NYSA of SHHH, Inc.
New York State Association of 
Self Help for Hard of  Hearing People, Inc.
Reporter
 
 
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OTOTOXIC DRUGS – Orin Kaufman, D.O.
 
 
 
This article indicates which most commonly used medications could potentially cause damage to your hearing, or aggravate an already existent problem. It is important that you, the patient, take responsibility in knowing which drugs you should try to avoid. Usually the hearing problems caused by these medications are reversible upon discontinuation of the drug. But there are infrequent times when this change in hearing can be permanent. If you are experiencing a hearing problem, or if there is a hearing disorder in your family, it is imperative that your treating physician and pharmacist be aware of this fact. If you are prescribed one of the medications found on this list, you should speak to your physician to see if another, potentially less toxic drug, could be used in its place. If the drug is over-the-counter, you should ask the pharmacist for a recommendation of a less toxic drug. 

In the list that follows, the generic name of the drug is given first, with the trade name, if available, following in (parentheses) and Capitalized: 

    1 = known to cause hearing loss 
    2 = known to cause tinnitus 
    (ringing in the ear)
Many times a particular generic drug is manufactured under several trade names. The trade names mentioned in this article were selected randomly by the author. The inclusion of a particular trade name and the exclusion of another should not be interpreted as prejudicial either for one nor against the other. 

ANTIBIOTICS 

Aminoglycosides 1,2 amikacin (Amakin), gentamycin (Garamycin), kanamycin (Kantrex), neomycin, streptomycin, tobramycin (Nebcin) amphotericin B 2 capreomycin (Capestat) 1 chloramphenicol (Chloromycetin) 2 erythromycin 1 (EES, E-mycin, Ilosone, Eryc, Pediazole, Biaxin, Zithromax), (Usually ototoxic when given in intravenous doses of 2-4 grams per 24 hours, especially if there is underlying kidney failure), minocycline (Minocin) 1,2 (Similar to erythromycin), polymyxine B 1,2 sulfonamides (Septra, Bactrim) 2 vancomycin (Vancocin) 1,2. 

Found in many over-the- counter antibiotic ointments, Neomycin is the drug that is most toxic to the structure involved in hearing, the cochlea, so it is recommended for external use only. But even this topical therapy has resulted in hearing loss when large areas were treated which allowed for large amounts of the drug to be absorbed into the body. Hearing loss caused by Aminoglycosides is usually permanent. Of particular interest is that topical ear drop medications containing gentamycin or neomycin do not appear to be ototoxic in humans unless the tympanic membrane (eardrum) is perforated. When a solution of an aminoglycoside antibiotic is used on the skin together with an aminoglycoside antibiotic used intravenously, there is a an increased risk of the ototoxic effect, especially if the solution is used on a wound that is open or raw, or if the patient has underlying kidney damage. 

Vancomycin is similar to aminoglycosides in that it may be ototoxic when used intravenously for life-threatening infections. To further exaggerate the problem is the fact that aminoglycosides and vancomycin are often used together intravenously when treating life-threatening infections. 

ANESTHETICS 

lidocaine (Novocain) 2 

ANTIMALARIALS (QUININE) 

chloroquine phosphate (Aralen) 1,2 hydroxychloroquine (Plaquinil) 1,2 quinacrine hydrochloride (Atabrine) 1 quinine sulfate (Quinam) 1. (The ototoxic effects are very similar to those of aspirin). 

CARDIAC (HEART) MEDICATIONS 

flecainide (Tambocar) 2 lidocaine 2, metoprolol (Lopressor) 2 procainamide (Pronestyl) 2 propranolol (Inderal) 2 quinidine (Quinaglute, Quinidex) 1,2 

CHEMOTHERAPEUTIC (CANCER) AGENTS 

bleomycine (Blenoxane) 1,2 bromocriptine (Parlodel) 1 carboplatinum (Carbo-platin) 1,2 cis-platinum (Platinol) 1,2 methotrexate (Rheumatrex) 1,2 nitrogen mustard (Mustargen) 1,2 vinblastin (Velban) 1,2 vincristine (Oncovin) 1. (The ototoxic effects can be minimized by carefully monitoring blood levels). 

DIURETICS 

acetazolamide (diamox) 2 bumetanide (Bumex) 1,2 lorothalidone (Hygroton, Tenoretic) 1,2 ethacrynic acid (Edecrin) 1,2 furosemide (Lasix) 1,2 hydrochlorthiazide (Hydrodiuril) 2 methylchlorthizide (Enduron) 2 

GLUCOCORTICOSTEROIDS (CORTISONE, STEROIDS) 

prednisolone (Prednisone) 2 ACTH (adrenocorticotrophic hormone) (Acthar) 2 

MISCELLANEOUS SUBSTANCES 

alcohol 2 arsenum 2 caffeine 2 lead 2 marijuana 2 nicotine 2 mercury 2 auro-nofin (gold), (Ridaura) 2 

MUCOSAL PROTECTANT (STOMACH ULCER) 

misoprostol (Cytotec) 1 

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) (ARTHRITIS) 

aspirin 1,2 diclofenac (Voltaren) 1,2 diflunisal (Dolobid) 2 etocolac (Lodine) 1 fenoprofen (Nalfon) 1,2 Ibuprofen (Motrin, Advil, Nuprin) 1,2 indomethacin (Indocin) 1,2 isoxicam 2 ketoprofen (Orudis) 2 methyl salicylates (BenGay) 2 naproxen (Naprosyn, Anaprox, Aleve) 1,2 phenylbutazone (Butazolidine) 2 piroxicam (Feldene) 1,2 salicylates 1,2 sulindac (Clinoril) 1,2 tolmetin (Tolectin) 2 

PSYCHOPHARMACOLOGIC (MOOD ALTERING) AGENTS 

amitryptiline (Elavil) 2 benzodiazepine class 2 alprazolam (Xanax), clorazepate (Tranxene), chlordiazepoxide (Librium), diazepam (Valium), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed), oxazepam (Serax), prozepam (Centrax), quazepam (Doral), temazepam (Restoril), triazolam (Halcion) bupropion (Welbutrin) 2 carbamzepine (Tegretol) 2 doxepin (Sinequin) 2 desiprimine (Norpramin) 2 fluoxetin (Prozac) 2 imipramine (Tofranil) 2 lithium (Lithobid) 2 molindon (Moban) 2 phenelzin (Nardil) 2 protriptilin (Vivactil) 2 trazodon (Desyrel) 2 

VAPORS, SOLVENTS 

cyclohexane 2 dichloromethane 2 hexane (gasoline) 2 lindane (Kwell) 2 methyl-chloride 2 methyl-n-butyl-ketone 2 perchlor-ethylene 2 Styrene 2 tetrachlor-ethane 2 toluol 2 trichloroethylene 2 

Ironically, several of the drugs found to cause tinnitus, are also used to treat tinnitus (e.g., amitryptiline, benzodia- zepine class, carbamazapine, furosemide, lidocaine, prednisone). 

Dr. Orin Kaufman is the Chair of the NYSA Health Care Committee.