Can chlorthalidone cause hearing loss?

Chlorthalidone and Hearing Loss

Chlorthalidone is not known to cause hearing loss based on current clinical guidelines and available evidence. While thiazide and thiazide-like diuretics like chlorthalidone have several well-documented side effects, hearing loss is not among them.

Known Side Effects of Chlorthalidone

Chlorthalidone has several documented adverse effects that clinicians should monitor for:

1. Electrolyte Abnormalities:

   • Hypokalemia is the most significant concern, with chlorthalidone causing a 2-3 times higher risk compared to hydrochlorothiazide 1
   • A large retrospective cohort study found chlorthalidone significantly increased the risk for hospitalization due to hypokalemia compared with hydrochlorothiazide (adjusted hazard ratio: 3.06) 1

2. Metabolic Effects:

   • May increase uric acid levels, though gout is uncommon with dosages ≤25 mg 2
   • Small increases in fasting glucose levels (1.5–4.0 mg/dL) 2

3. Sexual Dysfunction:

   • In the Treatment of Mild Hypertension Study (TOMHS), participants randomized to chlorthalidone reported a significantly higher incidence of erection problems through 24 months, though incidence rates at 48 months were similar to placebo 2

Ototoxic Medications (Not Including Chlorthalidone)

Several medications are known to cause hearing loss, but chlorthalidone is not among them. Known ototoxic medications include:

• Aminoglycoside antibiotics 3, 4
• Loop diuretics (such as furosemide) 3, 4
• Cancer drugs (particularly cisplatin) 3
• Non-steroidal anti-inflammatory drugs 4
• Phosphodiesterase-5 inhibitors such as tadalafil 3

Therapeutic Use in Inner Ear Conditions

Interestingly, chlorthalidone has actually been used therapeutically for certain inner ear conditions:

• Chlorthalidone has been used in the treatment of Menière's disease, where it can cause short-term fluctuations in hearing that may be beneficial diagnostically and for managing vertigo attacks 5
• A retrospective analysis found that while chlorthalidone caused short-term changes in hearing in Menière's disease patients, it did not cause long-term hearing deterioration even after 5-13.4 years of use 5

Clinical Implications

When prescribing chlorthalidone:

• Monitor for electrolyte abnormalities, particularly hypokalemia, which is more common with chlorthalidone than hydrochlorothiazide 1
• Consider starting with lower doses (6.25 mg) which have been shown to effectively reduce 24-hour ambulatory blood pressure while minimizing side effects 6
• Be aware that sodium restriction may increase diuretic-induced potassium loss through increased renin-angiotensin-aldosterone system activity 7

Conclusion

While monitoring for the known side effects of chlorthalidone is important, current evidence does not support hearing loss as an adverse effect of this medication. If a patient on chlorthalidone reports hearing changes, other causes should be investigated, including other potentially ototoxic medications, age-related hearing loss, or underlying conditions.