Can trazodone cause tinnitus (buzzing in the ears)?

Can Trazodone Cause Tinnitus (Buzzing in the Ears)?

Yes, trazodone can cause tinnitus as a recognized adverse effect, though this occurs rarely and is specifically listed in the FDA drug label as part of a discontinuation syndrome. 1

FDA-Documented Tinnitus Risk

The FDA label for trazodone explicitly identifies tinnitus as an adverse reaction that can occur during discontinuation syndrome when stopping the medication, particularly after abrupt cessation. 1 This places tinnitus in the category of withdrawal-related neurological symptoms alongside dizziness, sensory disturbances, tremor, and seizures. 1

• The discontinuation syndrome includes tinnitus along with nausea, dysphoric mood, irritability, agitation, dizziness, paresthesia, tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, and seizures. 1
• The FDA recommends gradual dose reduction rather than abrupt cessation to minimize these withdrawal effects. 1

Clinical Evidence on Trazodone and Tinnitus

The relationship between trazodone and tinnitus is complex—it has been studied as a potential treatment for tinnitus but paradoxically can also cause it:

• A 2007 randomized, double-blind, placebo-controlled trial found that trazodone was not effective in controlling tinnitus intensity, discomfort, or quality of life impact compared to placebo, though both groups showed improvement (likely placebo effect). 2
• The American Academy of Sleep Medicine guidelines note that trazodone is not recommended for treating insomnia due to minimal efficacy and side effect concerns. 3
• A comprehensive Cochrane review found insufficient evidence that antidepressants (including trazodone) improve tinnitus, with common side effects including sedation, sexual dysfunction, and dry mouth. 4

Mechanism and Context

Trazodone's effect on serotonergic pathways in the auditory system may explain both its investigation as a tinnitus treatment and its potential to cause tinnitus:

• Serotonin plays a critical role in filtering auditory stimuli through complex interactions between serotonergic, glutamatergic, and GABAergic neurotransmitter systems in the cochlea and auditory pathways. 5
• Over 130 drugs have been reported as potentially ototoxic, with antidepressants representing one major class that can affect auditory function. 6
• Drug-induced tinnitus may involve biochemical and electrophysiological changes in the inner ear and eighth cranial nerve impulse transmission. 6

Clinical Recommendations

If a patient develops tinnitus while taking trazodone:

• First, determine the temporal relationship: Did tinnitus begin shortly after starting trazodone, during dose escalation, or after discontinuation? 1
• Assess tinnitus characteristics: Determine if it is pulsatile versus non-pulsatile, unilateral versus bilateral, and whether it is associated with hearing loss, vertigo, or neurological symptoms. 7
• Consider gradual discontinuation if tinnitus is bothersome and temporally related to trazodone initiation, as abrupt cessation may worsen symptoms. 1
• Obtain comprehensive audiologic examination if tinnitus persists beyond 6 months or is unilateral, including pure tone audiometry, speech audiometry, and acoustic reflex testing. 8

Critical Pitfalls to Avoid

• Do not dismiss new-onset tinnitus in a patient on trazodone as purely drug-related without proper evaluation, as tinnitus can signal serious underlying conditions including vestibular schwannoma, vascular abnormalities, or sudden sensorineural hearing loss. 7, 8
• Do not abruptly discontinue trazodone if attempting to resolve drug-induced tinnitus, as this may paradoxically worsen tinnitus as part of discontinuation syndrome. 1
• Do not order imaging for bilateral, symmetric, non-pulsatile tinnitus without other red flags, but do obtain imaging if tinnitus is unilateral, pulsatile, or associated with asymmetric hearing loss or neurological deficits. 9
• Screen for depression and anxiety in patients with bothersome tinnitus, as these conditions increase suicide risk and require prompt intervention regardless of whether trazodone is the cause. 7, 8