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   Tinnitus and hearing loss - drugs that can cause it (Hearing Disorders board)

26th April 2005
Found this on the internet which may be of use to some people. I was prescribed temazepam last week to help me sleep as I'm suffering from severe tinnitus after an ear infection. It's on the list!

Ototoxic Medications:
Drugs That Can Cause Hearing Loss and Tinnitus

Orin S. Kaufman, D.O.
Physician, a volunteer at the League for the Hard of Hearing, and a late-deafened adult.

The importance of compiling and publishing a list of fairly commonly used medications and compounds that can cause either tinnitus and/or hearing loss is self-evident. Usually, these problems are reversible; that is, the hearing change is corrected when the medication is discontinued. But there are still infrequent times when this change can be permanent. If someone is experiencing a hearing problem or if there is a hearing disorder in the family, it is imperative the treating physician be aware of this fact. If a person is prescribed one of the medications found on this list, (s)he should speak to the physician to see if another, potentially less toxic drug could be used in its place.

This information is very important to a physician. Armed with it, (s)he may then be able to prescribe a drug that would have a potentially less toxic effect on hearing. The likelihood of having a problem with hearing from the use of one of these medications is usually extremely small. The drugs with the greatest potential to cause a hearing loss are usually used only in life-threatening situations.

Remember, the physician is the person best qualified to determine which medication is best for you. It is important that (s)he be aware of not only any real or potential problems concerning hearing, but also of any other conditions which may be present that would influence the selection of medication.

In the lists that follow, the generic name of the drug is given first, with the trade name, if available, following in parentheses and capitalized. Also, many times a particular generic drug is produced by different manufacturers with different trade names. The trade names mentioned in this article were selected by the author over other trade names purely by coincidence. The inclusion of a particular trade name and the exclusion of another should not be interpreted as prejudicial either for one nor against the other.

Drugs That Can Cause Hearing Loss


A. Salicylates

1. aspirin and aspirin-containing products
2. salicylates & methyl-salicylates (linaments)

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

B. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

1. diclofenac (Voltaren)
2. etocolac (Lodine)
3. fenprofen (Nalfon)
4. ibuprofen (Motrin, Advil, Nuprin, etc.)
5. indomethacin (Indocin)
6. naproxen (Naprosyn, Anaprox, Alleve)
7. piroxicam (Feldene)
8. sulindac (Clinoril)

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

C. Antibiotics

1. aminoglycosides
a. amikacin (Amakin)
b. gentamycin (Garamycin)
c. kanamycin (Kantrex)
d. neomycin (Found in many over-the-counter antibiotic ointments)
e. netilmicin (Netromycin)
f. streptomycin
g. tobramycin (Nebcin)

(Of particular interest is that topical ear drop medications containing gentamycin or neomycin do not appear to be 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).

2. erythromycin

a. EES
b. E-mycin
c. Ilosone
d. Eryc
e. Pediazole
f. Biaxin
g. Zithromax

(Usually ototoxic when given in intravenous doses of 2-4 grams per 24 hours, especially if there is underlying kidney failure).

3. vancomycin (Vancocin) (Similar to aminoglycosides in that it may be ototoxic when used intravenously in life- threatening infections. To further exaggerate the problem is the fact that aminoglycosides and vancomycin are often used together intravenously when treating life-threatening infections).
4. minocycline (Minocin) (Similar to erythromycin).
5. polymixin B & amphotericin B (Antifungal preparations).
6. capreomycin (Capestat) (Anti-tuberculosis medication).

D. Diuretics

1. bendroflumethazide (Corzide)
2. bumetadine (Bumex)
3. chlor-thalidone (Tenoretic)
4. ethacrynic acid (Edecrin)
5. 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).

E. Chemotherapeutic Agents

1. bleomycine (Blenoxane)
2. bromocriptine (Parlodel)
3. carboplatinum (Carboplatin)
4. cisplatin (Platinol)
5. methotrexate (Rheumatrex)
6. nitrogen mustard (Mustargen)
7. vinblastin (Velban)
8. vincristine (Oncovin)

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

F. Quinine

1. chloroquine phosphate (Aralen)
2. quinacrine hydrochloride (Atabrine)
3. quinine sulfate (Quinam)

(The ototoxic effects are very similar to those of aspirin).

G. Mucosal Protectant

1. misoprostol (Cytotec)

Drugs That Can Cause Tinnitus

This list of drugs is very similar to the list of ototoxic drugs that can cause hearing loss. There are some notable additions to the previous list.

A. Vapors, Solvents

1. cychohexane
2. dichloromethane
3. hexane (gasoline)
4. lindane (Kwell)
5. methyl-chloride
6. methyl-n-butyl-ketone
7. perchlor-ethylene
8. styrene
9. tetrachlor-ethane
10. toluol
11. trichloroethylene

B. Antibiotics

1. aminoglycosides (see previous section)
2. amphotericin B
3. chloramphenicol (Chloromycetin)
4. minocycline (Minocin)
5. polymyxine B
6. sulfonamides (Septra, Bactrim)
7. vancomycin (Vancocin)

C. Anti-Neoplastics

1. bleomycin (Blenoxane)
2. cis-platinum (platinol)
3. carboplatinum (Paraplatin)
4. methotrexate (Rheumatrex)
5. nitrogen mustard (Mustagen)
6. vinblastin (Velban)

D. Diuretics

1. acetazolamide (diamox)
2. bumetanide (Bumex)
3. bendrofluazide
4. clorothalidone (Hygroton, Tenoretic)
5. diapamide
6. ethacrynic acid (Edecrin)
7. furosemide (Lasix)
8. hydrochlorthiazide (Hydrodiuvil)
9. methylchlorthizide (Enduron)

E. Cardiac Medications

1. celiprolol
2. flecainide (Tambocar)
3. lidocaine
4. metoprolol (Lopressor)
5. procainamide (Pronestyl)
6. propranolol (Inderal)
7. quinidine (Quinaglute, Quinidex)

F. Psychopharmacologic Agents

1. amitryptiline (Elavil)
2. benzodiazepine class
a. alprazolam (Xanax)
b. clorazepate (Tranxene)
c. chlordiazepoxide (Librium)
d. diazepam (Valium)
e. flurazepam (Dalmane)
f. lorazepam (Ativan)
g. midazolam (Versed)
h. oxazepam (Serax)
i. prozepam (Centrax)
j. quazepam (Doral)
k. temazepam (Restoril)
l. triazolam (Halcion)
3. bupropion (Welbutrin)
4. carbamzepine (Tegretol)
5. diclofensine
6. doexpin (Sinequin)
7. desiprimine (Norpramin)
8. fluoxetin (Prozac)
9. imipramine (Tofranil)
10. lithium
11. melitracen
12. molindon (Moban)
13. paroxetin
14. phenelzin (Nardil)
15. protriptilin (Vivactil)
16. trazodon (Desyrel)
17. zimeldin

G. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

1. asprin
2. acematacine
3. benorilate
4. benoxaprofen
5. carprofen
6. diclofenac (Voltaren)
7. diflunisal (Dolobid)
8. fenoprofen (Nalfon)
9. feprazon
10. ibuprofen (Motrin, Advil, Nuprin)
11. indomethacin (Indocin)
12. isoxicam
13. ketoprofen (Orudis)
14. methyl salicylates (BenGay)
15. naproxen (Naprosyn, Anaprox, Alleve)
16. D-Penicilliamin
17. phenylbutazone (Butazolidine)
18. piroxicam (Feldene)
19. proglumetacin
20. proquazon
21. salicylates
22. sulindac (Clinoril)
23. tolmetin (Tolectin)
24. zomepirac

H. Glucocorticosteroids

1. prednisolone (Prednisone)
2. ACTH (adrenocorticotrophic hormone) (Acthar)

I. Anesthetics

1. bupivacain
2. tetracain
3. lidocaine (Novacaine)

J. Antimalarials

1. chloroquine (Aralen)
2. hydroxychloroquine (Plaquinil)

K. Miscellaneous Toxic Substances

1. alcohol
2. arsenum
3. caffeine
4. lead
5. marijuana
6. nicotine
7. mercury
8. auronofin (gold), (Ridaura)

Ironically, several of these drugs found to cause tinnitus are also used to treat tinntus (e.g. amitryptiline, benzodiazepine class, carbamzazpine, furosemide, lidocaine, prednisone).
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