Medication Interaction Causing Buzzing and Tinnitus
Your symptoms of buzzing and tinnitus are most likely caused by the combination of medications you took, particularly the interaction between bupropion (Wellbutrin) and the components in Tylenol Cold and Flu Severe, with hydroxyzine potentially contributing to the overall effect.
Primary Culprit: Bupropion and Cold Medication Interaction
The FDA drug label for bupropion explicitly lists tinnitus as a common adverse reaction occurring in at least 5% of patients at both 300 mg/day and 400 mg/day doses 1. When combined with other medications that affect the central nervous system, these effects can be amplified 1.
Why This Combination Is Problematic
- Phenylephrine in Tylenol Cold and Flu Severe acts as a sympathomimetic decongestant that can interact with bupropion, which has stimulant-like properties, potentially creating an additive CNS stimulation effect 1
- Dextromethorphan (also in the cold medication) affects neurotransmitter systems and can interact with bupropion to produce neuropsychiatric symptoms including concentration disturbance and confusion 1
- Hydroxyzine, while a sedating antihistamine, can paradoxically contribute to CNS effects when combined with other medications 2
Understanding Your "Buzzing" Sensation
The FDA label for bupropion documents that patients experience agitation, anxiety, dizziness, and tinnitus as common adverse reactions, particularly at higher doses or when combined with other medications 1. Your "buzzing" or "high" feeling likely represents:
- CNS overstimulation from the combined stimulant effects of bupropion and phenylephrine 1
- Tinnitus (ringing in ears) which is a documented adverse effect of bupropion occurring in >5% of patients 1
- Possible mild serotonergic effects from the dextromethorphan-bupropion interaction 1
Critical Warning Signs to Monitor
The American Academy of Otolaryngology-Head and Neck Surgery advises seeking immediate evaluation if experiencing severe anxiety or depression related to tinnitus 3. Additionally, bupropion's FDA label warns about:
- Psychosis and neuropsychiatric reactions including concentration disturbance, paranoia, and confusion 1
- Seizure risk, which is dose-dependent and can be increased by factors that lower seizure threshold 1
Immediate Management Steps
Stop taking the Tylenol Cold and Flu Severe immediately 3. The American Academy of Family Physicians recommends stopping causative medications immediately if medically feasible when tinnitus develops 3.
What to Expect
- Tinnitus from NSAIDs and similar medications is typically reversible upon discontinuation 3
- Your symptoms should improve within 24-48 hours as the cold medication clears your system
- Continue your Wellbutrin as prescribed unless directed otherwise by your prescribing physician 1
Safer Alternatives for Cold Symptoms
If you need cold symptom relief while taking Wellbutrin:
- Avoid combination cold medications that contain multiple active ingredients, as these increase interaction risk 4
- Intranasal corticosteroids (like fluticasone) are safer options that don't interact with bupropion 2
- Second-generation antihistamines (cetirizine, loratadine) are preferable to first-generation agents and have fewer CNS effects 2, 5
- Avoid decongestants containing phenylephrine or pseudoephedrine when taking bupropion due to additive stimulant effects 1
When to Seek Immediate Medical Attention
Contact your physician or seek emergency care if you experience:
- Worsening confusion, hallucinations, or paranoia 1
- Seizure activity 1
- Severe agitation or anxiety 1
- Chest pain or palpitations 1
- Symptoms persisting beyond 48 hours after stopping the cold medication 3
Common Pitfall to Avoid
Never assume over-the-counter medications are safe to combine with prescription psychiatric medications 4. The American Academy of Pediatrics emphasizes that OTC status does not guarantee safety, particularly when combined with other medications 4. Over 130 drugs and chemicals have been reported as potentially ototoxic 6, and combination products significantly increase the risk of adverse interactions 4.
Follow-Up Recommendation
If tinnitus persists beyond one week after discontinuing the cold medication, audiometric testing should be performed to assess for any hearing loss, as the American Academy of Otolaryngology-Head and Neck Surgery recommends comprehensive audiologic examination including pure tone audiometry covering 500-8000 Hz to detect early hearing loss that often accompanies medication-induced tinnitus 3.