Version May 2024
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).
Refer to adult dosing.
(For additional information see "Dimethyl sulfoxide: Pediatric drug information")
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).
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): $15.89
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravesical:
Rimso-50: 50% (50 mL)
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).
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).
Interstitial cystitis: Symptomatic relief of interstitial cystitis.
Limitation of use: There is no clinical evidence of effectiveness of dimethyl sulfoxide in the treatment of bacterial urinary tract infections.
Extravasation management
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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
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.
It is not known if dimethyl sulfoxide is excreted in breast milk. The manufacturer recommends that caution be exercised when administering dimethyl sulfoxide to nursing women.
CBC, chemistry panel, liver and renal function tests about every 6 months; eye examinations and slit lamp examinations (baseline and periodically during treatment). For extravasation management, monitor and document extravasation site.
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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