Dimethyl Sulfoxide

(BAN, USAN, rINN)
Dimethyl Sulfoxide Chemical formula
Synonyms: Dimethyl Sulphoxide; Dimethyli Sulfoxidum; Dimethylis sulfoxidum; Dimethylsulfoxid; Diméthylsulfoxyde; Dimetil sulfóxido; Dimetilsulfoksidas; Dimetil-szulfoxid; Dimetylosulfotlenek; Dimetylsulfoxid; Dimetyylisulfoksidi; DMSO; Methyl Sulphoxide; NSC763; SQ-9453; Sulphinylbismethane.
Cyrillic synonym: Диметилсульфоксид.

💊 Chemical information

Chemical formula: C2H6OS = 78.13.
CAS — 67-68-5.
ATC — G04BX13; M02AX03.
ATC Vet — QG04BX13; QM02AX03.

Pharmacopoeias.

In Eur. and US.

Ph. Eur. 6.2

(Dimethyl Sulfoxide). A colourless hygroscopic liquid or crystals. F.p. not lower than 18.3°. Relative density 1.100 to 1.104. Miscible with water and with alcohol. Store in airtight glass containers. Protect from light.

USP 31

(Dimethyl Sulfoxide). A clear, colourless, odourless, hygroscopic liquid. M.p. about 18.4°. Sp. gr. 1.095 to 1.097. Soluble in water; practically insoluble in alcohol, in acetone, in chloroform, in ether, and in benzene. Store in airtight containers. Protect from light.

💊 Adverse Effects and Treatment

High concentrations of dimethyl sulfoxide applied to the skin may cause burning discomfort, itching, erythema, vesiculation, and urticaria. Continued use may result in scaling. Systemic effects, including gastrointestinal disturbances, drowsiness, headache, and hypersensitivity reactions, may occur after use by any route. A garlic-like odour on the breath and skin is attributed to the formation of dimethyl sulfide (see Pharmacokinetics, below). Intravascular haemolysis has followed intravenous use. Local discomfort and spasm may occur when given by bladder instillation. Treatment of adverse effects consists of symptomatic and supportive measures. Gastric lavage may be helpful after acute ingestion, although it should be remembered that absorption is rapid.
1. Brobyn RD. The human toxicology of dimethyl sulfoxide. Ann N Y Acad Sci 1975; 243: 497–506
2. Willhite CC, Katz PI. Toxicology updates: dimethyl sulfoxide. J Appl Toxicol 1984; 4: 155–60.
Infusion strengths greater than 10% were associated with grossly discoloured urine but there was no evidence of renal damage. In 2 patients, raised liver and muscle enzyme concentrations, mild jaundice, and evidence of haemolysis developed when given dimethyl sulfoxide intravenously for arthritis.2One also developed acute renal tubular necrosis, deterioration in level of consciousness, and evidence of cerebral infarction. Acute, reversible neurological deterioration in a patient has been associated with intravenous dimethyl sulfoxide.3 Adverse effects have also been reported in patients given haematopoietic stem cells cryopreserved in dimethyl sulfoxide. A patient with pre-existing diabetes insipidus4 developed serum hyperosmolality when given stem cells after chemotherapy for a malignant germ-cell tumour; symptoms included severe headache, confusion, and abdominal pain. Acute neurotoxicity has also been reported,5,6 although it appears to be rare;5 2 patients also had myocardial damage.6
1. Muther RS, Bennett WM. Effects of dimethyl sulfoxide on renal function in man. JAMA 1980; 244: 2081–3
2. Yellowlees P, et al. Dimethylsulphoxide-induced toxicity. Lancet 1980; ii: 1004–6
3. Bond GR, et al. Dimethylsulphoxide-induced encephalopathy. Lancet 1989; i: 1134–5
4. Thomé S, et al. Dimethylsulphoxide-induced serum hyperosmolality after cryopreserved stem-cell graft. Lancet 1994; 344: 1431–2
5. Mueller LP, et al. Neurotoxicity upon infusion of dimethylsulfoxide-cryopreserved peripheral blood stem cells in patients with and without pre-existing cerebral disease. Eur J Haematol 2007; 78: 527–31
6. Chen-Plotkin AS, et al. Encephalopathy, stroke, and myocardial infarction with DMSO use in stem cell transplantation. Neurology 2007; 68: 859–61.

💊 Precautions

When used as a penetrating basis for other drugs applied topically, dimethyl sulfoxide may enhance their toxic effects. Since dimethyl sulfoxide has been associated with lens changes in animals, licensed product information recommends assessment of ophthalmic function every 6 months during long-term treatment of cystitis with intravesical instillation of dimethyl sulfoxide. Hepatic and renal function should also be assessed at intervals of 6 months. Bladder instillation may be harmful in patients with urinary-tract malignancy because of vasodilatation.

💊 Interactions

💊 Pharmacokinetics

Dimethyl sulfoxide is readily absorbed by all routes. It is metabolised by oxidation to dimethyl sulfone and by reduction to dimethyl sulfide. Dimethyl sulfoxide and the sulfone metabolite are excreted in the urine and faeces. Dimethyl sulfide is excreted through the lungs and skin and is responsible for the characteristic odour from patients.

💊 Uses and Administration

Dimethyl sulfoxide is a highly polar substance with exceptional solvent properties for both organic and inorganic chemicals, and is widely used as an industrial solvent. It has been reported to have a wide spectrum of pharmacological activity including membrane penetration, anti-inflammatory effects, local analgesia, weak bacteriostasis, diuresis, vasodilatation, dissolution of collagen, and free-radical scavenging. The principal use of dimethyl sulfoxide is as a vehicle for drugs such as idoxuridine; it aids penetration of the drug into the skin, and so may enhance the drug’s effect. It is also used as a 50% aqueous solution for bladder instillation for the symptomatic relief of interstitial cystitis; doses of 50 mL are instilled and allowed to remain for 15 minutes. Treatment is repeated every 2 weeks initially. Dimethyl sulfoxide has been given orally, intravenously, or topically for a wide range of indications including cutaneous and musculoskeletal disorders, but evidence of beneficial effects is limited. Dimethyl sulfoxide is used as a cryoprotectant for various human tissues.

Amyloidosis.

Oral or local dimethyl sulfoxide has been tried1-3as part of the management of some forms of amyloidosis.
1. Ichida M, et al. Successful treatment of multiple myeloma-associated amyloidosis by interferon-alpha, dimethyl sulfoxide, and VAD (vincristine, adriamycin, and dexamethasone). Int J Hematol 2000; 72: 491–3
2. Malek RS, et al. Primary localized amyloidosis of the bladder: experience with dimethyl sulfoxide therapy. J Urol (Baltimore) 2002; 168: 1018–20
3. Amemori S, et al. Oral dimethyl sulfoxide for systemic amyloid A amyloidosis complication in chronic inflammatory disease: a retrospective patient chart review. J Gastroenterol 2006; 41: 444–9.

Cryopreservation.

Dimethyl sulfoxide is used as a cryoprotectant in various assisted conception techniques.1 Adverse effects have been reported in patients receiving haematopoietic stem cells cryopreserved in dimethyl sulfoxide (see under Adverse Effects, above).
1. Trounson AO. Cryopreservation. Br Med Bull 1990; 46: 695–708.

Extravasation of antineoplastics.

Several reports have suggested a role for topical dimethyl sulfoxide in the treatment of anthracycline extravasation.1-4
1. Lawrence HJ, Goodnight SH. Dimethyl sulfoxide and extravasation of anthracycline agents. Ann Intern Med 1983; 98: 1025
2. Olver IN, et al. A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation. J Clin Oncol 1988; 6: 1732–5
3. Rospond RM, Engel LM. Dimethyl sulfoxide for treating anthracycline extravasation. Clin Pharm 1993; 12: 560–1
4. Bertelli G, et al. Dimethylsulphoxide and cooling after extravasation of antitumour agents. Lancet 1993; 341: 1098.

Gallstones.

For mention of the use of a mixture containing dimethyl sulfoxide to dissolve gallstones, see Methyl tert-Butyl Ether.

Interstitial cystitis.

Bladder instillation of dimethyl sulfoxide is used1,2 in the symptomatic management of interstitial cystitis. Treatment usually consists of 50 mL of a 50% aqueous solution that is retained in the bladder for 15 minutes. This may be repeated every 1 to 2 weeks for 4 to 8 treatments, and overall response rates of 50 to 90% have been reported. Although relapse rates after a 4 to 8 week course of treatment are high (35 to 40%), about half of these patients will respond to additional dimethyl sulfoxide treatment. Maintenance therapy on either a regular or intermittent basis may be used.1
1. Parkin J, et al. Intravesical dimethyl sulfoxide (DMSO) for interstitial cystitis—a practical approach. Urology 1997; 49 (suppl 5A): 105–7
2. Rössberger J, et al. Critical appraisal of dimethyl sulfoxide treatment for interstitial cystitis: discomfort, side-effects and treatment outcome. Scand J Urol Nephrol 2005; 39: 73–7.
Published October 26, 2018.