Ototoxic Drug

See Also

Causes
Medications

Analgesics
1. Aspirin (>2.7 g/day) and other Salicylates
2. NSAIDs
3. Acetaminophen
4. Sulfasalazine (Azulfidine)
5. Hydrocodone
Antimicrobials
1. Aminoglycosides (Gentamicin, Streptomycin, Amikacin, Kanamycin, Neomycin, Tobramycin)
  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. Vancomycin
  1. Rare, except in combination with other Ototoxic Drugs
3. Macrolides
  1. Erythromycin (dose >2 g/day)
  2. Azithromycin
4. Other antibiotics
  1. Chloramphenicol
  2. Tetracyclines (transient vestibular toxicity)
    1. Doxycycline
    2. Minocycline
  3. Imipenem-Cilastin (Primaxin)
  4. Linezolid (Zyvox)
  5. Sulfonamide
  6. Fluoroquinolones
5. Antifungals
  1. Voriconazole
  2. Amphoteracin B
6. Antivirals
  1. Ganciclovir
  2. Ribavirin
  3. Sofosbuvir (Solvaldil)
  4. Telaprevir (Incivek)
7. Antimalarial Agents
  1. Quinine
  2. Chloroquine
  3. Mefloquine
Loop Diuretics (especially at high dose with rapid infusion)
1. Ethacrynic Acid (Demadex)
2. Furosemide (Lasix)
Antineoplastic
1. Platinum agents (most common)
  1. Cisplatin
  2. Carboplatin
2. Bleomycin
3. Vincristine and other Vinca Alkaloids
4. Nitrogen Mustard
5. Methotrexate
6. Etoposide
7. Protein kinase inhibitors (e.g. Axitinib, Dasatinib, Imatinib, lapatinib, Osimertinib, Ruxolitinib)
Other medications
1. PDE5 Inhibitors
  1. Sildenafil (Viagra)
  2. Tadalafil (Cialis)
2. Caffeine
3. Atorvastatin (Lipitor)
4. Bupropion (Wellbutrin)
5. Risedronate (Actonel)
6. Verenicline (Chantix)
7. Misoprostol (Cytotec)

Causes
Industrial and Home Poisonings

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
Asphyxiants
1. Carbon Monoxide Poisoning
2. Tobacco Smoke
Heavy metal Poisoning
1. Mercury Poisoning
2. Lead Poisoning
3. Organic Tin Compounds
Nitriles
1. Acrylonitrile (Hydrogen cyanide with a replaced ethenyl group)
2. 3-Butenenitrile (Allyl Cyanide)
Solvents
1. Toluene
2. Styrene
3. P-Xylene
4. Trichloroethylene

Causes
Ilicit Drugs and Poisonings

Ilicit Drugs
1. Ecstasy

Causes
Tinnitus

All Ototoxic Medications listed above may cause Tinnitus
1. Meds listed here are additional medications that have been associated with Tinnitus
Common Causes of Tinnitus (includes medications above)
1. Aspirin (high dose>2-3 g/day)
2. NSAIDs
3. Loop Diuretics
4. PDE5 Inhibitors (e.g. Sildenafil)
5. Quinine
6. Mefloquine
Neurologic
1. Carbamazepine (Tegretol)
  1. Carbamazepine dampens cortical responses to sound (may alter hearing)
2. Pregabalin (Lyrica)
3. Anesthetics (Lidocaine, Bupivacaine)
Antineoplastics
1. Capecitabine (Xeloda)
2. Taxanes (e.g. Paclitaxel) - uncommon
Immunosuppressants
1. Cyclosporine
2. Interferon
3. Monoclonal Antibody (e.g. Ipilimumab, Nivolumab, Trastuzumab)
Vaccinations
1. HPV Vaccine
2. Pneumovax
Miscellaneous
1. Proton Pump Inhibitors
2. Vecuronium

Symptoms

Tinnitus may be present
Sensorineural Hearing Loss from Ototoxic Drugs typically develops over weeks after exposure
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

Evaluation

See Sensorineural Hearing Loss

Resources

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

References