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Ototoxic Medications (Mustargen)

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Ototoxic Medications (Mustargen) Ototoxic Medications The following lists of medications have been Antibiotics known to cause hearing loss or tinnitus in some people or exacerbate an existing • aminoglycosides hearing problem. Usually this problem will - amikacin (Amakin) only be caused by exceeding the - gentamycin (Garamycin) recommended dosage. Be sure to consult - kanamycin (Kantrex) with your medical professional if you are - neomycin (Found in many over-the-counter unsure of your drug’s ototoxicity or if you antibiotic ointments) experience any changes in your hearing. - netilmicin (Netromycin) Although there are times when the drugs - streptomycin can cause permanent damage, some - tobramycin (Nebcin) hearing problems are reversible when the (Of particular interest is that topical ear drop drug is discontinued. medications containing gentamycin or neomycin do not appear to be ototoxic in humans unless the tympanic membrane (ear drum) is perforated. When a 9058 (FAX) 9058 - solution of an aminoglycoside antibiotic is used on the skin together with an aminoglycoside antibiotic used 352 - 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 Drugs That Can Cause when large areas were treated which allowed for large amounts of the drug to be absorbed into the Hearing Loss body. Hearing loss caused by this class of antibiotics 9056 (TTY) 703 • (TTY) 9056 is usually permanent.) - Salicylates erythromycin 352 - aspirin and aspirin-containing products - (EES) - (E-mycin) salicylagtes and methylsalicylates - (Ilosone) - (Eryc) (linaments) - (Pediazole) - (Biaxin) - (Zithromax) www.nvrc.org • [email protected] • www.nvrc.org (Toxic effects appear to be dose related and are almost always reversible once medications are (Usually ototoxic when given in intravenous doses of discontinued.) 2-4 grams per 24 hours, especially if there is underlying kidney failure.) 9055 (V) • 703 • (V) 9055 - Chemotherapeutic Agents vancomycin (Vancocin) 3951 Pender Drive, Suite 130 • Fairfax, VA 22030 VA Fairfax, • 130 Suite Drive, 3951 Pender 352 (Similar to aminoglycosides in that it may be ototoxic - • bleomycine (Blenoxane) when used intravenously in life-threatening • bromocriptine (Parlodel) infections. The fact that aminoglycosides and 703 • carboplatinum (Carboplatin) vancomycin are often used together intravenously • cisplatin (Platinol) when treating life-threatening infections further • methotrexate (Rheumatrex) exaggerates the problem.) • nitrogen mustard (Mustargen) • vinblastin (Velban) • minocycline (Minocin) (Similar to erythromycin) • vincristine (Oncovin) • polymixin B & amphotericin B Northern Virginia Resource Center for Deaf and Hard of Hearing Persons (Antifungal preparations) (The ototoxic effects can be minimized by care- • capreomycin (Capestat) (Anti-tuberculosis fully monitoring blood levels.) medication) Copyright 10/2010 by Northern Virginia Resource Center for Deaf and Hard of Hearing Persons. Reproduction in whole or in part is prohibited without written permission. Non-Steroidal Anti-Inflammatory Drugs Diuretics (NSAIDS) • bendroflumethazide (Corzide) Most NSAIDS have the potential for causing hearing • bumetadine (Bumex) loss and/or tinnitus. Because new drugs are being frequently approved for use, it is • chlor-thalidone (Tenoretic) important that you check with your doctor or pharma- • ethacrynic acid (Edecrin) cist to determine if the drug you were prescribed can • furosemide (Lasix) cause a problem.) (These are usually ototoxic when given intravenously for • dicofenac (Voltaren) acute kidney failure, acute hypertensive crisis, or acute • etocolac (Lodine) pulmonary edema/congestive heart failure. Rare cases of • fenprofen (Nalfon) ototoxicity have been found when these medications are taken orally in high doses by people with chronic kidney • ibuprofen (Motrin, Advil, Nuprin, etc.) disease.) • indomethacin (Indocin) • naproxen (Naprosyn, Anaprox, Aleve) • piroxican (Feldene) Quinine • sulindac (Clinoril) • chloroquine phosphate (Aralen) (Toxic effects are dose related and are almost al- • quinacrine hydrochloride (Atabrine) ways reversible once medications are discontinued.) • quinine sulfate (Quinam) (The ototoxic effects are very similar to those of aspirin.) Mucosal Protectant Narcotic Analgesics • misoprostol (Cytotec) • hydrocodone (Lorcet, Vicodin) Drugs that Can Cause Tinnitus Antibiotics Vapors, Solvents • aminoglycosides (see previous section) • cyclohexane • amphotericin B • dichloromethane • chloramphenicol (Chloromycetin) • hexane (gasoline) • minocycline (Monocin) • lindane (Kwell) • polymyxine B • methyl-chloride • sulfonamides (Septra, Bactrim) • methyl-n-butyl-ketone • vancomycin (Vancocin) • perchlor-ethylene • Styrene • tetrachlor-ethane Cardiac Medications • toluol • trichloroethylene • celiprolol • flecainide (Tambocar) • lidocaine Anesthetics • metoprolol (Lopressor) • procainamide (Pronestyl) • bupivacain • propranolol (Inderal) • tetracain • quinidine (Quinaglute, Quiniedex) • lidocaine (Novacaine) Glucocorticosteroids Antimalarials • prednisone (Deltasone) • chloroquine (Aralen) • prednisolone (Prelone) • hydroxychloroquine (Plaquinil) • ACTH (adrenocorticotrophic hormone) (Acthar) 2 Non-Steroidal Anti-inflammatory Drugs Psychopharmacologic Agents (NSAIDS) (Please see notation for NSAIDS under “hearing loss.”) • amitryptiline (Elavil) • benzodiazepine class • aspirin - alprazolam (Xanax) • acematacine - clorazepate (Tranxene) • benorilate - chlordiazepoxide (Librium) • benoxaprofen - diazepam (Valium) • carprofen - flurazepam (Dalmane) • diclofenac (Voltaren) - lorazepam (Ativan) • diflunisal (Dolobid) - midazolam (Versed) • fenoprofen (Nalfon) - oxazepam (Serax) • feprazon - prozepam (Centrax) • ibuprofen (Motrin, Advil, Nuprin) - quazepam (Doral) • indomethacin (Indocin) - temazepam (Restoril) • isoxicam - triazolam (Halcion) • ketoprofen (Orudis) • buptopion (Welbutrin) • methyl salicylates (BenGay) • carbamazepine (Tegretol) • naproxen (Naprosyn, Anaprox, Aleve) • diclofensine •D-Penicilliamin • doxepin (Sinequin) • phenylbutazone (Butazolidine) • desiprimine (Norpramin) • piroxicam (Feldene) • fluoxetin (Prozac) • proglumetacin • imipramine (Tofranil) • proquazon • lithium • rofecoxib (Vioxx) • melitracen • salicylates • molindon (Moban) • sulindac (Clinoril) • paroxetin • tolmetin (Tolectin) • phenelzin (Nardil) • zomepirac • protriptilin (Vivactil) • trazodon (Desyrel) • zimeldin Miscellaneous Toxic Substances • alcohol Anti-neoplastics • arsenum • caffeine • bleomycin (Blenoxane) • lead • cis-platinum (Platinol) • marijuana • carboplatinum (Paraplatin) • nicotine • methotrexate (Rheumatrex) • mercury • nitrogen mustard (Mustagen) • auronofin (gold, Ridaura) • vinblastin (Velban) (Ironically, several of these drugs found to cause tinnitus, are also used to treat tinnitus; for example: Others amitryptiline, benzodiazepine class, carbamazepine, furosemide, lidocaine, prednisone.) thalidomide (Thalomid) Adapted from the pamphlet: Diuretics Ototoxic Medications: Drugs that can cause • acetazolamide (Diamox) hearing loss and tinnitus Article by Orin S. Kaufman, D.O. • bumetanide (Bumex) • bendrofluazide League for the Hard of Hearing • clorothalidone (Hygroton, Tenoretic) 50 Broadway, New York, NY 10004 • diapamide www.lhh.org • ethacrynic acid (Edecrin) • furosemide (Lasix) For a more complete list of medications we recommend: • hydrochlorthiazide (Hydrodiuril) Ototoxic Drugs Exposed by Neil G. Bauman. Ph.D. • methylchlorthizide (Enduron) http://www.HearingLossHelp.com 3 .
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