Which medications are known to cause or worsen tinnitus (ringing in the ears)?

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Medications That Cause Tinnitus (Ringing in the Ears)

Multiple drug classes are well-established causes of tinnitus, with chemotherapeutic agents (particularly cisplatin and carboplatin), aminoglycoside antibiotics, loop diuretics, and NSAIDs being the most common and potent offenders. 1, 2

Highest-Risk Medications

Chemotherapeutic Agents (Greatest Risk)

  • Cisplatin increases tinnitus risk by 5.53-fold compared to non-ototoxic medications, making it the most potent ototoxic agent for causing tinnitus 1
  • Carboplatin increases tinnitus risk by 3.75-fold, representing the second-highest risk among chemotherapy agents 1
  • No treatment exists to reverse established ototoxicity from platinum-based chemotherapy 3

Antibiotics

  • Aminoglycoside antibiotics (streptomycin, amikacin, kanamycin) cause both tinnitus and permanent hearing loss through destruction of auditory sensory cells in the organ of Corti 4, 2, 5
  • Capreomycin causes tinnitus and deafness, particularly in elderly patients or those with preexisting renal impairment 4
  • Ciprofloxacin shows strong association with tinnitus (ROR 9.96) in post-marketing surveillance data 6
  • Chloramphenicol has minimal direct ototoxicity but potentiates noise-induced cochlear damage 7

Loop Diuretics

  • Furosemide, bumetanide, and other loop diuretics cause acute, typically transient tinnitus and hearing impairment, especially with high-dose therapy 2, 5
  • Thiazide diuretics (hydrochlorothiazide, indapamide) also cause tinnitus 4, 2

Anti-Inflammatory Medications

  • NSAIDs (ibuprofen, naproxen, indomethacin, celecoxib, diclofenac) cause acute and typically transient tinnitus, particularly with high-dose therapy 2, 5

Moderate-Risk Medications

Cardiovascular Drugs

  • Antiarrhythmics: amiodarone and dronedarone 4
  • ACE inhibitors: ramipril, enalapril, quinapril 4
  • Angiotensin receptor blockers: candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan 4
  • Calcium channel blockers: amlodipine, diltiazem, nifedipine 4
  • Statins: atorvastatin, pravastatin, simvastatin 4

Psychiatric Medications

  • Antidepressants show strong association with tinnitus, particularly duloxetine (ROR 11.99, the highest among all drugs analyzed) 6
  • Other antidepressants: citalopram, escitalopram, fluoxetine, paroxetine, sertraline, venlafaxine 4
  • Antipsychotics: aripiprazole, chlorpromazine, clozapine, haloperidol, olanzapine, risperidone 4
  • Anxiolytics: alprazolam, chlordiazepoxide 4

Other Antimicrobials

  • Antifungals, antimalarials, anti-tuberculous drugs, antiretrovirals, beta-lactams, fluoroquinolones, sulfonamides, tetracyclines 4, 2

Critical Clinical Considerations

Risk Factors for Permanent Damage

  • Renal insufficiency dramatically increases both ototoxicity and nephrotoxicity risk with aminoglycosides and capreomycin, requiring dose reduction to 2-3 times weekly (but maintaining mg/kg dose) 4
  • Elderly patients face higher risk of vestibular disturbances, tinnitus, and deafness from capreomycin 4
  • Pregnancy: capreomycin causes fetal nephrotoxicity and congenital hearing loss and should be avoided 4

Mechanism Patterns

  • Drugs causing permanent hearing loss produce tinnitus secondary to cochlear damage (aminoglycosides, platinum chemotherapy, long-term antineoplastics) 2, 5, 7
  • Drugs causing tinnitus without hearing loss likely act through central nervous system biogenic amine effects or proconvulsant mechanisms 7
  • Pre-existing cochlear impairment is the underlying factor in most patients who develop drug-induced tinnitus 7

Synergistic Toxicity

  • Simultaneous administration of multiple ototoxic agents causes synergistic hearing loss 5
  • Noise exposure potentiates ototoxicity from cochleotoxic drugs, placing patients at greater risk than either exposure alone 5, 7

Management Approach

When Tinnitus Develops During Treatment

  • For chemotherapy-induced tinnitus, hearing aids and cognitive behavioral therapy remain beneficial, though no treatment reverses established ototoxicity 3, 8
  • Discontinuation may be necessary to prevent permanent damage when tinnitus develops with reversible ototoxic agents 2
  • Monitor renal function, serum drug concentrations, and auditory function before and during therapy with high-risk medications 4, 2

Common Pitfall

  • Do not prescribe antidepressants, anticonvulsants, or anxiolytics to treat drug-induced tinnitus, as these medications themselves can cause or worsen tinnitus and lack evidence for benefit 8, 9

References

3
Guideline

Tinnitus Treatment Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

4
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Drug-induced ototoxicity. Pathogenesis and prevention.

Medical toxicology and adverse drug experience, 1989

6
Research

Analysis of Drug-Related Tinnitus Based on the FDA Adverse Event Reporting System Database.

British journal of hospital medicine (London, England : 2005), 2024

7
Research

Ototoxic drugs and noise.

Ciba Foundation symposium, 1981

8
Guideline

Tinnitus Management Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

9
Guideline

Tinnitus Management Guideline

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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