Extravasation management, anthracyclines or mitomycin: Limited data available: Children and Adolescents: Topical dimethyl sulfoxide: Apply to a region covering twice the affected area every 8 hours for 7 days; begin within 10 minutes of extravasation; do not cover with a dressing (Ref).
(For additional information see "Dimethyl sulfoxide: Drug information")
Extravasation management (anthracyclines, mitomycin, or mitoxantrone; off-label use): Topical dimethyl sulfoxide: Apply to a region covering twice the affected area every 8 hours for 7 days. Begin within 10 minutes of extravasation; do not cover with a dressing (Ref).
Interstitial cystitis: Bladder instillation: Instill 50 mL directly into bladder and retain for 15 minutes; repeat every 2 weeks until symptoms are relieved, then increase intervals between treatments or 50 mL directly into bladder and retain for 15 to 20 minutes every 1 to 2 weeks for 4 to 8 treatments (Ref).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Dermatologic: Body odor (garlic; duration: Up to 72 hours)
Gastrointestinal: Halitosis/unpleasant taste (garlic; onset: Within a few minutes after instillation; duration: Up to 72 hours)
Genitourinary: Bladder pain, cystitis (transient)
Local: Localized erythema (topical application; ESMO/EONS [Pérez Fidalgo 2012])
Hypersensitivity: Hypersensitivity
Postmarketing and/or case reports: Contact dermatitis, cystitis (eosinophilic), pigment deposits on lens
There are no contraindications listed in the manufacturer's labeling.
Concerns related to adverse effects:
• Bladder symptoms: Bladder discomfort may occur; generally diminishes with repeated administration.
• Hypersensitivity reactions: Hypersensitivity reactions have been reported with intravesical administration (rare); hypersensitivity has also occurred with topical administration. If anaphylactoid symptoms occur, manage appropriately.
• Ophthalmic effects: Lens changes and opacities have been observed in animal studies. Full eye exams (including slit lamp) are recommended prior to use and periodically during treatment.
• Taste alteration: A garlic-like taste may occur, beginning a few minutes after instillation and lasting for several hours. Garlic odor on the breath and skin may also occur and persist for up to 3 days.
Disease-related concerns:
• Urinary tract malignancy: Use with caution in patients with urinary tract malignancy; may be harmful due to vasodilatory effects.
Other warnings/precautions:
• Appropriate use: For bladder instillation or topical administration for extravasation management (off-label use) only; not for IV or IM administration. Do not use in patients receiving dexrazoxane for anthracycline extravasation (Mourdisen, 2007); dimethyl sulfoxide (DMSO) may diminish dexrazoxane efficacy.
Severe pain following topical administration of dimethyl sulfoxide (DMSO) has been reported in a 4-year-old patient who was receiving DMSO for idarubicin extravasation; administration of analgesia (nonopioid or opioid) prior to DMSO application did not provide effective pain control; DMSO treatment was discontinued after 5 days due to pain with application and significant erythema; after discontinuation, no further analgesia was required (Llinares 2005).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravesical:
Rimso-50: 50% (50 mL)
No
Solution (Rimso-50 Intravesical)
50% (per mL): $16.68
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Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravesical:
Rimso-50: 50% (50 mL)
Not for IV or IM use.
Topical: Extravasation management, anthracyclines or mitomycin: Stop vesicant infusion immediately and disconnect IV line (leave needle/cannula in place); gently aspirate extravasated solution from the IV line (do NOT flush the line); remove needle/cannula; elevate extremity. Apply dimethyl sulfoxide topically (within 10 minutes of extravasation) to extravasation site, covering an area twice the size of extravasation; allow to air dry; do not cover with a dressing (Ref).
Intravesical (for interstitial cystitis): Instill directly into the bladder via catheter or syringe. To reduce bladder spasm, apply an analgesic lubricant (eg, lidocaine jelly) to urethra prior to catheter insertion; oral analgesics or belladonna and opium suppositories prior to administration may be of benefit. Not for IV or IM use.
Extravasation management (off-label use): Stop vesicant infusion immediately and disconnect IV line (leave needle/cannula in place); gently aspirate extravasated solution from the IV line (do NOT flush the line); remove needle/cannula; elevate extremity. Apply dimethyl sulfoxide topically (within 10 minutes of extravasation) to extravasation site, covering an area twice the size of extravasation; allow to air dry; do not cover with a dressing (Ref).
Store at 20°C to 25°C (68°F to 77°F). Protect from strong light.
Symptomatic relief of interstitial cystitis (FDA approved in adults); has also been used for management of extravasation of certain chemotherapeutic agents (eg, anthracyclines, mitomycin).
Dimethyl sulfoxide may be confused with dimethyl fumarate
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Dexrazoxane: Dimethyl Sulfoxide may diminish the therapeutic effect of Dexrazoxane. Risk X: Avoid combination
Sulindac: Dimethyl Sulfoxide may enhance the neurotoxic effect of Sulindac. Dimethyl Sulfoxide may decrease the metabolism of Sulindac. Specifically, the concentrations of the active sulfide metabolite are decreased. Risk C: Monitor therapy
Adverse events have been observed in some animal reproduction studies.
For management of cystitis, dimethyl sulfoxide (DMSO) has anti-inflammatory, analgesic, mast cell inhibition, and muscle relaxing effects (Chancellor, 2004). DMSO also has free-radical scavenger properties, which increases removal of vesicant drugs from tissues to minimize tissue damage in extravasation management (ESMO/EONS [Pérez Fidalgo 2012]).
Absorption: Topical: Well absorbed from application site
Distribution: Topical: Rapidly penetrates tissues (Bertelli 1995)
Metabolism: Oxidation to dimethyl sulfone; reduction to dimethyl sulfide
Excretion: Urine and feces (as unchanged drug and dimethyl sulfone); some elimination via skin and lungs (dimethyl sulfide)
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