From the Guidelines
Medications that can cause tinnitus as a side effect include aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), aminoglycosides, cancer medications, loop diuretics, antimalarial drugs, antidepressants, blood pressure medications, and antiseizure drugs. These medications can damage the delicate hair cells in the inner ear or disrupt nerve signals from the ear to the brain, leading to tinnitus 1.
Key Medications to Avoid
- High doses of aspirin and other NSAIDs like ibuprofen and naproxen
- Aminoglycosides such as gentamicin, streptomycin, and neomycin
- Cancer medications like cisplatin and vincristine
- Loop diuretics including furosemide and bumetanide
- Antimalarial drugs like quinine and chloroquine
- Certain antidepressants, which can worsen tinnitus 2 ### Recommendation Clinicians should not routinely recommend medications that may exacerbate tinnitus, and patients should consult their healthcare provider if they experience ringing or other phantom sounds after starting a new medication. The healthcare provider can help determine if the medication is the cause and suggest alternatives if necessary [(1, 2)]. It is essential to weigh the benefits and harms of medical therapy, considering the potential for medications to worsen tinnitus or have significant side effects 1.
From the FDA Drug Label
ADVERSE REACTIONS: ... Serious adverse effects on both vestibular and auditory branches of the eighth nerve have been reported, primarily in patients with renal impairment (especially if hemodialysis is required) and in patients on high doses and/or prolonged therapy Symptoms include dizziness, vertigo, tinnitus, roaring in the ears and also hearing loss, which, as with the other aminoglycosides, may be irreversible.
- Gentamicin is a medication that can cause tinnitus (ringing in the ears) 3.
- The risk of tinnitus is higher in patients with renal impairment, those receiving high doses, and those on prolonged therapy.
- Tinnitus may be accompanied by other symptoms such as dizziness, vertigo, roaring in the ears, and hearing loss.
From the Research
Medications that Cause Tinnitus
The following medications can cause or aggravate tinnitus:
- Anesthetics, antiarrhythmics, anticonvulsants, antidepressants, antihistamines, antipsychotics, anxiolytics, calcium channel blockers, cholinergic antagonists, NMDA antagonists, muscle relaxants, vasodilators, and vitamins 4
- Antineoplastic chemotherapeutic agents and heavy metals, antimetabolites, antitumor agents, antibiotics, caffeine, cocaine, marijuana, nonnarcotic analgesics and antipyretics, ototoxic antibiotics and diuretics, oral contraceptives, quinine and chloroquine, and salicylates 4
- Ototoxic antibiotics such as aminoglycoside antibiotics 5, 6
- Chemotherapeutic agents such as cisplatin and carboplatin 6
- Diuretics such as chlorthalidone, hydrochlorothiazide, and acetazolamide 5
- Non-steroidal anti-inflammatory agents 5
- Certain anticancer agents and some miscellaneous chemicals 5
Mechanisms of Tinnitus Onset
The mechanisms of tinnitus onset from these medications are not fully understood, but it is thought that they may be related to their effects on the inner ear or the central nervous system 4, 5, 7. Some medications may cause tinnitus by inducing hearing loss, while others may cause tinnitus without any accompanying hearing loss 7.
Risk Factors for Tinnitus Onset
The risk of developing tinnitus from these medications may be increased in patients with pre-existing hearing loss or other underlying conditions 6, 8. However, the exact risk factors and mechanisms of tinnitus onset are still not fully understood and require further research.