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11 Oct 2018

IV DMSO “Hoang” Protocols with US Equivalents – And clinical Q&A

Hoang BX, et.al. Dimethyl Sulfoxide–Sodium Bicarbonate Infusion for Palliative Care and Pain Relief in Patients With Metastatic Prostate Cancer.
Journal of Pain & Palliative Care Pharmacotherapy. 2011;25:350–355. DOI: 10.3109/15360288.2011.606294
AND
Palliative Treatment for Advanced Biliary Adenocarcinomas With Combination Dimethyl Sulfoxide–Sodium Bicarbonate Infusion and S-Adenosyl-L-Methionine
Journal of Pain and Palliative Care Pharmacotherapy. September 2014, Vol. 28, No. 3 , Pages 206-211 (doi:10.3109/15360288.2014.938882)

Ba X. Hoang, Hung Q. Tran, Ut V. Vu, Quynh T. Pham, and D. Graeme Shaw

Ba X. Hoang, MD, PhD, is a medical consultant with the Department of Oncology, and Hung Q. Tran, MD, PhD, is head of the Oncology Center, 198 Hospital, Hanoi, Vietnam. Quynh T. Pham, MD, is with the Departments of Internal Medicine and Palliative Care, Labor Medical Center, Hanoi, Vietnam. Ut V. Vu, MD, is with the Departments of Surgery and Oncology, Hospital of Traditional Medicine, Hanoi, Vietnam. D. Graeme Shaw, MD, is an internist in private practice in Los Altos, California, USA.

 

ABSTRACT

Adenocarcinoma of the gallbladder and cholangiocarcinoma account for 4% and 3%, respectively, of all gastrointestinal cancers. Advanced biliary tract carcinoma has a very poor prognosis with all current available modalities of treatment. In this pilot open-label study, the authors investigated the efficacy and safety of a combination of dimethyl sulfoxide–sodium bicarbonate (DMSO-SB) infusion and S-adenosyl-L-methionine (ademetionine) oral supplementation as palliative pharmacotherapy in nine patients with advanced nonresectable biliary tract carcinomas (ABTCs). Patients with evidence of biliary obstruction with a total serum bilirubin ≤300 μmol/L were allowed to join the study. The results of this 6-month study and follow-up of all nine patients with ABTC indicated that the investigated combination treatment improved pain control, blood biochemical parameters, and quality of life for the patients. Moreover, this method of treatment has led to a 6-month progression-free survival for all investigated patients. The treatment was well tolerated for all patients without major adverse reactions. Given that ABTC is a highly fatal malignancy with poor response to chemotherapy and targeted drugs, the authors consider that the combination of DMSO-SB and ademetionine deserves further research and application as a palliative care and survival-enhancing treatment for this group of patients.

Read More: http://informahealthcare.com/doi/abs/10.3109/15360288.2014.938882

 

The two formulas in “US” equivalents:

 

#1:

42 mL 8.4% Bicarbonate

208 mL Sterile Water

25 mL 99% DMSO

10 mL Magnesium Sulfate

4 ml (8 mEq) Potassium Chloride

 

#2:

83 mL 8.4% Bicarbonate

417 mL Sterile Water

40 mL 99% DMSO

10 mL Magnesium Sulfate

6 ml (12 mEq) Potassium Chloride

 

Q&A Regarding this protocol:

QUESTION: Hoang Protocol. Pt has been on this protocol three times, once at half dose, twice at full dose. On the full dose therapy she has experienced “wracking” migraines although she generally very good the next day. The migraines begin during the IV. She also experiences a total collapse of energy after the IVs (1) Thoughts regarding a cause of the migraines and drop of energy (2) She is interested in research supporting the use of sodium bicarb and DMSO. Is there anything more to offer outside of what is available in the Clinical Applications and Advanced Topics of IV Nutrient Therapies notes?

ANSWER: A couple of observations:  

(1) This is a potential and expected side effect, usually from sodium load and CNS dehydration.  Sometimes hydrating them first with half-NS works for that part, sometimes time does. Same for feeling low energy after.  

(2) I assume you are either doing the 1 gram K+ orally QD or in the IV (our newer notes [as above] have that as well as Hoang updated the protocol as well).  If they take the 1 gram K+ orally its fine but putting it in the IV and not trusting them to do PO may be safer. As for other places in the literature here is the short list one can look at. PMID: 21426213; PMID: 21936635; PMID: 20887267; PMID: 25102038

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