디메틸설폭사이드 (DMSO)

자유 라디칼 소거제 / 항염증제

**디메틸설폭사이드(DMSO)**는 독특한 약리학적 특성을 지닌 매우 다재다능한 쌍극성 비양성자성 용매입니다. 수의학에서는 주로 **자유 라디칼 소거제** 및 **국소 항염증제**로 사용됩니다. * **주요 승인 용도:** 개와 말에서 외상으로 인한 급성 부종을 줄이기 위한 국소 도포제로 FDA 승인을 받았습니다. * **허가 외 사용:** 중추신경계 외상, 뇌부종, 일과성 허혈 상태, 피부 궤양, 화상, 장 수술 보조 요법, 아밀로이드증 및 항암제(예: 독소루비신) 일출로 인한 조직 손상 제한. * **침투 촉진제:** DMSO는 비가역적인 손상을 일으키지 않고 온전한 피부와 생체막을 쉽게 통과합니다. 강력한 운반체 역할을 하여 다른 약물(예: 코르티코스테로이드, 항생제, 진통제) 및 잠재적인 독성 화합물의 경피 흡수를 촉진합니다. * **임상적 주의사항:** 흡습성이 매우 강하여 실내 공기에 노출되면 스스로 희석됩니다. 산업용 불순물이 전신 순환으로 유입되는 것을 방지하기 위해 반드시 의료용 DMSO를 사용해야 합니다.

작용 기전: DMSO exhibits a diverse array of pharmacological effects through multiple pathways: * **Free Radical Scavenging:** DMSO directly traps the **free radical hydroxide (OH•)**, while its primary metabolite, **dimethyl sulfide (DMS)**, traps free radical oxygen. This mechanism underpins its anti-inflammatory, cryopreservative, anti-ischemic, and radioprotective qualities. * **Enzyme Inhibition:** Inhibits **alcohol dehydrogenase** → slows the metabolism of alcohol and prevents the conversion of ethylene glycol into its toxic metabolites (making it a potential, though less common, antidote for antifreeze toxicity). * **Prostaglandin Modulation:** Enhances **Prostaglandin E (PGE)** but blocks the synthesis of **PGE2, PGF2-alpha, PGH2, and PGG2**, contributing to its analgesic and anti-inflammatory effects. * **Vascular Effects:** Provokes **histamine** release from mast cells → local vasodilation. It also decreases platelet aggregation. * **Neuromuscular:** Exhibits weak **anticholinesterase** activity.

동물 종별 용량

Horses

Acute swelling due to trauma · Liberal application should be administered topically to the skin over the affected area 2-3 times daily. Total daily dosage should not exceed 100 grams (or mL of liquid) · topical · q8-12h · Max 30 days
Adjunctive treatment with surgical colics · 25 mg/kg IV intraoperatively and continued twice daily for the first 24-48 hours post-op. · IV · q12h · 24-48 hours · Administer slowly at 10% concentration.
Acute rhabdomyolysis · 1 g/kg in a 10% solution of lactated Ringer's or Multisol IV or orally. · IV/PO · once · May be given in the acute stages once hydration status has been restored.
Adjunctive treatment for laminitis · 0.1-1 g/kg IV, 2-3 times daily · IV · q8-12h · Administer slowly at 10% concentration.

Dogs

Acute swelling due to trauma · Liberal application should be administered topically to the skin over the affected area 3-4 times daily. Total daily dosage should not exceed 20 grams (or mL of liquid) · topical · q6-8h · Max 14 days
Calcinosis cutis · Apply topically to a small area of the body initially (if extensive areas are involved) once daily; and as these areas improve, add new treatment areas. · topical · q24h · Dogs may 'feel bad' if large areas are treated initially, but do not become hypercalcemic.
Persistent cases of hemorrhagic cystitis (secondary to cyclophosphamide tx) · 10 mL of DMSO medical grade 50% solution is diluted with 10 mL of water and instilled into bladder and removed after 20 minutes. · intravesical · once · 20 minutes

투여 경로

TopicalIVPOIntravesical (bladder instillation)

금기

Mastocytomas (due to mast cell degranulation)
Dehydration or shock (diuretic and vasodilatory effects may exacerbate)
Pregnancy (teratogenic at high doses in some species; use with extreme caution)

이상반응

Local 'burning', erythema, vesiculation, and dry skin (topical)
Garlic or oyster-like breath odor
Lenticular changes (myopia) with chronic high doses
Hemolysis and hemoglobinuria (IV in horses, especially at >10% concentration or rapid administration)
Diarrhea, muscle tremors, and colic (IV in horses)
Rare hepatotoxicity and renal toxicity

약물 상호작용

Organophosphates / Cholinesterase Inhibitors · Avoid concurrent use due to DMSO's anticholinesterase activity.
Mercury salts · Can cause fatal mercury intoxication if mixed and applied topically.
Alcohol · DMSO inhibits alcohol dehydrogenase and may prolong the effects of alcohol.
Insulin · May be potentiated by DMSO.
Corticosteroids · May be potentiated by DMSO.
Atropine · May be potentiated by DMSO.
Topical toxins or other topical medications · Profound enhancement of systemic absorption of the co-administered substance, potentially leading to systemic toxicity. · major
Dexrazoxane · DMSO may decrease the activity and efficacy of dexrazoxane; concurrent use should be discouraged. · moderate

모니터링

Clinical efficacy (reduction in swelling/inflammation)
Hemoglobinuria and hematocrit (especially in horses receiving IV therapy)
Ophthalmic exams (with high doses or chronic use in dogs to monitor for lenticular changes)

과용량

The reported LD50 following IV dosage is approximately 4 g/kg in cats and 2.5 g/kg in dogs. **Clinical Signs of Toxicity:** * *Non-lethal doses:* Sedation and hematuria. * *Higher dosages:* Coma, seizures, opisthotonus, dyspnea, and pulmonary edema. **Treatment:** Should an acute overdosage be encountered, treat supportively.

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