To: sea_biscuit who wrote (570362 ) 5/4/2004 12:12:59 PM From: Gordon A. Langston Respond to of 769667 Naprosyn was the one that probably affected my mother in law. Drugs That Can Cause Hearing Loss A. Salicylates 1. aspirin and aspirin-containing products 2. salicylates & methyl-salicylates (linaments) (Toxic effects appear to be dose related and are almost always reversible once medications are discontinued). B. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) 1. diclofenac (Voltaren) 2. etocolac (Lodine) 3. fenprofen (Nalfon) 4. ibuprofen (Motrin, Advil, Nuprin, etc.) 5. indomethacin (Indocin) 6. naproxen (Naprosyn, Anaprox, Alleve) 7. piroxicam (Feldene) 8. sulindac (Clinoril) (Toxic effects are dose related and are almost always reversible once medications are discontinued). C. Antibiotics 1. aminoglycosides a. amikacin (Amakin) b. gentamycin (Garamycin) c. kanamycin (Kantrex) d. neomycin (Found in many over-the-counter antibiotic ointments) e. netilmicin (Netromycin) f. streptomycin g. tobramycin (Nebcin) (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 (ear drum) is perforated. When a solution of an aminoglycoside antibiotic is used on the skin together with an aminoglycoside antibiotic used intravenously, there is a risk of an increase 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. Neomycin is the drug that is most toxic to the structure involved in hearing, the cochlea, so it is recommended for topical use only. But even 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 this class of antibiotics is usually permanent). 2. erythromycin a. EES b. E-mycin c. Ilosone d. Eryc e. Pediazole f. Biaxin g. Zithromax (Usually ototoxic when given in intravenous doses of 2-4 grams per 24 hours, especially if there is underlying kidney failure). 3. vancomycin (Vancocin) (Similar to aminoglycosides in that it may be ototoxic when used intravenously in 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). 4. minocycline (Minocin) (Similar to erythromycin). 5. polymixin B & amphotericin B (Antifungal preparations). 6. capreomycin (Capestat) (Anti-tuberculosis medication). D. Diuretics 1. bendroflumethazide (Corzide) 2. bumetadine (Bumex) 3. chlor-thalidone (Tenoretic) 4. ethacrynic acid (Edecrin) 5. furosemide (Lasix) (These are usually ototoxic when given intravenously for acute kidney failure, acute hypertensive crisis, or acute pulmonary edema/congestive heart failure. Rare cases of ototoxicity have been found when these medications are taken orally in high doses by people with chronic kidney disease). E. Chemotherapeutic Agents 1. bleomycine (Blenoxane) 2. bromocriptine (Parlodel) 3. carboplatinum (Carboplatin) 4. cisplatin (Platinol) 5. methotrexate (Rheumatrex) 6. nitrogen mustard (Mustargen) 7. vinblastin (Velban) 8. vincristine (Oncovin) (The ototoxic effects can be minimized by carefully monitoring blood levels). F. Quinine 1. chloroquine phosphate (Aralen) 2. quinacrine hydrochloride (Atabrine) 3. quinine sulfate (Quinam) (The ototoxic effects are very similar to those of aspirin). G. Mucosal Protectant 1. misoprostol (Cytotec) Drugs That Can Cause Tinnitus This list of drugs is very similar to the list of ototoxic drugs that can cause hearing loss. There are some notable additions to the previous list. A. Vapors, Solvents 1. cychohexane 2. dichloromethane 3. hexane (gasoline) 4. lindane (Kwell) 5. methyl-chloride 6. methyl-n-butyl-ketone 7. perchlor-ethylene 8. styrene 9. tetrachlor-ethane 10. toluol 11. trichloroethylene B. Antibiotics 1. aminoglycosides (see previous section) 2. amphotericin B 3. chloramphenicol (Chloromycetin) 4. minocycline (Minocin) 5. polymyxine B 6. sulfonamides (Septra, Bactrim) 7. vancomycin (Vancocin) C. Anti-Neoplastics 1. bleomycin (Blenoxane) 2. cis-platinum (platinol) 3. carboplatinum (Paraplatin) 4. methotrexate (Rheumatrex) 5. nitrogen mustard (Mustagen) 6. vinblastin (Velban) D. Diuretics 1. acetazolamide (diamox) 2. bumetanide (Bumex) 3. bendrofluazide 4. clorothalidone (Hygroton, Tenoretic) 5. diapamide 6. ethacrynic acid (Edecrin) 7. furosemide (Lasix) 8. hydrochlorthiazide (Hydrodiuvil) 9. methylchlorthizide (Enduron) E. Cardiac Medications 1. celiprolol 2. flecainide (Tambocar) 3. lidocaine 4. metoprolol (Lopressor) 5. procainamide (Pronestyl) 6. propranolol (Inderal) 7. quinidine (Quinaglute, Quinidex) F. Psychopharmacologic Agents 1. amitryptiline (Elavil) 2. benzodiazepine class a. alprazolam (Xanax) b. clorazepate (Tranxene) c. chlordiazepoxide (Librium) d. diazepam (Valium) e. flurazepam (Dalmane) f. lorazepam (Ativan) g. midazolam (Versed) h. oxazepam (Serax) i. prozepam (Centrax) j. quazepam (Doral) k. temazepam (Restoril) l. triazolam (Halcion) 3. bupropion (Welbutrin) 4. carbamzepine (Tegretol) 5. diclofensine 6. doexpin (Sinequin) 7. desiprimine (Norpramin) 8. fluoxetin (Prozac) 9. imipramine (Tofranil) 10. lithium 11. melitracen 12. molindon (Moban) 13. paroxetin 14. phenelzin (Nardil) 15. protriptilin (Vivactil) 16. trazodon (Desyrel) 17. zimeldin G. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) 1. asprin 2. acematacine 3. benorilate 4. benoxaprofen 5. carprofen 6. diclofenac (Voltaren) 7. diflunisal (Dolobid) 8. fenoprofen (Nalfon) 9. feprazon 10. ibuprofen (Motrin, Advil, Nuprin) 11. indomethacin (Indocin) 12. isoxicam 13. ketoprofen (Orudis) 14. methyl salicylates (BenGay) 15. naproxen (Naprosyn, Anaprox, Alleve) 16. D-Penicilliamin 17. phenylbutazone (Butazolidine) 18. piroxicam (Feldene) 19. proglumetacin 20. proquazon 21. salicylates 22. sulindac (Clinoril) 23. tolmetin (Tolectin) 24. zomepirac H. Glucocorticosteroids 1. prednisolone (Prednisone) 2. ACTH (adrenocorticotrophic hormone) (Acthar) I. Anesthetics 1. bupivacain 2. tetracain 3. lidocaine (Novacaine) J. Antimalarials 1. chloroquine (Aralen) 2. hydroxychloroquine (Plaquinil) K. Miscellaneous Toxic Substances 1. alcohol 2. arsenum 3. caffeine 4. lead 5. marijuana 6. nicotine 7. mercury 8. auronofin (gold), (Ridaura) Ironically, several of these drugs found to cause tinnitus are also used to treat tinntus (e.g. amitryptiline, benzodiazepine class, carbamzazpine, furosemide, lidocaine, prednisone).