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Hearing Loss Association of AmericaOtotoxic Drugs by Category,
with Examples
Anti-Bacterial
Aminoglycosies (amikacin, gentamicin,
tobramycin) Amphotericin B Ampicillin
-Antihelminthics (Praziquantel,thiabendazole)
-Chloramphenicol
-Chlorhexidine (or topical use)Chloroquine
-Colistin!riseoul"in (antiungal)#acrolides (azithromycin,
erythromycin)#etronidazole$alidixic
acid%ulonamides&etracyclines (#inocycline,
tetracycline)&hiabenzazole (antihelmintic)!ancomycin
Anti-inflammatory agents"#$A%Ds, salicylates&
Aspirin (salicylic
acid)'buproen$aproxenenoproen'ndomethacinetoproenPiroxicam%ulindac
Antineoplastic
agentsBleomycinCisplatinCytarabine#echlorethamine#ethotrexate (also
or *A)$itrogen mustard+inblastine+incristine
Cario'ascular agentsnalaprilCaptopril
igitalis!uanethidine!uanacine#etroprolol#inoxidil (also or
alopecia).uinidine&ocainide
Diuretics AcetazolamideBumetanide
thacrynic acid(urosemie#annitol
)ricyclic
antiepressants Amitriptyline Amoxapineesipramineoxepin'mipramine$ortriptyline
$ubstances with abuse
potential AlcoholCaeineCocaine$icotinePhencyclidine (PCP)
*iscellaneous agents
Albuterol Antihistamines AtropineBromatesCarbamazepine
(anticon"ulsant)/aloperidol/ydroquinone (antipigmentation
agent)0ithium0ocal anesthetics (Bupi"acaine,
lidocaine,mepi"acaine)#etal chelators (eeroxamine,
penicillamine)
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#ethylphenidate1ral
contracepti"esPentobarbital.uinine&heophylline222222222222222222222222222222
http3445556medscape6com4"ie5article47879:8
Aminoglycosies+ Aminoglycoside antibiotics
(e6g6,kanamycin, neomycin, amikacin, streptomycin,gentamicin)
exhibit cochleotoxicity but also aect thestria "ascularis, causing
"estibular problems6;&heyproduce damage through the ability to
generate reeradicals in the inner ear6;7> Babies ha"e
sueredcongenital deaness 5hen their mothers took kanamycinor
streptomycin during pregnancy6;?>$eomycin is the5orst oender
relating to cochleotoxicity6;@>
Loop Diuretics+ 0oop diuretics (e6g6, urosemide,
ethacrynic acid, bumetanide) aect the potassium
gradient o the stria "ascularis, as 5ell as the electrical
potential o the endocochlear structure6;,&hesemedications
produce tinnitus and hearing loss6 &he
hearing loss may be perceptible to patients or may be
apparent only 5ith audiometric testing6 &heir toxicity
is
dose-related6;8> &hus, ototoxicity is more likely
5hen the
patient recei"es a rapid inusion o inectable loop
diuretics in renal ailure, 5hich allo5s the medications to
accumulate6 urosemide-related ototoxicity is usually
re"ersible but may be permanent in rare instances (e6g6,
in patients 5ith renal ailure)6;@> thacrynic acid is
"irtually
obsolete, partly due to the potential or ototoxicity,
especially 5hen it 5as gi"en intra"enously to patients
5hose regimen also included aminoglycosides6;@>
Antineoplastics+ Cisplatin aects the cochlea and stria
"ascularis through its ability to generate ree radicals
5ithin the inner ear6;8 *esearchers ha"e examined
"arious compounds 5ith possible otoprotecti"e acti"ity
that might be administered concomitantly 5ith cisplatin
to pre"ent ototoxicty6;8/o5e"er, none o those
in"estigated (e6g6, alpha-tocopherol, d-methionine,
salicylate, iron chelators) is clearly eecti"e6
$alicylates+ %alicylates impact the cochlea6 'n high
doses, they cause tinnitus and loss o hearing both areusually
seen only 5ith higher doses and regress upon
discontinuation in most instances6;@>
&he relationship bet5een salicylate serum
concentrations and the le"el o hearing loss is linear6
%erum concentrations belo5 : to 7: mg4d0 produce
little risk o hearing loss6;> Concentrations exceeding
this
le"el expose the patient to a possible hearing loss o
&hereore, 5hile alternati"e
medicines in general must be used 5ith caution, otic
instillation o tea tree oil appears un5arranted due to the
lack o inormation on eicacy and should also be
a"oided to pre"ent possible cochleotoxicity6
reisposing (actors
#ost medications 5ith ototoxic potential are renallyeliminated,
and renal impairment is a risk actor
orototoxicity6;@> Additional aminoglycoside risk
actorsinclude therapy that exceeds t5o 5eeks in duration,extremes o
age, amily history o ototoxicity, and peakand trough le"els that
are ele"ated beyond thoserequired or a therapeutic
response6; *isk actors thatincrease the likelihood o
ototoxicity 5ith salicylatesinclude excessi"e doses, increased age,
anddehydration6; Patients 5ho are magnesium-deicientappear to
ha"e increased susceptibility to ototoxicity andnoise-induced
hearing loss6;8?>
recautions to Obser'e
1totoxic medications should be administered topregnant 5omen
only 5ith great care6 ;@> Patients 5ith ahistory o hearing
loss, dizziness, #eniereEs disease, ortinnitus should also a"oid
ototoxic medications6 Baselinehearing should be measured in all
patients beore aregimen that includes a potentially ototoxic
medication isstarted6 &his precaution is "ital, as the typical
patientdoes not notice that hearing is aected until the loss
hasprogressed to inluence perception o speech6; Fnortunately,
standard audiometric tests do not
