Dimethyl Sulfoxide Advanced Drug Monograph

Dimethyl Sulfoxide

• Name: Dimethyl Sulfoxide
• Name (English): Dimethyl Sulfoxide
• DrugBank ID: DB01093
• Type: Small Molecule
• CAS Number: 67-68-5

Pharmacology:

• Mechanism of Action: Multiple mechanisms including membrane penetration, membrane transport, effects on connective tissue, anti-inflammation, nerve blockade (analgesia), bacteriostasis, diuresis, enhancement or reduction of the effectiveness of other substances, induction of differentiation of malignant cells, radioprotective and cryoprotective actions, and protection against ischemic injury. It can also modulate cell membrane structure and properties, scavenge free radicals, and influence signal transduction pathways and gene expression.
• Therapeutic Uses: Treatment of interstitial cystitis (intravesical administration). Topical use (not always FDA-approved) for pain relief, accelerating healing of wounds, burns, muscle and skeletal injuries, and treating conditions like osteoarthritis and rheumatoid arthritis. Also used to prevent soft tissue damage from IV chemotherapeutic agents (topical).

Pharmacokinetics:

• Absorption: Well absorbed topically and rapidly penetrates tissues.
• Metabolism: Oxidized to dimethyl sulfone and reduced to dimethyl sulfide.
• Excretion: Urine and feces (as unchanged drug and dimethyl sulfone), with some elimination via skin and lungs (dimethyl sulfide).

Side Effects:

• Common: Garlic-like taste in the mouth, garlic odor on breath and skin, bladder pain or discomfort.
• Less Common/Serious: Rash, blistering, burning, redness, scaling, hives, itching, swelling of the face, lips, tongue, or throat, shortness of breath, dizziness, nausea, vomiting, headache, nasal congestion, vision changes, severe dizziness, altered heart rate, chest pain, confusion, slurred speech, weakness, loss of coordination, fever, tremors, severe eye or heart symptoms. Anaphylaxis and severe infusion reactions can occur.

Contraindications:

• No absolute contraindications listed in the manufacturer's labeling for intravesical use.
• Warnings/Precautions: Use with caution in patients with urinary tract malignancy (may cause vasodilation), and potential risk of eye lens opacity (periodic eye exams recommended). Not for IV or IM use (intravesical use only). Use with caution during pregnancy and lactation.

Drug Interactions:

• Avoid combination: Dexrazoxane (may diminish dexrazoxane efficacy).
• Monitor therapy: Sulindac (may reduce plasma concentration of dimethyl sulfoxide and has reportedly caused peripheral neuropathy; may enhance sulindac neurotoxicity and decrease its metabolism); Verteporfin (concomitant use reduces verteporfin efficacy).

Chemical Properties:

• Molecular Formula: $\text{C}_2\text{H}_6\text{OS}$
• Molecular Weight: 78.13 g/mol
• Appearance: Colorless liquid, essentially odorless or with a slight odor of sulfur, garlic, or oysters.
• Melting Point: 16-19 °C
• Boiling Point: 189 °C
• Density: 1.10 g/mL at 20 °C
• Solubility: Miscible in water and many organic solvents (but not diethyl ether).
• Polarity: Highly polar, aprotic solvent.
• Hygroscopic: Readily absorbs water.

Note: This report provides a general overview. Always consult the prescribing information and a healthcare professional for specific medical advice and treatment. Industrial and veterinary grade DMSO products should not be used by humans due to unknown purity.