What should I do if I experience tinnitus while taking Simponi (golimumab)?

Management of Tinnitus Associated with Simponi (Golimumab)

If you experience tinnitus while taking Simponi (golimumab), you should discontinue the medication and consult your healthcare provider immediately to discuss alternative treatment options, as medication-induced tinnitus typically resolves upon discontinuation of the causative agent. 1

Initial Assessment

When experiencing tinnitus while on Simponi, determine the following characteristics:

• Whether the tinnitus is unilateral or bilateral
• Whether it is pulsatile or non-pulsatile
• Presence of associated symptoms:
  • Hearing loss
  • Neurological symptoms
  • Vertigo

Red Flags Requiring Immediate Medical Attention

• Worsening headache
• Focal neurological deficits
• Confusion or memory problems
• Increased sleepiness 1

Diagnostic Approach

1. Medication-induced tinnitus evaluation:

   • Simponi (golimumab) is a TNF inhibitor that can potentially cause tinnitus as an adverse effect
   • Medication-induced tinnitus is typically bilateral and non-pulsatile 1

2. Audiologic examination is recommended if:

   • Tinnitus persists beyond medication discontinuation
   • Tinnitus is unilateral
   • Tinnitus is associated with hearing difficulties 1, 2

3. Imaging studies should only be considered if:

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

Management Algorithm

1. First-line approach:

   • Discontinue Simponi (golimumab) in consultation with your rheumatologist 1
   • Most medication-induced tinnitus resolves with discontinuation of the offending agent

2. If tinnitus persists after discontinuation:

   • Comprehensive audiologic examination 1, 2
   • Consider alternative causes of tinnitus

3. Treatment options for persistent tinnitus:

   • Hearing aids if hearing loss is identified (even mild or unilateral) 1, 2
   • Sound therapy to provide relief from tinnitus-associated stress 1, 2
   • Cognitive Behavioral Therapy (CBT) has the strongest evidence base among all interventions for tinnitus management 1, 2
   • Education and counseling about tinnitus mechanisms and management strategies 1

Treatments to Avoid

The American Academy of Otolaryngology-Head and Neck Surgery recommends against:

• Dietary supplements (e.g., Ginkgo biloba, melatonin, zinc) 3, 1
• Antidepressants, anticonvulsants, anxiolytics (except in acute phase) 1, 2
• Transcranial Magnetic Stimulation (TMS) 3, 1
• Acupuncture (insufficient evidence) 3

Alternative Treatment Options

If Simponi was prescribed for an autoimmune condition and needs to be discontinued due to tinnitus:

• Discuss with your rheumatologist about alternative TNF inhibitors or different classes of medications
• Consider non-serotonergic anxiolytics if appropriate for your condition 1
• Monitor closely when starting any new medication for recurrence of tinnitus

Important Considerations

• Tinnitus can significantly impact quality of life and may cause anxiety, depression, and sleep disturbances 4
• The evidence base is strongest for a combination of sound therapy and CBT-based counseling 4
• Medication-induced tinnitus is typically reversible upon discontinuation of the causative agent, unlike other forms of tinnitus which may be permanent 1

Remember that prompt discontinuation of Simponi upon experiencing tinnitus is crucial to prevent potential permanent damage, and always consult with your healthcare provider before making any changes to your medication regimen.