Last month’s article was about ototoxic drugs, drugs that cause hearing loss. Among the most common listed in that article were aspirin, non-steroidal anti-inflammatory drugs or NSAIDs like ibuprofen, indomethacin, naproxen and piroxicam, many antibiotics, and certain diuretics. As extensive as that list was, it was not complete. This week’s article adds to that list.
Some chemotherapeutic agents can be ototoxic such as methotrexate (Rheumatrex), cisplatin (Platinol) and nitrogen mustard (Mustargen). The ototoxic effects can be minimized by carefully monitoring blood levels.
Quinine is ototoxic, including tonic water. The ototoxic effects of quinine are very similar to those of aspirin.
Another class of drugs that can cause hearing loss are the erectile dysfunction (ED) drugs in the class that includes Cialis, Levitra, and Viagra. These drugs can cause sudden hearing loss. A case report in the April 2007 issue of the Journal of Laryngology & Otology involving sudden hearing loss in a man taking Viagra prompted the FDA to search the FDA’s Adverse Events Reporting System for instances of hearing loss and this class of drugs. The FDA found a total of 29 post marketing reports of sudden hearing loss, both with and without accompanying ringing in the ears, vertigo, or dizziness. In most of the cases, the hearing loss involved one ear.
Drugs That Cause Tinnitus Besides the drugs already mentioned, there are other drugs that cause tinnitus. These include cardiac medications such as metoprolol (Lopressor) and propranolol (Inderal).
Many psychopharmacologic agents cause tinnitus. Among them are amitryptiline (Elavil) and the benzodiazepine class of drugs that include alprazolam (Xanax), chlordiazepoxide (Librium), diazepam (Valium) and triazolam (Halcion). Bupropion (Welbutrin), fluoxetin (Prozac), migraine (Tofranil), lithium and phenelzin (Nardil) are other psychopharmacologic drugs that can cause tinnitus. I looked up Paxil in The Physicians’ Desk Reference and found, under “Other Events Observed During Coolman 1/4 Page Ad Here the Premarketing Evaluation of Paxil,” side effects related to hearing. These side effects were as follows: tinnitus, frequent; otitis media (inflammation or infection of the middle ear), infrequent; deafness, rare. Glucocorticosteroids can cause tinnitus. Among them are prednisolone (Prednisone) and adrenocorticotrophic hormone or ACTH.
Anesthetics that can cause tinnitus are bupivacain, tetracain and lidocaine (Novacaine).
Antimalarials that can cause tinnitus are chloroquine (Aralen) and hydroxychloroquine (Plaquinil). Besides these medications, some common toxic substances that can cause tinnitus are alcohol, caffeine, lead, marijuana, nicotine and mercury.
This list is not exhaustive. Consult with your doctor if you have a question about the ototoxic effect of any drug you are taking.
Most of the information in this article was obtained from an article published in the Hearing Rehabilitation Quarterly, Vol. 22, No. 2, 1997, by Orin S. Kaufman, D.O., a physician and volunteer at the League for the Hard of Hearing. Their website address is www. lhh.org. Click on site contents. Then scroll down to ototoxic medications.
