6) What are some ototoxic drugs?
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This article is from the Tinnitus FAQ, by markb@cccd.edu (Mark Bixby) with numerous contributions by others.
6) What are some ototoxic drugs?
All tinnitus sufferers should ask their physician and/or pharmacist about
the potential for ototoxic side effects BEFORE starting a new prescription.
In her book _When the Hearing Gets Hard_ (Insight Books 1993, ISBN
0-306-44505-0), author Elaine Suss names several potentially ototoxic
substances. She lists them in three categories: (1) substances that most
physicians consider ototoxic; (2) substances that many physicians consider
potentially ototoxic; and (3) substances that may be ototoxic in rare
cases. The ototoxic effects of the substances in the third list are
considered to be reversible--the effects diminish when you stop taking the
drug. Ms. Suss does not list dosages.
The first group includes a few antibiotics and several diuretics. Not being
a physician, I don't recognize them all, though Capreomycin, Gentamicin ,
Kanamycin, Neomycin, Streptomycin, Tobramycin sulphate, Vancomycin, and
Viomycin are obviously antibiotics. Ms. Suss mentions that Streptomycin is
used only for certain cases of tuberculosis.
The first group also includes aspirin--ototoxic at higher doses and whose
effects are usually reversible--and other salicylates such as Oil of
Wintergreen (Ben Gay). The other substances in the first group are:
Amikacin, Amphotericin B (Fungizone), Bumetanide (Bumex), Carboplatin
(Paraplatin), Chloroquine (Aralen), Cisplatin (Platinol), Ethacrynic acid
(Edecrin), Furosemide (Lasix), and Hydroxychloroquine (Plaquenil).
The second group includes the analgesic Ibuprofen (Advil) and the tricyclic
anti-depressant Imipramine (Tofranil), along with Chloramphenicol
(Chloromycetin), lead, and quinine sulphate.
The third group includes alcohol, toluene, and trichloroethylene, as well
as Chlordiazepoxide (Librium), Chlorhexidene (Phisohex, Hexachlorophene),
Ampicillin, Iodoform, Clemastin fumarate (Tavist), Chlomipramine
hydrochloride (Anafranil), and Chorpheniramine Maleate (Chlor-trimeton and
several others).
Ms. Suss points out that the _Physicians Desk Reference_ (PDR) did not list
ototoxic drugs until the 1989 and later editions. She refers to a separate
document, _Drug Interactions and Side Effects Index_, which is keyed to the
PDR. She then points out that the Index is incomplete: several problem
drugs are not listed there.
Although the lists of ototoxic drugs are useful, I cannot recommend this
book to tinnitus sufferers in general because it is devoted almost entirely
to the problems of the hearing impaired and methods for ameliorating them.
The book mentions tinnitus primarily as a precursor to hearing loss. (I do
not believe that is the general case.)
The book _Tinnitus: Diagnosis/Treatment_ (Lea & Febiger, 1991, ISBN
0-8121-1121-4) adds that ototoxic symptoms may arise days or even weeks
after the termination of aminoglycoside antibiotics. Some of these
aminoglycosides not listed above are Netilmycin and Erythromycin. Other
trouble antibiotics include Colistimethate, Doxycycline and Minocycline.
The following is a list of drugs that have demonstrated Tinnitus side
effects as indicated in the 1995 "Physicians Desk Reference" and
distributed by the American Tinnitus Association:
Accutane [less than 1%] Mazicon [less than 1%] Acromycin V Meclomen [greater than 1%] Actifed with Codiene Cough Syrup Methergine [rare] Adalat CC [less than 1%] Methotrexate [less common] Alferon N [one patient] Mexitil [1.9% to 2.4%] Altace [less than 1%] Midamor [less than or equel to 1%] Ambien [infrequent] Minipress [less than 1%] Amicar [occasional] Minizide [rare] Anatranil [4-5%] Mintezol Anaprox and Anaprox DS [3-9%] Moduretic Anestacon [among most common] Mono-Cesac Ansaid [1-3%] Monopril [0.2-1%] Aralen Hydrochloride [one Patient] Monopril [0.2-1%] Arithritis Strength BC Powder Motrin [less than 3%] Asacol Mustargen [infrequent] Ascriptin A/D Mykrox [less than 2%] Ascriptin Nalfon [4.5%] Asendin [less than 1%] Naprosyn [3-9%] Asperin [among most frequent] Nebcin Atretol Neptazane Atrofen Nescaine Atrohist Plus Netromycin Azactam [less than 1%] Neurontin [infrequent] Azo Gantanol Nicorette Azo Gantrisin Nipent [less than 3%] Azulfidine [rare] Nipride BC Powder Noroxin Bactrim DS Norpramin Bactrim I.V. Norvasc [0.1-1%] Bactrim Omnipaque [less than 0.1%] Blocadren [less than 1%] Omniscan [less than 1%] Buprenex [less than 1%] Ornade BuSpar [frequent] Orthoclone OKT3 Cama Orudis [greater than 1%] Capastat Sulfate Oruvail [greater than 1%] Carbocaine Hydrochloride P-A-C Analgesic Cardene [rare] PBZ Cardioquin Pamelor Cardizem [less than 1%] Parnate '' CD [less than 1%] Paxil [infrequent] '' SR [less than 1%] Pedia-Profen [greater than 1% less than 3%] Cardura [1%] Pediazole Cartrol [less common] Penetrex [less than 1%] Cataflam [1-3%] Pepcid [infrequent] Childrens Advil [less than 3%] Pepto-Bismol Cibalith-S Periactin Cinobac [less than 1 in 100] permax [infrequent] Cipro [less than 1%] Phenergan Claritin [2% or less] Phrenilin [infrequent] Clinoril [greater than 1%] Piroxicam [1-3%] Cognex Plaquenil Corgard [1-5 of 1000 patients] Platinol Corzide [ '' ] Plendil [0.5% or greater] Cuprimine [greater than 1%] Pontocaine Hydrochloride Cytotec [infrequent] Prilosec [less than 1%] Dalgan [less than 1%] Primaxin [less than 2%] Dapsone USP Prinvil [0.3-1%] Daypro [greater than 1% less than 3%] Prinzide [0.3-1%] Deconamine Procardia [1% or less] Demadex ProSam [infrequent] Depen Titratable Proventil [2%] Desferal Vials Prozac [infrequent] Desyrel & Desyrel Dividose [1.4%] Questran Diamox Quinaglute Dilacor XR Quinamm Dipentum [rare] Quinidex Diprivan [less than 1%] Q-vel Muscle Relaxant Pain Reliever Disalcid Recombivax HB [less than 1%] Dolobid [greater than 1% in 100] Relafen [3-9%] Duranest Rheumatrex Methotrexate [less common] Dyphenhydramine [Nytol, Benydrl, etc] Rifater Dyclone Romazicon [less than 1%] Dasprin Ru-Tuss Easprin Rythmol Ecotrin Salflex Edecrin Sandimmune [2% or less] Effexor [2%] Sedapap [infrequent] Elavil Sensorcaine Eldepryl Septra Emcyt Sinequan [occasional] Emla cream Soma Compound Empirin with Codiene Sporanox [less than 1%] Endep Stadol [3-9%] Engerix-B Streptomycin Sulfate Equagesic Sulfadiazine Esgic-plus [infrequent Surmontil Eskalith Talacen [rare] Ethmozine [less than 2%] Talwin [rare] Etrafon Tambocor [1% or less than 3%] Fansidar Tavist and Tavist-D Feidene [1-3%] Tegretol Fioricat with Codeine [infrequent] Temaril Flexeril [less than 1%] Tenex [3% or less] Floxin [less than 1%] Thera-Besic Foscavir [1-5%] Thiosulfil Forte Fungijzone Ticlid [0.5-1%] Ganite Timolide Gantanol Timoptic Gantrisin Tobramycin Garamycin Tofranil Glauctabs Tolectin [1-3%] HIVID [less than 1%] Tonocard [0.4-1.5%] Halcion [rare] Toprol XL Hyperstat Toradol [1% or less] Hytrin [at least 1%] Torecan Ibuprofen [less than 3%] [Advil, etc.} Trexan Ilosone Triaminic Imdur [less than or equal to 5%] Triavil Indocin [greater than 1%] Trilisate [less than 20%] Intron A [up to 4%] Trinalin Repetabs Kerione [less than 2%] Tympagesic Ear Drops Lariam [among most frequent] Ursinus Lasix Vancocin HCI [rare] Legatrin Vantin [less than 1%] Lncocin [occasional] Vascor [up to 6.52%] Lioresal Vaseretic [0.5-2%] lithane Vasotec [0.5-1%] Lithium Carbonate Vivactil Lithobid Voltqaren [1-3%] Lithonate Wellbutrin Lodine [greater than 1% less than 3%] Xanax [6.6%] Lopressor Ampuis Xylocaine [among most common] Lopressor DCT [1 in 100] Zestril '0.3-1%] Lopressor Zestoretic [0.3-1%] Loreico Ziac Lotensin HCT [0.3-1%] Zoleft [1.4%] Ludiomil [rare] Zosyn [less than 1%] MZM [among most frequent] Zyloprim [less than 1%] Magnevist [less than 1%] Marinol (Dronabinol) [less than 1%] Risperdal [rare] Marcaine Hydrochloride Marcaine Spinal Maxaquin [less than 1%]
Your physician should always be consulted about questions before any
changes are made in your medication.
The absence of incidence data means there was none given, and/or it is
unknown.
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