What medications can cause tinnitus?

From the Guidelines

Medications such as cisplatin, high-dose carboplatin, and certain antibiotics like aminoglycosides can cause tinnitus as a side effect. When considering the potential for medications to cause tinnitus, it's essential to look at the most recent and highest quality evidence available. According to a 2019 study published in The Lancet Oncology 1, patients treated with platinum agents, such as cisplatin, have an increased risk of tinnitus. This study suggests that the risk of tinnitus is also elevated in patients who receive moderate-dose to high-dose head or brain radiotherapy (≥30 Gy) or a combination of both. Some key points to consider regarding medications that can cause tinnitus include:

• Platinum agents like cisplatin are known to increase the risk of tinnitus 1
• High-dose carboplatin (>1500 mg/m2) may also contribute to the development of tinnitus 1
• Certain antibiotics, particularly aminoglycosides, can damage inner ear structures and lead to tinnitus
• The mechanism of medication-induced tinnitus often involves direct damage to the sensory cells in the inner ear or altered blood flow to the ear
• Tinnitus caused by medications can be dose-dependent and may improve when the medication is stopped or the dosage is reduced It's crucial for healthcare providers to be aware of the potential risks of tinnitus associated with certain medications and to refer patients with symptoms of tinnitus to an audiologist for further evaluation and management 1.

From the FDA Drug Label

BOXED WARNING WARNINGS ... Neurotoxicity manifested by ototoxicity, both vestibular and auditory, can occur in patients treated with Gentamicin Sulfate Injection, USP, primarily in those with pre-existing renal damage and in patients with normal renal function treated with higher doses and/or for longer periods than recommended. Aminoglycoside-induced ototoxicity is usually irreversible ... Evidence of ototoxicity (dizziness, vertigo, tinnitus, roaring in the ears or hearing loss) or nephrotoxicity requires dosage adjustment or discontinuance of the drug.

WARNINGS ... Cases of tinnitus and reversible or irreversible hearing impairment and deafness have been reported Reports usually indicate that furosemide ototoxicity is associated with rapid injection, severe renal impairment, the use of higher than recommended doses, hypoproteinemia or concomitant therapy with aminoglycoside antibiotics, ethacrynic acid, or other ototoxic drugs

The medications that can cause tinnitus are:

• Gentamicin (IV) 2
• Furosemide (PO) 3 Key factors that may increase the risk of ototoxicity include:
• High doses
• Prolonged therapy
• Pre-existing renal damage
• Concomitant use of other ototoxic drugs
• Rapid injection
• Severe renal impairment
• Hypoproteinemia

From the Research

Medications that Can Cause Tinnitus

The following medications have been identified as potential causes of tinnitus:

• Antineoplastic chemotherapeutic agents and heavy metals 4
• Antimetabolites, antitumor agents, antibiotics, and ototoxic antibiotics and diuretics 4
• Nonnarcotic analgesics and antipyretics, such as aspirin and acetaminophen 4, 5
• Oral contraceptives 4
• Quinine and chloroquine 4
• Salicylates, including high-dose aspirin 4, 5
• Selective serotonin reuptake inhibitors (SSRIs), such as sertraline 6
• Non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) 5

Mechanisms of Action

The exact mechanisms by which these medications cause tinnitus are not fully understood, but may involve:

• Alterations in serotonin receptor subtypes within the auditory system 6
• Priming effect of salicylate agents on the auditory system, predisposing patients to be more sensitive to auditory stimuli 6
• Ototoxic effects of certain antibiotics and diuretics 4
• Analgesic use, which may be associated with a higher risk of developing persistent tinnitus 5

Key Findings

• Frequent moderate-dose aspirin use was associated with a higher risk of tinnitus among women aged < 60 years 5
• Frequent NSAID use and frequent acetaminophen use were associated with a higher risk of incident persistent tinnitus among all women 5
• The risk of developing persistent tinnitus was not elevated among frequent low-dose aspirin users 5