Understanding Drug-Induced Tinnitus
Tinnitus is the perception of sound, like ringing or buzzing, without an external source [1.4.5]. When a medication causes or worsens this condition, it's known as ototoxicity, which literally means 'ear poisoning' [1.4.7]. These drugs can damage the delicate sensory cells in the inner ear responsible for hearing and balance [1.4.2]. The damage can result from reduced blood flow to the cochlea, direct toxicity to the inner ear hair cells, or interference with the neurotransmitters that process sound [1.4.6, 1.4.7]. While many instances of drug-induced tinnitus are temporary and resolve after discontinuing the medication, some drugs can cause permanent damage, especially at high doses or with long-term use [1.6.1, 1.6.2].
Common Classes of Medications That Trigger Tinnitus
A wide range of prescription and over-the-counter medications have been linked to tinnitus. It's important to note that not everyone who takes these drugs will experience this side effect [1.2.6].
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Commonly used for pain and inflammation, frequent or high-dose use of NSAIDs like ibuprofen (Advil, Motrin) and naproxen (Aleve) can lead to tinnitus [1.3.5]. Aspirin is particularly well-known for this, though the tinnitus is typically reversible once the dosage is reduced or stopped [1.6.1]. Low-dose aspirin (100 mg or less) is not generally associated with a higher risk [1.4.1]. The mechanism involves reducing blood flow to the cochlea [1.4.6].
Antibiotics
Certain classes of antibiotics are known to be ototoxic. Aminoglycosides, such as gentamicin and neomycin, are powerful antibiotics used for severe bacterial infections that can cause permanent tinnitus and hearing loss [1.6.2, 1.3.8]. Other antibiotics, including erythromycin, tetracycline, and ciprofloxacin, have also been identified as potential triggers [1.2.2, 1.2.3]. A study analyzing the FDA Adverse Event Reporting System found a strong association between the antibiotic ciprofloxacin and reports of tinnitus [1.3.2, 1.3.3].
Diuretics
Loop diuretics, such as furosemide (Lasix) and bumetanide (Bumex), are used to treat high blood pressure and fluid retention [1.2.6]. These medications can alter the fluid and electrolyte balance within the inner ear, potentially causing temporary or, in rare cases, permanent tinnitus [1.4.6, 1.2.6]. The risk is higher for patients with renal failure or those receiving high intravenous doses [1.4.4].
Antidepressants and Anti-Anxiety Medications
Some antidepressants, particularly tricyclic antidepressants (like amitriptyline) and Selective Serotonin Reuptake Inhibitors (SSRIs) (like Zoloft and Prozac), can induce or worsen tinnitus [1.2.3, 1.2.6]. It's thought that these drugs may affect neurotransmitters in the brain that influence auditory processing [1.2.6]. A recent analysis identified the antidepressant duloxetine as having one of the strongest associations with drug-induced tinnitus [1.3.2, 1.3.3]. Tinnitus can also be a withdrawal symptom when tapering off benzodiazepines like Xanax and Valium [1.4.1].
Cancer Medications (Chemotherapy)
Certain chemotherapy drugs, especially platinum-based agents like cisplatin and carboplatin, are highly ototoxic and can lead to permanent, irreversible hearing loss and tinnitus [1.2.3, 1.4.4]. The damage is dose-dependent and can appear days or even months after treatment has concluded [1.4.4]. Patients undergoing treatment with these drugs should have their hearing monitored regularly [1.5.5].
Blood Pressure Medications
In addition to diuretics, other blood pressure medications can be associated with tinnitus. These include ACE inhibitors (e.g., lisinopril, enalapril) and some beta-blockers (e.g., metoprolol, carvedilol) [1.2.7]. The association can sometimes depend on whether the drug is taken alone or in combination with other medications [1.2.7].
Comparison of Ototoxic Drug Classes
| Medication Class | Common Examples | Risk of Tinnitus | Potential for Permanence |
|---|---|---|---|
| NSAIDs | Aspirin, Ibuprofen, Naproxen | Dose-dependent, especially with frequent high-dose use [1.3.5] | Usually reversible upon discontinuation [1.6.1] |
| Aminoglycoside Antibiotics | Gentamicin, Neomycin, Tobramycin | High risk, especially with IV use [1.3.8] | Often permanent [1.6.2] |
| Loop Diuretics | Furosemide (Lasix), Bumetanide (Bumex) | Moderate, especially with IV use or kidney failure [1.4.4] | Usually temporary, but can be permanent [1.4.6] |
| Antidepressants (SSRIs, Tricyclics) | Sertraline (Zoloft), Fluoxetine (Prozac), Amitriptyline | Varies by drug; can induce or worsen tinnitus [1.2.6] | Can be temporary or long-lasting [1.4.1] |
| Chemotherapy (Platinum-based) | Cisplatin, Carboplatin | High risk [1.2.3] | Often permanent and irreversible [1.4.4] |
| Antimalarials | Quinine, Chloroquine | Dose-dependent [1.4.1] | Usually temporary, but can be permanent [1.4.8] |
What to Do If You Suspect Drug-Induced Tinnitus
If you develop or notice a worsening of tinnitus after starting a new medication, it is crucial to act promptly. The first and most important step is to contact your prescribing doctor immediately [1.5.6]. Do not stop or alter your medication dosage on your own, as this can have serious health consequences [1.3.1].
Your doctor will:
- Review your full medication list to identify potential culprits [1.5.1].
- Weigh the benefits versus the risks of the medication in question [1.5.1].
- Consider alternatives by possibly recommending a lower dose, switching to a different medication with a lower ototoxicity risk, or stopping the drug if it's safe to do so [1.5.6].
In some cases, especially when taking life-saving drugs like certain chemotherapy agents, discontinuing the medication may not be an option. In these instances, management focuses on hearing monitoring and strategies to cope with the tinnitus, such as sound therapy or Cognitive Behavioral Therapy (CBT) [1.5.4, 1.5.5].
Conclusion
While a long list of medications can potentially trigger tinnitus, the incidence for many is rare [1.3.1]. The key is awareness and communication. Understanding that your new or ongoing tinnitus could be linked to a medication is the first step. By working closely with your healthcare provider, you can assess the cause and determine the best course of action, balancing your treatment needs with your auditory health. In many cases, the tinnitus is temporary and will resolve, but for some potent drugs, the effects can be lasting, highlighting the importance of proactive monitoring and management [1.6.3].
For more information from an authoritative source on tinnitus, please visit the American Tinnitus Association.
