Dimethylsulfoxide (DMSO) was first synthesized in 1867 as a byproduct of the wood pulp industry. The antiinflam-matory, analgesic, and bacteriostatic effects were first described by Jacob et al.48 Since the 1960s, DMSO has been used clinically for treatment of IC. The beneficial effect of DMSO appears in its ability to release and ultimately deplete substance P from the bladder wall. Initially, DMSO may exacerbate the symptoms because it may stimulate mast cell degranulation and stimulate bladder efferent pathways to cause nitric oxide release.

Dimethylsulfoxide is excreted through the alveoli and causes a garlic-like odor of the breath. Dimethylsulfoxide is administered as a 50% solution or as a DMSO cocktail.49 The component of the solution consists of 50 mL of 50% DMSO (Rimso-50), 10 mL of sodium bicarbonate, steroid (40 mg of triamcinolone), 10000U of heparin sulfate, and 80 mg of gentamicin. The mixture is administered and the patient is asked to hold it for 30 to 60 minutes. If the patient cannot hold the solution, a decreasing volume can be used in each visit or preceded with belladonna and opium suppository. Instillations are usually performed on a weekly basis for 6 weeks. Patients may experience an initial flare up of symptoms caused by increased substance P. These symptoms usually improve after 2 weeks of treatment. Therapy is ultimately discontinued when symptoms have been reduced and stabilized.

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