Ototoxic drugs


In the development of a conscious and ethical medicine, all professionals should perform an anannesis or medical history of the patient before prescribing any drug. In the diagnostic tests, the physician should include a hearing check-up, with special emphasis if drugs with ototoxic effects are to be prescribed.

This anannesis will facilitate the work to rule out these drugs in ailments, as in the case of tinnitus, and to choose the most appropriate treatment for the patient.

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The anamnesis is a set of data collected from the patient's clinical history to facilitate an objective follow-up and diagnosis.

According to the American Speech-Language-Hearing Association, ASHA (acronym in English) are about 200 drugs which can cause damage to the auditory system. In the following we will mention the active ingredients and not their brand names.

Ototoxicity in over-the-counter analgesics

Among these are the most common. The acetylsalicylic acid is one of them, in high doses it can alter the hearing, it is recommended not to exceed 4 grams per day. 

Also included in this classification is the ibuprofen, naproxen, acetaminophen.

Ototoxic antibiotics

Neomycin is the antibiotic with the highest ototoxicity.. When high doses are taken orally or by colonic irrigation for intestinal sterilization, it is possible that a sufficient amount may be absorbed to alter hearing, especially if there are diffuse lesions of the colonic mucosa.

These include ciprofloxacin and levofloxacin, prescribed for a wide range of bacterial infections that can cause hearing loss and tinnitus.

Also included in this group are aminoglycosides, particularly gentamicin, streptomycin and neomycin.

Ototoxic Antidepressants

Although they are most often prescribed to alleviate the psychological effects of tinnitus, they are also ototoxic. fluoxetine, amitriptyline, paroxetine, sertraline and citalopram.

Ototoxic diuretics 

Diuretic drugs in medicine are used to treat kidney failure or high blood pressure. Those that cause ototoxicity include loop diuretics, or "high ceiling" diuretics, such as furosemide, bumetanide, ethacrynic acid in which high doses may even cause hearing loss. 

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Neomycin is the antibiotic with the highest ototoxicity.

Ototoxics in chemotherapy

The carboplatin and cisplatin Both are toxic, although the former is used as an alternative to the latter as it is less harmful in the treatment of chemotherapy.

The specialists oncologists should review the patient's history before prescribingThe use of this product is not to be administered to those with hearing loss or with a history of hearing loss.

Ototoxicity of quinine

Quinine is frequently used in the treatment of malaria o malaria. If administered long-term in high doses it may be the origin of hearing loss, although in most cases the effect is reversible.

Ototoxicity of combination drugs

Taking combined prescription and over-the-counter medications may aggravate hearing disorders.

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We should never combine drugs without a doctor's prescription

For example, aminoglycoside antibiotics are highly harmful to inner ear hair cells when combined with drugs such as vancomycin, which causes tinnitus, or with a loop diuretic such as furosemide.

Risk factors for ototoxicity

Medications that damage hearing should be used with great caution. Affected patients often develop hearing disorders due to: 

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  • The dose of the drug ingested
  • Prolonged intake of the drug
  • When the patient has reduced renal function, he/she is unable to eliminate the drug from the body properly.
  • Family history of hearing problems caused by drugs
  • Genetic predisposition to the effects of ototoxic drugs.

Symptoms of ototoxic drugs

Among the most prominent symptoms are the following:

  • Ringing in the ear
  • Vertigo or instability
  • Hearing loss


Ototoxic drugs should be taken at the effective dose. Lower correctly prescribed and administered by a medical practitionerThe concentration of the drug in the blood will be determined periodically during the treatment.

If possible, before administering treatment with an ototoxic drug it is advisable to define the patient's hearing abilityThe symptoms are signs that appear when the damage caused by the drug is severe. 

Pregnant women should avoid taking ototoxic antibiotics, as they may affect the fetus.

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Always consult your specialist for a proper diagnosis

Older people, those with a history and/or hearing loss, should avoid ototoxic drugs and opt for other equally effective drugs if an alternative is possible.

Likewise, topical otic application should be avoided. ototoxic drugs when the eardrum is perforated, because they can diffuse to the inner ear.

Although the ototoxicity of all these drugs is known, they are prescribed because the incidence of damage is infrequent, because there are no alternative drugs, or because the benefit of alleviating certain ailments is greater than the effects produced. 

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