What should I do if I experience tinnitus (ringing in the ears) while taking buspirone (anxiolytic medication)?

Managing Tinnitus Associated with Buspirone

If you experience tinnitus (ringing in the ears) while taking buspirone, you should discontinue the medication and consult your healthcare provider as this is likely a medication side effect that warrants consideration of alternative anxiolytic treatment. 1, 2

Understanding the Connection

Tinnitus (perception of sound when no external sound is present) can be classified in several ways:

• Subjective (heard only by the patient) vs. objective (audible to examiner)
• Pulsatile (synchronous with heartbeat) vs. nonpulsatile (continuous sound)
• Primary (idiopathic) vs. secondary (associated with an underlying cause)

In the case of buspirone-associated tinnitus:

• This would be classified as secondary, medication-induced tinnitus
• It is typically nonpulsatile and subjective in nature
• It represents an adverse drug effect that should prompt medication reassessment

Evaluation Process

When experiencing tinnitus while on buspirone:

1. Determine if the tinnitus is unilateral or bilateral

   • Unilateral tinnitus requires more urgent evaluation 1
   • Bilateral tinnitus is more consistent with medication effect

2. Assess if tinnitus is pulsatile or nonpulsatile

   • Medication-induced tinnitus is typically nonpulsatile
   • Pulsatile tinnitus requires vascular imaging evaluation 1

3. Check for associated symptoms

   • Hearing loss
   • Neurological symptoms
   • Vertigo
   • These would require additional evaluation beyond medication adjustment 1, 2

Management Algorithm

1. Discontinue buspirone

   • This is the first-line approach as buspirone is likely the causative agent
   • Most medication-induced tinnitus resolves with discontinuation of the offending agent

2. Audiologic examination

   • Recommended if tinnitus persists beyond medication discontinuation
   • Essential if tinnitus is unilateral or associated with hearing difficulties 1, 2

3. Consider imaging only if:

   • Tinnitus localizes to one ear
   • Tinnitus is pulsatile
   • There are focal neurological abnormalities
   • There is asymmetric hearing loss 1, 2

4. Alternative anxiolytic options:

   • Consider non-serotonergic anxiolytics
   • Cognitive Behavioral Therapy (CBT) has the strongest evidence base for anxiety management 2
   • Sound therapy may help manage both anxiety and tinnitus symptoms 2

Important Considerations

• Avoid other medications known to cause tinnitus while recovering from buspirone-induced tinnitus
• Do not use dietary supplements like Ginkgo biloba, melatonin, or zinc for tinnitus management as they lack evidence of efficacy 2
• Report this adverse effect to your healthcare provider as it may need to be documented as a medication allergy/intolerance
• Temporary sound therapy (background noise, white noise machines) may help manage tinnitus symptoms during recovery

Red Flags Requiring Immediate Attention

Seek immediate medical attention if tinnitus is accompanied by:

• Worsening headache
• Focal neurological deficits
• Confusion or memory problems
• Sudden hearing loss
• Severe vertigo 2

Buspirone-induced tinnitus is not well-documented in major clinical trials but represents an adverse effect that should prompt medication discontinuation and consideration of alternative anxiolytic strategies.