Does Celebrex Make Tinnitus Worse?
Celebrex (celecoxib) is not specifically documented as a cause or exacerbating factor for tinnitus in the available clinical guidelines and evidence. While NSAIDs as a class have been historically associated with ototoxicity, celecoxib does not appear prominently in systematic analyses of drug-induced tinnitus.
Evidence from Drug-Induced Tinnitus Surveillance
The most comprehensive real-world analysis of drug-related tinnitus from the FDA Adverse Event Reporting System (2012-2023) identified the top 25 tinnitus-associated medications, and celecoxib was not among them 1. The drugs most strongly associated with tinnitus were duloxetine, ciprofloxacin, and adalimumab 1.
NSAIDs and Ototoxicity Context
While non-steroidal anti-inflammatory agents as a class have been noted among drugs with ototoxic potential 2, the specific evidence linking celecoxib to tinnitus causation or worsening is absent from current guidelines. The guideline literature on ototoxicity focuses primarily on:
- Platinum-based chemotherapy agents (cisplatin causing tinnitus in most patients during treatment and 40% of long-term survivors) 3
- Aminoglycoside antibiotics (capreomycin, gentamicin causing vestibular disturbances and tinnitus, especially in elderly patients) 3
- Loop diuretics when combined with other ototoxic agents 3
Clinical Considerations for Celebrex Use
If you are concerned about potential auditory effects in a patient taking celecoxib, focus instead on the well-documented risks that should guide prescribing decisions:
Cardiovascular Risk
- Use the lowest effective dose for the shortest duration necessary 4
- Avoid entirely in patients with established cardiovascular disease, heart failure, or elevated cardiovascular risk 4
- May increase blood pressure by approximately 5 mm Hg 4
Gastrointestinal Risk
- While lower than nonselective NSAIDs, GI bleeding risk increases dramatically with age (1 in 110 for adults over 75 versus 1 in 2,100 for adults under 45) 4
- Combine with a proton pump inhibitor in high-risk patients 4
Renal Complications
- Avoid in patients with renal disease or when combining with ACE inhibitors and beta blockers 4
- Approximately 2% of patients develop renal complications requiring discontinuation 4
Medication-Overuse Headache
- Limit use to no more than twice per week or 15 days per month to prevent medication-overuse headache 4, 5
Common Pitfall to Avoid
Do not confuse the general class effect of NSAIDs with specific celecoxib risk. While older literature mentions NSAIDs broadly as potentially ototoxic 2, modern surveillance data does not identify celecoxib as a significant tinnitus-inducing agent 1. If a patient on celecoxib develops tinnitus, investigate other causes including concomitant medications (particularly aminoglycosides, loop diuretics, or chemotherapy agents), underlying Ménière's disease, or age-related hearing changes rather than automatically attributing it to celecoxib.