Can bupropion (antidepressant) cause tinnitus?

Bupropion and Tinnitus

Yes, bupropion can cause tinnitus, as it is specifically listed as an adverse reaction in the FDA drug label at rates significantly higher than placebo (6% vs. 2% at 300mg/day dosing). 1

Evidence for Bupropion-Induced Tinnitus

The FDA drug label for bupropion clearly documents tinnitus as an adverse reaction:

• In controlled clinical trials, tinnitus occurred in 6% of patients taking bupropion HCl sustained-release 300mg/day compared to only 2% in the placebo group 1
• Tinnitus was also reported in 6% of patients taking bupropion HCl sustained-release 400mg/day 1
• In seasonal affective disorder (SAD) trials, tinnitus occurred in 3% of patients taking bupropion extended-release compared to less than 1% on placebo 1

Additionally, case reports have documented tinnitus as part of the symptom complex in patients taking bupropion. One report described a 67-year-old man who developed paresthesia, dizziness, tinnitus, confusion, and gait impairment shortly after starting bupropion for smoking cessation 2.

Mechanism and Risk Factors

Bupropion's mechanism for causing tinnitus may be related to its effects on:

• Dopaminergic and adrenergic systems 3
• Nicotinic acetylcholinergic receptors inhibition 3
• Neuropsychiatric effects on central nervous system function 1

Clinical Considerations

Dose-Relationship

• Higher incidence of tinnitus is observed at higher doses (300-400mg/day) 1
• Risk appears to be dose-dependent, suggesting dose reduction may help if tinnitus occurs

Management Options

If a patient develops tinnitus while on bupropion:

1. Evaluate severity and impact on quality of life
2. Consider dose reduction if clinically appropriate
3. Discontinuation may be necessary if symptoms are severe or persistent
   • The FDA label notes that tinnitus was among the adverse reactions leading to discontinuation in clinical trials 1

Special Populations

• Patients with pre-existing hearing disorders or tinnitus may be at higher risk
• Elderly patients should be considered for lower starting doses due to increased risk of adverse effects 3

Common Pitfalls

1. Failure to recognize tinnitus as a medication side effect - Always consider medication-induced causes when a patient reports new-onset tinnitus

2. Attributing tinnitus to other causes - While tinnitus has many potential etiologies, the temporal relationship with bupropion initiation or dose increase should raise suspicion for drug-induced tinnitus

3. Missing drug interactions - Combinations with other potentially ototoxic medications may increase risk 4

4. Continuing full-dose therapy despite symptoms - Consider dose reduction or alternative antidepressants if tinnitus is troublesome

Remember that while tinnitus can be distressing, abrupt discontinuation of bupropion should be avoided when possible, as the FDA label recommends gradual tapering to minimize withdrawal symptoms 3.