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Pronunciation
(dye meth il sul FOKS ide)
Generic Available (U.S.)
No
Index Terms
Brand Names: U.S.
Brand Names: Canada
Pharmacologic Category
Use: Labeled Indications
Symptomatic relief of interstitial cystitis
Pregnancy Risk Factor
C
Pregnancy Considerations
Adverse events have been observed in animal reproduction studies.
Lactation
Excretion in breast milk unknown/use caution
Contraindications
There are no contraindications listed within the manufacturer's labeling.
Warnings/Precautions
Concerns related to adverse effects:
• Hypersensitivity reactions: May cause hypersensitivity reactions (rare).
• Ophthalmic effects: Lens changes and opacities have been observed in animal studies; precaution is advised in humans and eye exams (prior to use and periodically) are recommended.
Disease-related concerns:
• Urinary tract malignancy: Use with caution in patients with urinary tract malignancy; may be harmful due to vasodilatory effects.
Special populations:
• Pediatrics: Safety and efficacy have not been established in children.
Other warnings/precautions:
• Appropriate administration: For bladder instillation only; do not administer I.V./I.M.
Adverse Reactions
Frequency not defined.
Gastrointestinal: Garlic-like breath (may persist for up to 72 hours), garlic-like taste (may persist for several hours)
Genitourinary: Cystitis (transient)
Local: Discomfort (moderate-to-severe)
Miscellaneous: Skin odor (may persist for up to 72 hours)
Postmarketing and/or case reports: Contact dermatitis, eosinophilic cystitis, hypersensitivity reactions, lens deposits
Metabolism/Transport Effects
Inhibits CYP2C19 (weak), CYP2C9 (weak)
Drug Interactions
Dexrazoxane: Dimethyl Sulfoxide may diminish the therapeutic effect of Dexrazoxane. Risk X: Avoid combination
Sulindac: Dimethyl Sulfoxide may decrease the metabolism of Sulindac. Specifically, the concentrations of the active sulfide metabolite are decreased. Risk C: Monitor therapy
Storage
Store at room temperature of 15°C to 30°C (59°F to 86°F). Protect from light.
Mechanism of Action
Exact mechanism unknown; reported to induce and alter inflammatory tissue responses, modulate collagen disposition, influence nerve conduction and neurotransmission, and alter cell proliferation in fibroblasts and hepatocytes; thus exerting an anti-inflammatory, analgesic, and muscle relaxant effect. It may also interact with free radicals forming formaldehyde, possibly contributing to fixative effect on biological tissues.
Pharmacodynamics/Kinetics
Absorption: Well absorbed (topical administration)
Distribution: Body fluids and tissues (topical administration)
Metabolism: Oxidation to dimethyl sulfone; reduction to dimethyl sulfide
Excretion: Urine and feces (as unchanged drug and dimethyl sulfone); skin and lungs (dimethyl sulfoxide)
Dosage
Bladder instillation: Adults: Instill 50 mL directly into bladder and allow to remain for 15 minutes; repeat every 2 weeks until symptoms are relieved, then increase intervals between treatments or 50 mL directly into bladder for 15-20 minutes every 1-2 weeks for 4-8 treatments (Chancellor, 2004)
Administration: Other
Not for I.V. or I.M. use. Intravesical: Instill directly into the bladder via catheter or syringe. To reduce bladder spasm it is recommended to apply an analgesic lubricant (eg, lidocaine jelly) to urethra prior to catheter insertion; belladonna and opium suppositories may be of benefit.
Monitoring Parameters
CBC, liver and renal function tests about every 6 months; eye examinations and slit lamp examinations (baseline and periodically)
Patient Education
This medication is only for use as a bladder instillation. Maintain adequate hydration, unless instructed to restrict fluid intake.
Additional Information
Dimethyl sulfoxide (≥99%) is used as a cryopreservative solution.
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause sedation
Mental Health: Effects on Psychiatric Treatment
None reported
Nursing: Physical Assessment/Monitoring
For bladder instillation only.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, intravesical:
Rimso-50®: 50% (50 mL) [500 mg/mL]
Pricing: U.S. (www.drugstore.com)
Solution (Rimso-50)
50% (50): $112.99
References
Abramov Y, Goldberg RP, McGuire M, et al, “Eosinophilic Cystitis After Bladder Instillation With Dimethyl Sulfoxide,” Urology, 2004, 63(6):1182-3.
Chancellor MB and Yoshimura N, “Treatment of Interstitial Cystitis,” Urology, 2004, 63(Suppl 1):85-92.
Melchior D, Packer CS, Johnson TC, et al, “Dimethyl Sulfoxide: Does it Change the Functional Properties of the Bladder Wall?,” J Urol, 2003, 170(1):253-8.
Nishimura M, Takano Y, Toshitani S, “Systemic Contact Dermatitis Medicamentosa Occurring After Intravesical Dimethyl Sulfoxide Treatment For Interstitial Cystitis,” Arch Dermatol, 1988, 124(2):182-3.
Perez-Marrero R, Emerson LE, and Feltis JT, “A Controlled Study of Dimethyl Sulfoxide in Interstitial Cystitis,” J Urol, 1988, 140(1):36-9.
Rowley S and Baer R, “Lens Deposits Associated With RIMSO-50 (Dimethylsulphoxide),” Eye, 2001, 15(pt 3):332-3.
International Brand Names
Lexi-Comp.com
Last full review/revision February 2012
Content last modified February 2012
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