List of Ototoxic Medications That May Cause Tinnitus or Hearing Loss

In most cases, this type of tinnitus is an acute, short-lived side effect. If the patient stops taking the medication, the tinnitus symptoms typically recede. Familiarity with a complete list of ototoxic medications is unnecessary, but knowing which ones are known to cause more permanent tinnitus symptoms can save you a lot of frustration.

What is Ototoxicity?

Ototoxicity is a medical term that refers to the damage done to an individual’s hearing health as a result of taking a medication. Ototoxic drugs can cause hearing issues, such as tinnitus, hearing loss, or even balance problems. Many commonly prescribed drugs have been known to cause ototoxicity. While early detection is key in preventing hearing loss and significant damage to your hearing health, if left untreated, ototoxic symptoms can become permanent.

What is an Ototoxic Drug?

According to Neil Bauman, Ph.D., “Ototoxic drugs are those medications that can cause ototoxic (ear damaging) side effects to your ears. Such drugs can cause hearing loss, hyperacusis, tinnitus, and other phantom sounds and a whole host of balance problems.” Although physician-prescribed medications may effectively treat a specific health condition, they can also damage the fragile hair cells in the inner ear, impacting a person’s ability to hear and balance. The most common reported ototoxic drugs in clinical use are aminoglycoside antibiotics, macrolide antibiotics, loop diuretics, antimalarials, chemotherapeutic agents such as cisplatin, non-steroidal anti-inflammatory drugs (NSAIDs), quinine, and acetaminophen.

Tinnitus, of course, does not afflict everyone who takes drugs. Even if a drug’s description lists tinnitus as a side effect, it does not mean you will develop tinnitus if you take it. Some people do. Many don’t. However, it is still important to learn the side effects of any drug you take. That way, you can react accordingly if you do develop a side effect. To evaluate your level of tinnitus or hyperacusis, take our tinnitus and hyperacusis impact surveys.

How Do Ototoxic Drugs Harm Your Auditory System?

How exactly do these medications harm your hearing health? Essentially, ototoxic medications can damage the sensory hair cells that line your inner ears. These small and very delicate cells play an important role for both your hearing and your balance. If they become permanently damaged, some individuals may never regain full functionality. That’s why it’s important to prevent ototoxicity by understanding the potential effects of any medication you’re prescribed.

What are the Symptoms of Ototoxic Medications?

Ototoxicity symptoms may appear suddenly or take time to develop and become noticeable. For many individuals, tinnitus, which can be experienced as a slight ringing in the ears when there is no external stimuli present, is the first noticeable symptom. Over time, ototoxic drugs can also lead to tinnitus and hearing loss.

Additional symptoms of ototoxic drugs may include:

• Headaches.
• Poor balance.
• Ears feeling full.
• Inability to move your head fully.
• Oscillopsia.
• Difficulty walking.
• Feeling unsteady or lightheaded.

What Affects the Severity of Ototoxic Symptoms?

The severity of your ototoxicity symptoms may depend on a variety of factors including:

• How long you’ve taken the ototoxic drug.
• The amount of damage already caused.
• Whether or not the damage was rapid or slow to develop.
• Whether both ears or just one ear are affected.

How Do I Protect Myself from Ototoxicity?

Unlike threats to your hearing health like an ear infection or exposure to loud noises, protecting yourself from ototoxicity is relatively straightforward. Knowledge is power when it comes to protecting your hearing health from ototoxicity. Before beginning any prescription medication, ask your doctor about any potential ototoxic effects. While taking medication with potential ototoxic effects may be inevitable for certain health conditions, your doctor may be able to prescribe an alternative that does not affect your hearing health.

List of Ototoxic Medications

When a medication is ototoxic, it has a toxic effect on the ear or its nerve supply. Depending on the medication and dosage, the effects of ototoxic medications can be temporary or permanent.

The following ototoxic drugs may cause more permanent tinnitus symptoms as well as a myriad of other hearing health-related issues:

Brief Overview – Scroll down for a complete list.

• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Certain antibiotics, including aminoglycosides
• Certain cancer medications
• Water pills and loop diuretics
• Long-Term Hormone Therapy
• Quinine-based medications

Other common medications that can cause ototoxicity include the following:

• Certain anticonvulsants
• Tricyclic antidepressants
• Anti-anxiety medications
• Antimalarial medications
• Blood pressure controlling medications
• Allergy medications
• Chemotherapy drugs, including cisplatin

Drugs that can cause tinnitus

Vapors, Solvents

• cyclohexane
• dichloromethane
• hexane (gasoline)
• lindane (Kwell)
• methyl-chloride
• methyl-n-butyl-ketone
• perchlor-ethylene
• Styrene
• tetrachlor-ethane
• toluol
• trichloroethylene

Antibiotics

• aminoglycosides
• amphotericin B
• chloramphenicol (Chloromycetin)
• minocycline (Minocin)
• polymyxine B
• sulfonamides (Septra, Bactrim)
• vancomycin (Vancocin)

Antineoplastics

• bleomycin (Blenoxane)
• cis-platinum (Platinol)
• carboplatinum (Paraplatin)
• methotrexate (Rheumatrex)
• nitrogen mustard (Mustagen)
• vinblastin (Velban)Diuretics

Diuretics

• acetazolamide (Diamox)
• bumetanide (Bumex)
• bendrofluazide
• clorothalidone (Hygroton, Tenoretic)
• diapamide
• ethacrynic acid (Edecrin)
• furosemide (Lasix)
• hydrochlorthiazide (Hydrodiuril)
• methylchlorthizide (Enduron)

Cardiac Medications

• celiprolol
• flecainide (Tambocar)
• lidocaine
• metoprolol (Lopressor)
• procainamide (Pronestyl)
• propranolol (Inderal)
• quinidine (Quinaglute, Quinidex)

Psychopharmacologic Agents

• amitryptiline (Elavil)
• benzodiazepine class
  • alprazolam (Xanax)
  • clorazepate (Tranxene)
  • chlordiazepoxide (Librium)
  • diazepam (Valium)
  • flurazepam (Dalmane)
  • lorazepam (Ativan)
  • midazolam (Versed)
  • oxazepam (Serax)
  • prozepam (Centrax)
  • quazepam (Doral)
  • temazepam (Restoril)
  • triazolam (Halcion)
• bupropion (Welbutrin)
• carbamzepine (Tegretol)
• diclofensine
• doxepin (Sinequan)
• desiprimine (Norpramin)
• fluoxetin (Prozac)
• imipramine (Tofranil)
• lithium
• melitracen
• molindon (Moban)
• paroxetin
• phenelzin (Nardil)
• protriptilin (Vivactil)
• trazodon (Desyrel)
• zimeldin

Non-Steroidal Anti-inflammatory Drugs (NSAIDs)

Please see below for notation about NSAIDs under “hearing loss”

• asprin
• acematacine
• benorilate
• benoxaprofen
• carprofen
• diclofenac (Voltaren)
• diflunisal (Dolobid)
• fenoprofen (Nalfon)
• feprazon
• ibuprofen (Motrin, Advil, Nuprin)
• indomethacin (Indocin)
• isoxicam
• ketoprofen (Orudis)
• methyl salicylates (BenGay)
• naproxen (Naprosyn, Anaprox, Aleve)
• D-Penicilliamin
• phenylbutazone (Butazolidine)
• piroxicam (Feldene)
• proglumetacin
• proquazon
• rofecoxib (Vioxx)
• salicylates
• sulindac (Clinoril)
• tolmetin (Tolectin)
• zomepirac

Glucocorticosteroids

• prednisolone (Prednisone)
• ACTH (adrenocorticotrophic hormone) (Acthar)

Anesthetics

• bupivacain
• tetracain
• lidocaine (Novacaine)

Antimalarials

• chloroquine (Aralen)
• hydroxychloroquine (Plaquinil)

Others

• thalidomide (Thalomid)

Miscellaneous Toxic Substances

• Arsenicum
• lead
• Mercury
• auronofin (gold, Ridaura)

Drugs that can cause hearing loss and damage to your hearing health

Salicylates

• aspirin and aspirin-containing products
• salicylates and methyl- salicylates (linaments)

(Toxic effects appear to be dose-related and are almost always reversible once medications are discontinued).

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Most NSAIDS have the potential to cause hearing loss and/or tinnitus. Because new drugs are being frequently approved for use, it is important that you check with your doctor or pharmacist to determine if the drug you were prescribed can cause a problem.

• diclofenac (Voltaren)
• etocolac (Lodine)
• fenprofen (Nalfon)
• ibuprofen (Motrin, Advil, Nuprin, etc.)
• indomethacin (Indocin)
• naproxen (Naprosyn, Anaprox, Aleve)
• piroxicam (Feldene)
• sulindac (Clinoril)

(Toxic effects are dose-related and are almost always reversible once medications are discontinued.)

Antibiotics

• aminoglycosides
  • amikacin (Amakin)
  • gentamycin (Garamycin)
  • kanamycin (Kantrex)
  • neomycin (Found in many over-the-counter antibiotic ointments.)
  • netilmicin (Netromycin)
  • streptomycin
  • tobramycin (Nebcin)

Of particular interest is that topical ear drop medications containing gentamycin or neomycin do not appear ototoxic in humans unless the tympanic membrane (ear drum) is perforated. When a solution of an aminoglycoside antibiotic is used on the skin together with an aminoglycoside antibiotic used intravenously, there is a risk of an increase of the ototoxic effect, especially if the solution is used on a wound that is open or raw, or if the patient has underlying kidney damage.

Neomycin is the drug that is most toxic to the structure involved in hearing, the cochlea, so it is recommended for topical use only. But even topical therapy has resulted in hearing loss when large areas were treated which allowed for large amounts of the drug to be absorbed into the body. Hearing loss caused by this class of antibiotics is usually permanent.

• erythromycin
  • EES
  • E-mycin
  • Ilosone
  • Eryc
  • Pediazole
  • Biaxin
  • Zithromax – Usually ototoxic when given in intravenous doses of 2-4 grams per 24 hours, especially if there is underlying kidney failure.
  • vancomycin (Vancocin) Similar to aminoglycosides in that it may be ototoxic when used intravenously in life-threatening infections. The fact that aminoglycosides and vancomycin are often used together intravenously when treating life-threatening infections further exaggerates the problem.
  • minocycline (Minocin) (Similar to erythromycin)
  • polymixin B and amphotericin B (Antifungal preparations)
  • capreomycin (Capestat) (Anti-tuberculosis medication)

  Diuretics

  • bendroflumethazide (Corzide)
  • bumetadine (Bumex)
  • chlor-thalidone (Tenoretic)
  • ethacrynic acid (Edecrin)
  • furosemide (Lasix)

  These are usually ototoxic when given intravenously for acute kidney failure, acute hypertensive crisis, or acute pulmonary edema /congestive heart failure. Rare cases of ototoxicity have been found when these medications are taken orally in high doses by people with chronic kidney disease.

  Chemotherapeutic Agents

  • bleomycine (Blenoxane)
  • bromocriptine (Parlodel)
  • carboplatinum (Carboplatin)
  • cisplatin (Platinol)
  • methotrexate (Rheumatrex)
  • nitrogen mustard (Mustargen)
  • vinblastin (Velban)
  • vincristine (Oncovin)

  The ototoxic effects can be minimized by carefully monitoring blood levels.

  Quinine

  • chloroquine phosphate (Aralen)
  • quinacrine hydrochloride (Atabrine)
  • quinine sulfate (Quinam)

  The ototoxic effects are very similar to those of aspirin.

  Mucosal Protectant

  • misoprostol (Cytotec)

  Narcotic Analgesics

  • hydrocodone (Lorcet, Vicodin)

  Can Ototoxicity Be Reversed?

  As doctors and researchers continue to learn more about the effects and risks of ototoxicity, there is currently no direct way to reverse ototoxicity. For most patients, the most effective solution is to stop taking the ototoxic drug and give your ears time to heal naturally from the effects.

  If you believe medication is causing damage to your hearing, speak with your doctor. They may be able to lower your dosage or find an alternative medication that works for you.

  What to Do If You Suspect a New Drug is Causing Tinnitus or Hearing Loss

  When you are aware of which drugs can damage your ears via ototoxicity, you are in a position to help protect them. As a drug accumulates in your body, the risk for ototoxicity increases. If you experience tinnitus after you begin taking a new medication, contact your prescribing physician. You should not stop taking any medication without first consulting with your healthcare provider. The risks of stopping a medication may far exceed any potential benefit.

  While age-related hearing loss is the most common cause of tinnitus, ototoxic drugs can also lead to this hearing issue. If you already have tinnitus, let your physician know before he or she prescribes a new medication, as effective alternatives to ototoxic drugs may be available. If you are worried about tinnitus as a side effect of your medications, please consult your subscribing physician or pharmacist.

  Additionally, remember that just because your doctor prescribes one of these medications, that doesn’t mean you will lose your sense of hearing or develop tinnitus. Experiences with ototoxic medications vary from person to person.

  Sound Relief Hearing Center Can Help Treat Your Ototoxicity Symptoms

  If you have taken any drugs from our list of ototoxic medications and are now suffering from tinnitus, contact Sound Relief Hearing Center today to explore your treatment options. Our audiologists specialize in identifying common causes of tinnitus and tinnitus treatment. We have provided life-changing relief to thousands of patients through FDA-approved tinnitus treatments.

  With our unparalleled excellence in the hearing industry, our dedication to patient satisfaction, and our commitment to helping people control and conquer their hearing issues, you can count on Sound Relief Hearing Center for support and assistance. In addition to tinnitus and hyperacusis treatment, we also specialize in industry-leading hearing aids that can help individuals experiencing different types of hearing loss. With comprehensive hearing tests, we can identify the source of your hearing problems and find a solution that works for you.

  To learn more about us, please browse our website, visit our YouTube channel, or give us a call at (720) 344-7600.

  You can also schedule an appointment online to meet with one of our audiologists. We look forward to hearing from you!

  Ototoxic Drugs: Bibliography

  Claussen, C.F, (1996). Chemically induced or drug-induced tinnitus. International Tinnitus Journal, 2, l-2.

  https://www.tinnitusjournal.com/articles/chemically-induced-or-drug-induced-tinnitus.pdf

  Drug Facts & Comparisons. (1995) St. Louis, MO. J.B. Lippincott.

  https://www.worldcat.org/title/2913133

  Epstein, S. (1996) What you should know about ototoxic medications. Journal of Self Help for Hard of Hearing People, 16, 29-30.
  PDR Drug Interactions and Side Effects. (50th ed.). (1996). Montvale, N.J: Medical Economics Co.

  Physicians Desk Reference (50th ed.). (1996). Montvale, NJ: Medical Economics Co. Suss, E. When the Hearing Gets Hard. (pp. 167-216). New York, NY: Bantam Books.

  USP dispensing Information. (1997). In Drug Information for the Health Care Professional. Vol. 1. Rockville, MD: The United States Pharmacopeial Convention, Inc.

  https://www.usp.org/compounding/general-chapter-797