Dimethyl sulfoxide (DMSO) is an organosulfur compound with the formula (CH3)2SO. This colorless liquid is an important polar aprotic solvent that dissolves both polar and non polar compounds and is miscible in a wide range of organic solvents as well as water. It penetrates the skin very readily, giving it the unusual property for many individuals of being secreted onto the surface of the tongue after contact with the skin and causing a garlic-
Dimethyl sulfoxide (DMSO), a by-
Yet in the United States, DMSO has Food and Drug Administration (FDA) approval only for use as a preservative of organs for transplant and for interstitial cystitis, a bladder disease. It has fallen out of the limelight and out of the mainstream of medical discourse, leading some to believe that it was discredited. The truth is more complicated.
DMSO: A History of Controversy
The history of DMSO as a pharmaceutical began in 1961, when Dr. Jacob was head of the organ transplant program at Oregon Health Sciences University. It all started when he first picked up a bottle of the colorless liquid. While investigating its potential as a preservative for organs, he quickly discovered that it penetrated the skin quickly and deeply without damaging it. He was intrigued. Thus began his lifelong investigation of the drug.
The news media soon got word of his discovery, and it was not long before reporters, the pharmaceutical industry, and patients with a variety of medical complaints jumped on the news. Because it was available for industrial uses, patients could dose themselves. This early public interest interfered with the ability of Dr. Jacob-
Why, if DMSO possesses half the capabilities claimed by Dr. Jacob and others, is it still on the sidelines of medicine in the United States today?
"It's a square peg being pushed into a round hole," says Dr. Jacob. "It doesn't follow the rifle approach of one agent against one disease entity. It's the aspirin of our era. If aspirin were to come along today, it would have the same problem. If someone gave you a little white pill and said take this and your headache will go away, your body temperature will go down, it will help prevent strokes and major heart problems-
Others cite DMSO's principal side effect: an odd odour, akin to that of garlic, that emanates from the mouth shortly after use, even if use is through the skin. Certainly, this odour has made double-
Others, such as Terry Bristol, a Ph.D. candidate from the University of London and president of the Institute for Science, Engineering and Public Policy in Portland, Oregon, who assisted Dr. Jacob with his research in the 1960s and 1970s, believe that the smell of DMSO may also have put off the drug companies, that feared it would be hard to market. Worse, however, for the pharmaceutical companies was the fact that no company could acquire an exclusive patent for DMSO, a major consideration when the clinical testing required to win FDA approval for a drug routinely runs into millions of dollars. In addition, says Mr. Bristol, DMSO, with its wide range of attributes, would compete with many drugs these companies already have on the market or in development.
The FDA and DMSO
In the first flush of enthusiasm over the drug, six pharmaceutical companies embarked on clinical studies. Then, in November 1965, a woman in Ireland died of an allergic reaction after taking DMSO and several other drugs. Although the precise cause of the woman's death was never determined, the press reported it to be DMSO. Two months later, the FDA closed down clinical trials in the United States, citing the woman's death and changes in the lenses of certain laboratory animals that had been given doses of the drug many times higher than would be given humans.
Some 20 years and hundreds of laboratory and human studies later, no other deaths have been reported, nor have changes in the eyes of humans been documented or claimed. Since then, however, the FDA has refused seven applications to conduct clinical studies, and approved only 1, for intersititial cystitis, which subsequently was approved for prescriptive use in 1978.
Dr. Jacob believes the FDA "blackballed" DMSO, actively trying to kill interest in a drug that could end much suffering. Jack de la Torre, MD, Ph.D., professor of neurosurgery and physiology at the University of New Mexico Medical School in Albuquerque, a pioneer in the use of DMSO and closed head injury, says, "Years ago the FDA had a sort of chip on its shoulder because it thought DMSO was some kind of snake oil medicine. There were people there who were openly biased against the compound even though they knew very little about it. With the new administration at that agency, it has changed a bit." The FDA recently granted permission to conduct clinical trials in Dr. de la Torre's field of closed head injury.
DMSO Penetrates Membranes and Eases Pain
The first quality that struck Dr. Jacob about the drug was its ability to pass through membranes, an ability that has been verified by numerous subsequent researchers.1 DMSO's ability to do this varies proportionally with its strength-
In addition, DMSO can carry other drugs with it across membranes. It is more successful ferrying some drugs, such as morphine sulfate, penicillin, steroids, and cortisone, than others, such as insulin. What it will carry depends on the molecular weight, shape, and electrochemistry of the molecules. This property would enable DMSO to act as a new drug delivery system that would lower the risk of infection occurring whenever skin is penetrated.
DMSO perhaps has been used most widely as a topical analgesic, in a 70 percent DMSO, 30 percent water solution. Laboratory studies suggest that DMSO cuts pain by blocking peripheral nerve C fibers.3 Several clinical trials have demonstrated its effectiveness,4,5 although in one trial, no benefit was found.6 Burns, cuts, and sprains have been treated with DMSO. Relief is reported to be almost immediate, lasting up to 6 hours. A number of sports teams and Olympic athletes have used DMSO, although some have since moved on to other treatment modalities. When administration ceases, so do the effects of the drug.
Dr. Jacob said at a hearing of the U.S. Senate Subcommittee on Health in 1980, "DMSO is one of the few agents in which effectiveness can be demonstrated before the eyes of the observers....If we have patients appear before the Committee with edematous sprained ankles, the application of DMSO would be followed by objective diminution of swelling within an hour. No other therapeutic modality will do this."
Chronic pain patients often have to apply the substance for 6 weeks before a change occurs, but many report relief to a degree they had not been able to obtain from any other source.
DMSO and Inflammation
DMSO reduces inflammation by several mechanisms. It is an antioxidant, a scavenger of the free radicals that gather at the site of injury. This capability has been observed in experiments with laboratory animals7 and in 150 ulcerative colitis patients in a double-
At the Cleveland Clinic Foundation in Cleveland, Ohio, in 1978, 213 patients with inflammatory genitourinary disorders were studied. Researchers concluded that DMSO brought significant relief to the majority of patients. They recommended the drug for all inflammatory conditions not caused by infection or tumor in which symptoms were severe or patients failed to respond to conventional therapy.9
Stephen Edelson, MD, F.A.A.F.P., F.A.A.E.M., who practices medicine at the Environmental and Preventive Health Center of Atlanta, has used DMSO extensively for 4 years. "We use it intravenously as well as locally," he says. "We use it for all sorts of inflammatory conditions, from people with rheumatoid arthritis to people with chronic low back inflammatory-
"DMSO is not a cure," he continues. "It is a symptomatic approach used while you try to figure out why the individual has the process going on. When patients come in with rheumatoid arthritis, we put them on IV DMSO, maybe three times a week, while we are evaluating the causes of the disease, and it is amazing how free they get. It really is a dramatic treatment."
As for side effects, Dr. Edelson says: "Occasionally, a patient will develop a headache from it, when used intravenously-
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