Can atorvastatin (Lipitor) or rosuvastatin (Crestor) cause tinnitus?

Statins and Tinnitus: Relationship Between Atorvastatin, Rosuvastatin and Tinnitus

Atorvastatin can cause tinnitus as a documented adverse effect, while there is no strong evidence that rosuvastatin causes tinnitus. In fact, rosuvastatin may potentially improve tinnitus symptoms in some patients with hyperlipidemia.

Evidence for Atorvastatin and Tinnitus

• Tinnitus is specifically listed as an adverse reaction in the FDA-approved labeling for atorvastatin under "Special Senses" category of adverse effects 1

• A case report documented irreversible hearing loss and persistent tinnitus in a 32-year-old man after 18 months of atorvastatin therapy (20 mg daily), with symptoms beginning as occasional tinnitus at 6 months that progressed to continuous tinnitus by 18 months 2

• The manufacturer of atorvastatin has received three unpublished cases of deafness, although causal relationships were reportedly not established 2

Evidence for Rosuvastatin and Tinnitus

• Unlike atorvastatin, rosuvastatin is not specifically associated with tinnitus in the available guidelines or drug labeling 3

• A study examining the effects of statins on hearing function found that rosuvastatin (10 mg and 20 mg) actually showed a significant decrease in tinnitus frequency, duration, severity, and degree of annoyance in hyperlipidemic patients 4

• Rosuvastatin 10 mg was associated with a strong increase in Speech Discrimination percentages after treatment 4

Mechanism and Risk Factors

• The mechanism of statin-induced tinnitus is not fully understood but may involve:

  • Effects on cochlear microcirculation due to changes in cholesterol metabolism 2, 5
  • Possible impact on neuronal function in the auditory pathway 5

• Risk factors that may increase susceptibility to statin-induced tinnitus include:

  • Higher doses of atorvastatin (particularly doses above 20 mg) 2
  • Longer duration of therapy (symptoms may develop after months of treatment) 2
  • Pre-existing hearing issues 5

Therapeutic Considerations

• For patients experiencing tinnitus while on atorvastatin, consider:

  • Switching to rosuvastatin, which has not been associated with tinnitus and may potentially improve tinnitus symptoms in hyperlipidemic patients 4
  • Using the lowest effective dose of statin therapy to achieve lipid goals 3
  • Monitoring for progression of symptoms, as early tinnitus may be a warning sign of potential hearing loss 2

• For hyperlipidemic patients with pre-existing tinnitus:

  • Rosuvastatin may be preferred over atorvastatin based on available evidence 4, 6
  • A study showed that treating hyperlipidemia with atorvastatin improved tinnitus in 70.5% of patients whose cholesterol levels normalized, suggesting that in some cases, the benefit of treating hyperlipidemia may outweigh the risk of medication-induced tinnitus 6

Important Clinical Considerations

• Tinnitus symptoms should be taken seriously and prompt evaluation of statin therapy if they develop during treatment 2

• The risk of statin-induced tinnitus must be balanced against the cardiovascular benefits of statin therapy in patients at risk for cardiovascular disease 3

• Prompt discontinuation of the statin should be considered if tinnitus develops and worsens, as continued exposure may lead to irreversible hearing damage in some cases 2

• When switching between statins, consider that high-intensity statins (atorvastatin 40-80 mg, rosuvastatin 20-40 mg) provide ≥50% LDL-C reduction, while moderate-intensity statins (atorvastatin 10-20 mg, rosuvastatin 5-10 mg) provide 30-49% LDL-C reduction 3