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Ototoxic Drug

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Ototoxic Drug, Ototoxic Medication, Ototoxicity, Ototoxic Hearing Loss

  • 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)
  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
  1. Ilicit Drugs
    1. Ecstasy
  • 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
  • Resources
  1. Preventing Hearing Loss Caused by Chemical (Ototoxicity) and Noise Exposure (CDC NIOSH)
    1. https://www.cdc.gov/niosh/docs/2018-124/