Ototoxic Drug

Aka: Ototoxic Drug, Ototoxic Medication, Ototoxicity, Ototoxic Hearing Loss

1. See Also
   1. Hearing Loss
   2. Sensorineural Hearing Loss
2. Causes: Medications
   1. Analgesics
      1. Aspirin (>2.7 g/day) and other Salicylates
      2. NSAIDs
      3. Acetaminophen
      4. Sulfasalazine (Azulfidine)
      5. Hydrocodone
   2. Antibiotics
      1. Aminoglycosides (Gentamicin, Streptomycin)
         1. Starts with Tinnitus and rapidly progresses to Hearing Loss
         2. Ototoxicity symptoms are permanent if last >2-3 weeks after stopping the Aminoglycoside
      2. Streptomycin
      3. Vancomycin
      4. Erythromycin (dose >2 g/day) and other Macrolides
      5. Chloramphenicol
      6. Tetracyclines such as Doxycycline or Minocycline (transient vestibular toxicity)
      7. Imipenem-Cilastin (Primaxin)
      8. Linezolid (Zyvox)
      9. Sulfonamide
      10. Fluoroquinolones
      11. Voriconazole
      12. Amphoteracin B
      13. Ganciclovir
      14. Ribavirin
   3. Loop Diuretics (especially at high dose with rapid infusion)
      1. Ethacrynic Acid
      2. Furosemide (Lasix)
   4. Antineoplastic
      1. Cisplatin
      2. Carboplatin
      3. Bleomycin
      4. Vincristine and other Vinca Alkaloids
      5. Nitrogen Mustard
      6. Methotrexate
      7. Etoposide
      8. Protein kinase inhibitor
   5. Other medications
      1. Quinine
      2. Chloroquine
      3. Mefloquine
      4. PDE5 Inhibitors (e.g. Sildenafil or Viagra)
      5. Caffeine
      6. Atorvastatin (Lipitor)
      7. Bupropion (Wellbutrin)
      8. Risedronate (Actonel)
      9. Verenicline (Chantix)
      10. Misoprostol (Cytotec)
3. Causes: Industrial and Home Poisonings
   1. Background: Exposure Settings
      1. Automotive repair
      2. Boat building
      3. Manufacturing (leather, metal, battery, petroleum)
      4. Painting
      5. Pesticide spraying
      6. Fueling vehicles including aircraft
   2. Asphyxiants
      1. Carbon Monoxide Poisoning
      2. Tobacco Smoke
   3. Heavy metal Poisoning
      1. Mercury Poisoning
      2. Lead Poisoning
      3. Organic Tin Compounds
   4. Nitriles
      1. Acrylonitrile (Hydrogen cyanide with a replaced ethenyl group)
      2. 3-Butenenitrile (Allyl Cyanide)
   5. Solvents
      1. Toluene
      2. Styrene
      3. P-Xylene
      4. Trichloroethylene
4. Causes: Ilicit Drugs and Poisonings
   1. Ilicit Drugs
      1. Ecstasy
5. Symptoms
   1. Sensorineural Hearing Loss from Ototoxic Drugs typically develops over weeks after exposure
   2. Hearing Loss be transient for some agents used at therapeutic levels (e.g. Erythromycin, Tetracyclines, Analgesics)
      1. Hearing Loss is often reversible after decreasing or stopping the offending agent
6. Evaluation
   1. See Sensorineural Hearing Loss
7. Resources
   1. Preventing Hearing Loss Caused by Chemical (Ototoxicity) and Noise Exposure (CDC NIOSH)
      1. https://www.cdc.gov/niosh/docs/2018-124/
8. References
   1. Cianfrone (2011) Eur Rev Med Pharmacol Sci 15(6): 601-36 [PubMed]
   2. Ganesan (2018) J Audiol Otol 22(2): 59-68 [PubMed]
   3. Seligmann (1996) Drug Saf 14(3): 198-212 [PubMed]