Ototoxic Medications Drugs that can cause hearing loss and tinnitus

This pamphlet indicates which most commonly used medications could potentially cause damage to your hearing, or aggravatean already existing problem.

It is important that you, the patient, take responsibility in knowing which drugs you should try to avoid.
Usually any hearing problem will only be caused by exceeding the recommended dosage
of the medications.
Often these problems are reversible upon discontinuation of the drug.

Occasionally there are times when this change in hearing can be permanent. If you are experiencing a hearing problem, or if there is a hearing disorder in your family, it is imperative that your treating physician and pharmacist be aware of this fact.

If you are prescribed one of the medications found on this list, you should speak to your physician to see if another, potentially less toxic drug, could be used in its place.

If the drug is over-the-counter, you should ask the pharmacist for a recommendation
of a less toxic drug.

In the lists that follow, the generic name of the drug is given first, with the trade name, if available, followed in parentheses and capitalized.

Many times a particular generic drug is manufactured under several trade names.
Orin S. Kaufman, D.O.

The trade names mentioned in this article were selected by the author randomly. 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.

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 are
almost always reversible once medications
are discontinued.)

Antibiotics

• aminoglycosides
– amikacin (Amakin)
– gentamycin (Garamycin)
– kanamycin (Kantrex)
– neomycin (Found in many over-thecounter
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
• 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

• 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.)

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

Vapors, Solvents

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


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 (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).)

Fuente: http://www.chchearing.org/sites/default/files/Ototoxic_Brochure.pdf
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