General Information
    Brand Name: Rimso-50®
    Generic Name: dimethyl sulfoxide (DMSO)
    Manufacturer: Edwards Lifesciences Research Medical, Inc.

Drug Information
DMSO is a widely used treatment for interstitial cystitis (IC). It has both anti-inflammatory and analgesic properties. It is believed to inhibit free-radical production, thus reducing pain and inflammation. It also aids in the absorption of other bladder-instilled medication. Its liquid form, Rimso-50, was approved by the FDA for use in treating IC in 1978. Oral and topical forms of DMSO have not been formally studied in the treatment of IC and should therefore be used with caution.
 
Instillations
A 50% solution of DMSO is instilled intravesically, meaning that the drug is placed, via catheter, directly into the bladder. It is then held in the bladder for 10-20 minutes. This procedure is typically performed in a physician’s office.
 
Treatment Program

• IC patients initially receive a series of DMSO treatments.
• One treatment is given every one or two weeks for four to eight treatments, depending on the patient’s response to the medication.
• After this initial series, many patients do find some relief, both in pain and frequency. Additional treatments may be necessary, should symptoms recur.
• Some patients find they need only one DMSO instillation should a "flare-up" arise. It is best to schedule a treatment as soon as symptoms begin to recur, rather than waiting until symptoms have intensified.
• DMSO treatments should not be started until 3-4 weeks after IC diagnostic cystoscopy with hydrodistention. This waiting period ensures that bladder biopsy sites have healed.
• Improvement may not be seen until the third or fourth treatment.

Side Effects
A strong garlic-like taste or smell may be present for 24 hours after DMSO instillation. Many patients don’t notice this odor, though anyone in close proximity to the patient may detect it. Patients may experience a temporary worsening of bladder symptoms (a temporary chemical cystitis), lasting 24-72 hrs. after treatment. Also, some patients have reported short-lived flu-like symptoms after DMSO treatment.


Self-Help Strategies
Should you experience pain during treatment:

• Have your physician prescribe anticholinergics, bladder analgesics, or B&O suppositories to be used prior to instillation.
• Request a pediatric catheter for the instillation.
• Apply an analgesic gel such as lidocaine to the urethra prior to catheter insertion.
• A numbing agent such as lidocaine or Marcaine® may be inserted into the bladder before DMSO instillation.
• Some patients find that the pain experienced with this procedure subsides with repeated instillations.
• When DMSO is combined with other medications such as heparin, steroids, bicarbonate and analgesics, it may be referred to as a "bladder cocktail."

Pregnancy
No controlled studies have been done on the use of DMSO during pregnancy or lactation. The manufacturer of the product does not recommend its use during pregnancy. No studies have been done on the safety and effectiveness of DMSO instillations in children.


Resources and References

• Rossberger J, Fall M, Peeker R. Critical appraisal of dimethyl sulfoxide treatment for interstitial cystitis: discomfort, side-effects and treatment outcome. Scand J Urol Nephrol. 2005;39(1):73-7.
• Parkin, J, Shea, C, and Sant, G R, Intravesical DMSO for Intersitial Cystitis—A Practical Approach, Urology: Interstitial Cystitis Supplement to May 1997, Alan J. Wein, MD & Philip M Hanno, MD, Editors, pp. 105-7.
• Campbell’s Urology Update #14, Interstitial Cystitis, 1995.
• Sant, G and Theoharides, TC, The Role of the Mast Cell in Interstitial Cystitis,, Urologic Clinics Of North America: Interstitial Cystitis, Philip M. Hanno, MD, Editor, February, 1994, pp. 41-53.