tests, and complete blood counts 1
Dose-Dependent Adverse Reactions
- A clear relationship exists between DMSO dose and adverse reaction occurrence, with most reactions being transient and mild 3
- The therapeutic window is narrow: 0.5-2% DMSO provides anti-inflammatory effects, but 2% concentration causes significant monocyte viability reduction 5
- For animal studies and formulation guidance, organic solvent portions should not exceed 10% of injected volume 8
Common Adverse Effects
- Gastrointestinal and skin reactions are the most frequently reported adverse events 3
- Systemic side effects include nausea, vomiting, diarrhea, hemolysis, rashes, renal failure, hypertension, bradycardia, heart block, pulmonary edema, cardiac arrest, and bronchospasm 4
- The characteristic odor from dimethyl sulfide elimination through breath and skin is expected 1
Important Clinical Pitfalls
Contraindications and Warnings
- DMSO may be harmful to patients with urinary tract malignancy due to induced vasodilation 1
- The drug should be used during pregnancy only if potential benefits justify fetal risks, as teratogenic responses occurred in animal studies at high doses 1
- Caution is warranted in nursing mothers, as excretion in human milk is unknown 1
Drug Interactions
- DMSO potentiates concomitantly administered medications, requiring dose adjustments of other drugs 1