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6) What are some ototoxic drugs?


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


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