Ototoxic Medications

Audiologist Dr.Lawrence Cardano talks with a pharmacist about medications that can cause hearing loss.

Drugs that can cause Ototoxic Medicationshearing loss and tinnitus

Drugs that can cause hearing loss

Salicylates

  • aspirin and aspirin - containing products
  • salicylates and methylsalicylates (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 for causing 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 arealmost 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 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.)

  • 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 futher exaggerates the problem.)

  • minocycline (Minocin) (Similar to erythromycin)
  • polymixin B & amphotericin B (Antifungal preparations)
  • capreomycin (Capestat)
    (Anti-tuberculosis medication)

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

Anti-neoplastics

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

Diuretics

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

(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.)

Cardiac Medications

  • celiprolol
  • flecainide (Tambocar)
  • lidocaine
  • metoprolol (Lopressor)
  • procainamide (Pronestyl)

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)

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 (Sinequin)
  • 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 notation for 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

  • alcohol
  • arsenum
  • caffeine
  • lead
  • marijuana
  • nicotine
  • mercury
  • auronofin (gold, Ridaura)

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

Ototoxic Drugs Bibliography:

  • Ototoxic Medications : Drugs that can cause hearing loss and tinnitus, League for the Hard of Hearing
  • Claussen, C.F, (1996). Chemically induced or drug induced tinnitus.
  • International Tinnitus Journal, 2, l-2.
  • Drug Facts & Comparisons. (1995) St. Louis, MO. J.B. Lippincott.
  • 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.
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