Medications for Tinnitus: Treatment Efficacy and Side Effects
Direct Answer
No medications are recommended for the routine treatment of persistent, bothersome tinnitus due to insufficient evidence of benefit, known side effects, and potential for some medications (particularly antidepressants) to actually worsen tinnitus. 1, 2, 3
Medications Specifically NOT Recommended
The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends against the following medication classes for tinnitus treatment:
Psychotropic Medications
- Antidepressants: Not recommended due to insufficient evidence and potential to worsen tinnitus 1, 2, 3
- Anticonvulsants: Not recommended for routine treatment; systematic reviews show no evidence of large positive effect, with only small effects of doubtful clinical significance 1, 4, 5
- Anxiolytics (including benzodiazepines like clonazepam): Not recommended despite theoretical GABAergic mechanisms, due to insufficient evidence and significant side effects including daytime sleepiness, dizziness, postural instability, tolerance, dependence, and cognitive impairment 6, 5
Other Medications
Dietary Supplements NOT Recommended
Clinicians should not recommend the following supplements due to lack of consistent benefit, methodological concerns in trials, and variable content in over-the-counter preparations:
Side Effects of Commonly Used Medications
Anticonvulsants
- Side effects experienced by approximately 18% of patients 4
- Specific agents studied include gabapentin, carbamazepine, lamotrigine, and flunarizine 4
- One study showed gabapentin actually increased Tinnitus Questionnaire scores by 18.4 points compared to placebo 4
Benzodiazepines (Clonazepam)
- Daytime sleepiness, dizziness, and postural instability (particularly problematic in elderly) 6
- Long-term risks: tolerance, dependence, and cognitive impairment 6
- Listed as potentially inappropriate medication in older adults by the American Geriatrics Society 6
Medications That Can CAUSE Tinnitus
Multiple drug classes can induce unwanted tinnitus as a side effect 7, 8:
- Duloxetine: Strongest association (ROR 11.99) among tinnitus-related drugs 8
- Ciprofloxacin: Strong association (ROR 9.96) 8
- Antineoplastic chemotherapeutic agents and heavy metals 7
- Ototoxic antibiotics and diuretics 7
- Salicylates 7
- Nonnarcotic analgesics and antipyretics 7
What DOES Work for Tinnitus
Instead of medications, the evidence supports:
First-Line Interventions
- Cognitive Behavioral Therapy (CBT): Strongest evidence for improving quality of life in persistent, bothersome tinnitus 2, 3, 6, 5
- Hearing aids: Recommended for patients with hearing loss and tinnitus, even if hearing loss is mild or unilateral 2, 3, 6, 5
- Education and counseling: Essential for all patients with persistent, bothersome tinnitus 2, 3, 5
- Sound therapy: May be offered as a management option for symptomatic relief 3, 5
Clinical Pitfalls to Avoid
- Do not prescribe medications without clear evidence that may cause side effects or paradoxically worsen tinnitus 1, 2, 3
- Do not recommend dietary supplements that lack efficacy evidence and have variable active ingredient content 1, 3
- Do not overlook mild hearing loss that could benefit from hearing aid intervention 2, 3
- Recognize that depression and anxiety associated with tinnitus require separate psychiatric evaluation and treatment, not medication for tinnitus itself 3, 6
Special Consideration for Clonazepam
While clonazepam may theoretically address anxiety and sleep disturbances that exacerbate tinnitus perception, it should not be used as primary treatment for tinnitus 6. It may only be considered when tinnitus coexists with severe anxiety/depression significantly impacting quality of life, or when treating concurrent REM sleep behavior disorder 6.