DIMETHYL SULFOXIDE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DIMETHYL SULFOXIDE (DIMETHYL SULFOXIDE).
Dimethyl sulfoxide (DMSO) is a polar aprotic solvent that penetrates biological membranes, scavenges hydroxyl radicals, and stabilizes lysosomal membranes. It has anti-inflammatory, analgesic, and cryoprotective properties. It enhances cutaneous absorption of other drugs and induces histamine release from mast cells, causing vasodilation and urticaria.
| Metabolism | DMSO is metabolized by oxidation via cytochrome P450 (CYP2E1) to dimethyl sulfone (DMSO2), and reduction to dimethyl sulfide (DMS). The reduction is mediated by gastrointestinal bacteria and possibly by thiol-dependent reductases. DMS is excreted via breath and skin, causing a garlic-like odor. |
| Excretion | Renal: 30-50% unchanged; hepatic metabolism to dimethyl sulfone (DMSO2) and dimethyl sulfide (DMS); DMSO2 excreted renally, DMS exhaled; fecal elimination <5%. |
| Half-life | Terminal half-life: 11-14 hours for DMSO; DMSO2 half-life 60-70 hours, accumulates with repeated dosing. Clinical context: renal impairment prolongs half-life. |
| Protein binding | Low to moderate (10-20%) primarily to albumin; not extensive. |
| Volume of Distribution | 0.7-1.2 L/kg; indicates distribution into total body water and penetration into tissues including brain, joints, and skin. |
| Bioavailability | Oral: 70-90%; topical: 10-20% systemic absorption (varies with vehicle and skin condition); intravenous: 100%. |
| Onset of Action | Topical: within 1-2 hours for analgesia; intravenous: immediate but variable (minutes) for anti-inflammatory effect; oral: 1-3 hours. |
| Duration of Action | Topical: 6-12 hours for local effect; systemic: 24-72 hours for anti-inflammatory effects, prolonged with renal impairment. |
50% solution topically applied every 6 hours; intravenous: 0.5-1 g/kg as a 10-20% solution over 30-60 minutes every 6 hours for 3-5 doses
| Dosage form | SOLUTION |
| Renal impairment | No specific guidelines; caution in severe renal impairment (CrCl <30 mL/min) due to potential accumulation of dimethyl sulfoxide metabolites; consider dose reduction or increased dosing interval |
| Liver impairment | No specific guidelines; contraindicated in Child-Pugh class C cirrhosis due to risk of hepatic encephalopathy; use with caution in Child-Pugh class A or B |
| Pediatric use | Not established for systemic use; topical: apply 50% solution every 6-8 hours as needed; intravenous: not recommended due to lack of safety data |
| Geriatric use | Start at low end of dosing range due to age-related decline in renal function; monitor renal function and adjust dose accordingly; avoid prolonged use |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DIMETHYL SULFOXIDE (DIMETHYL SULFOXIDE).
| Breastfeeding | Excretion into human milk is unknown. Due to potential for adverse effects in the nursing infant, caution is advised. No M/P ratio available. |
| Teratogenic Risk | Dimethyl sulfoxide (DMSO) is teratogenic in animal studies, causing fetal malformations at doses close to maternal toxic doses. Human data are insufficient. Risk cannot be excluded during the first trimester; use only if clearly needed and benefit outweighs potential fetal harm. |
| Fetal Monitoring |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
["Absolute: Known hypersensitivity to DMSO","Relative: Severe hepatic or renal impairment","Relative: Pregnancy (Category C) unless clearly needed","Relative: Concurrent use of drugs metabolized by CYP2E1 (potential interaction)"]
| Precautions | ["Hypersensitivity reactions: Urticaria, angioedema, and anaphylaxis reported.","Ocular toxicity: Corneal opacities with high systemic doses; protect eyes during topical use.","Renal effects: Nephrotoxicity with high doses; use caution in renal impairment.","Hepatic effects: Transaminase elevations reported.","Drug interactions: Enhances absorption of concomitant topical drugs; may alter warfarin metabolism via CYP2E1 inhibition.","Pregnancy: Category C; avoid use unless benefit outweighs risk.","Breastfeeding: Excreted in milk; caution advised.","Garlic-like body odor and taste due to DMS excretion; inform patients."] |
| Food/Dietary | Alcohol may cause disulfiram-like reaction (nausea, vomiting, flushing). No other known food interactions. |
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| Monitor for maternal hypersensitivity reactions, gastrointestinal disturbances, and skin reactions. Fetal monitoring should include ultrasound for growth and anatomy if used during pregnancy. |
| Fertility Effects | DMSO may impair fertility based on animal studies, but human data are lacking. Effects on spermatogenesis or ovarian function are not well characterized. |
| Clinical Pearls | Dimethyl sulfoxide (DMSO) is FDA-approved only for intravesical instillation in interstitial cystitis. Its absorption through skin can cause a garlic-like taste and breath odor. Avoid use in patients with significant hepatic or renal impairment. DMSO may enhance absorption of other drugs; caution with concurrent topical agents. |
| Patient Advice | You may experience a garlic-like taste or breath odor shortly after treatment; this is normal and temporary. · Report any new or worsening pain, skin rash, or allergic reactions to your healthcare provider. · Do not apply DMSO to skin unless specifically instructed, as it can carry other substances into the body. · Avoid alcohol consumption during treatment due to potential disulfiram-like reaction. |