by Neil Bauman, Ph.D.
Revised September 5, 2016
Some drugs can cause “funny” hearing problems. One such drug is Carbamazepine, sometimes sold under the brand name of Tegretol.
Doctors frequently prescribe the anti-convulsant drug, Carbamazepine, to treat people who have epilepsy, neuralgia (nerve pain) or psychiatric disorders. Carbamazepine is ototoxic and can result in side effects such as hearing loss, tinnitus, hyperacusis, auditory hallucinations and ear pain. It can also cause balance problems such as dizziness, ataxia, nystagmus and vertigo.
Now there is another ototoxic side effect we can add to the list—lowered pitch perception. For example, a number of musicians have found that when they take the drug Carbamazepine (Tegretol) they hear music a half-tone lower than it should be.
This should not be all that surprising since Carbamazepine acts as a central nervous system (CNS) inhibitor. Doctors think that when Carbamazepine inhibits CNS function to some extent, the result is that people mis-perceive notes. (1)
This came to light when a number of young musicians (aged from 7 to 16) reported that when playing their instruments, they heard them a half-tone low in pitch.
For example, this happened to a 16-year-old young lady after taking Carbamazepine for a week for her epilepsy. She soon noticed that she now heard all music a semitone lower than it should have been. The good news is that when she stopped taking the Carbamazepine, her pitch-perception returned to normal. (2)
Here’s two more similar cases of children with epilepsy having lowered pitch perception. A 7-year-old boy began to complain that his pitch perception decreased after taking Carbamazepine. “When he played the piano, he felt as if he had played a musical note of almost a half pitch lower than he had.” His pitch perception recovered soon after he stopped taking the Carbamazepine.
A 14-year-old girl noticed she also had a lowered pitch perception of music when she played the piano after taking Carbamazepine. When she stopped the Carbamazepine, her hearing returned to normal too. (3)
All three of these people were musically-trained so they readily noticed the difference in pitch. The average person probably would not have noticed this semitone drop in pitch.
Nor are these the only people that have experienced lowered pitch perception. Another report presented 6 more similar cases. (4) Since 1993, at least 26 such cases have come to this doctor’s attention. What was formerly thought to be a very rare side effect is now thought to be “more frequent than previously suspected”. (4)
In addition, numbers of people have told me of similar experiences they have had with this drug. For example, a lady reported,
I have taken up to 800 mg of chewable Tegretol in a single session experimentally and I definitely noticed a semitone shift when listening to music the next day. I doubt that this is as rare a side-effect as it’s purported to be. Also, I’m not a musician and I do not have ‘perfect pitch’. So the population that experiences this side-effect from Tegretol is potentially broader than reported.
A man explained,
This happened to me also. It was very strange I noticed it a few days after taking Tegretol. I am a musician also and noticed right away while listening to music in my car. I thought my car radio was broken and I got confused. Later that night I realized it was happening when I listened to my laptop also and noticed people’s voices were not sounding correct either. This problem stopped soon after stopping the drug about a day later.”
Another man explained,
I just started the medicine and everything sounds strange. I first noticed it when my grandfather clock chimed, then on the way to work all music just sounded odd.
A mother wrote,
My 16 year old son started taking Tegretol 5 days ago. He is also a musician, and almost immediately began experiencing lower pitch perception.
Another mother explained,
My son started Tegretol two weeks ago and was complaining about certain voices being a lower pitch, as well as music and television. This really frustrated him.
I wouldn’t be at all surprised if other similar drugs will be found to have similar (or other weird) effects on our hearing. For example, another drug that messes up pitch perception is the beta-blocker Propranolol.
If you want to look up the ototoxic side effects of Carbamazepine or any other ototoxic drugs, see my book Ototoxic Drugs Exposed 3rd edition. This book contains information on the ototoxicity of 877 drugs, 35 herbs and 148 chemicals.
________(1) Fujimoto, A., et. al. 2004. Pitch Perception Abnormality as a Side Effect of Carbamazepine. Journal of Clinical Neuroscience. Volume 11, Issue 1. January 2004. Pages 69–70.
(2) Konno, Shyu, et. al. 2003. Half Pitch Lower Sound Perception Caused by Carbamazepine. The Japanese Society of Internal Medicine. Internal Medicine Vol. 42 (2003) No. 9. pp. 880-883.
(3) Yoshikawa, Hideto. 2003. Carbamazepine-Induced Abnormal Pitch Perception. Brain and Development. Volume 25, Issue 2. March 2003. pp. 127–129.
(4) Tateno, Akihiko, et. al. 2006. Carbamazepine-Induced Transient Auditory Pitch-Perception Deficit. Pediatric Neurology, Volume 35, Issue 2. August 2006. pp. 131-134.
I went through this tragic incident almost ten years ago. 2016 will mark ten years since this tragedy. I called the FDA a few years ago and asked them why they had not done anything about it, and they told me that things move very slowly. Well, I’m sorry, but that’s not good enough! More and more people are having their enjoyment of music, and their lives ruiened by this drug and it’s time to put a stop to this tragedy once and for all! I couldn’t enjoy my music for almost three weeks! Music plays a big part in my life, because I’m totally blind. But I also consider this incident a blessing, because I understand what it’s like to be misunderstood by people, especially doctors who have never even heard about this before. The medical world needs to stop hiding this side effect from their patients! They need to stop lying about it! I’m not saying that they’re lying about it on purpose, maybe out of ignorance, but that’s still doesn’t give the medical world the right to accuse us of lying, hallucinating, or making this up! This is real! I’ve had at least one doctor who came out and told me that the drug had actually done this to me and that I wasn’t making this up! I was so happy, that I hugged him! The time is now! The medical world needs to do something about this once and for all! This is real! We’re not lying, hallucinating, or making this up! I know! Because I went through it! I understand! Thank you very much. God bless you.
Finally! I swear I saw things when I accidentally took to much tegretol and was accused of taking acid and blaming it on my meds. My neurologist was like oh its just a side affect and I said um OK if its just a side affect why did I trip my ballZ off just that day? Why wasn’t I tripping for the past year? I’ve been on teg for a yr so this genius says I’d like to cut the teg out and replace it with carbatrol.I was so upset.I’ve been searching the internet and haven’t had much luck until I came across your post .
I had to use a movie editing software to increase the rate of my music by 3% to make it sound correct. I noticed it eventually going back to normal after a few months, but I felt devastated the first time, worried that I will never hear things the same way again. After two years, I’m now switching to a different medicine, since they didn’t work, and have noticed the pitch go higher than normal, but I’m assuming it won’t last long. After reading about hearing loss, I’m glad I’m no longer on this medicine. I wish I was medicine-free.
This happened to me also. It was very strange I noticed it a few days after taking the drug. I am a musician also and noticed right away while listening to music in my car. I thought my car radio was broken and I got confused. Later that night I realized it was happening when I listened to my laptop also and noticed people’s voices were not sounding correct either. This problem stopped soon after stopping the drug about a day later (i hadn’t been on it very long). I don’t see it as a serious risk since it goes away, but it is a deal breaker for those who enjoy music/want to hear people’s voices correctly.
Hello:
I have been on Tegretol now for many years – 16 – since being switched from Dilantin. I have had two seizures – in my early 20’s.
Two years ago I experienced Sudden Onset Hearing Loss in my right ear (with accompanying tinnitus). No one could give me an explanation (i was 45 at the time). Anyway, this is permanent nerve damage. I had an MRI done and several hearing tests – my hearing in the right ear is at what they call the PROFOUND level. I am very nervous of this happening in my left ear – as then I would not be able to function without lipreading, sign language, or surgery. As it is right now, I can cope with only minor problems and i have adjusted.
Thank you for providing this information.
I will make a doctor’s appointment to see about discontinuing the drug.
I don’t want a seizure though while driving – and risk injury to myself or others. This is very scary for me but so is the loss of my hearing.
Confused.
I just started the medicine and everything sounds strange. I first noticed it when my grandfather clock chimed then on the way to work hearing music everything just sounded odd.
My son just started tegretol last week and having the same experience. Are you still experiencing this or has it gotten better as your body adjusts?
I have taken up to 800mg of chewable tegretol in a single session experimentally (I suffer neither from trigeminal neuralgia nor bipolar disorder), and I definitely noticed a semitone shift when listening to music the next day. I doubt that this is as rare a side-effect as it’s purported to be. Also, I’m not a musician and I do not have ‘perfect pitch’. So the population that experiences this side-effect from tegretol is potentially broader in scope than the subject pool tested in these studies.
My 16 year old son started taking Tegretol 5 days ago. He is also a musician, and almost immediately began experiencing lower pitch perception. We can’t take him off the meds until I can see the Neurologist and discuss other options. Does anyone know if this side effect will subside after his body gets used to it, or is it permanent as long as he’s on the medication?
My son started Tegretol two weeks ago and was complaining about certain voices being a lower pitch, as well as music and television. His therapist made excuses for it. I almost let it go but he started exhibiting such frustration over it that I started researching. I am glad He is persistent and that I finally listened to him. We will be changing his med in the morning.
I am a professional musician and composer. I found this pitch change to be a horrible side effect of this drug. I first noticed the pitch change while hearing the AOL voice saying
“You’ve got mail” but it really became a problem when I was composing music for the superbowl this year.
My doctor is a wonderful and knowledgeable physician but had never heard about this side effect, and thought I was either kidding him or maybe having some mental breakdown.
He researched it after my appointment and called to tell me
he had never heard of this problem before and that he found it most interesting.
I have possible trigemenal neuralgia not seizures so I am directed to take the drug only as needed. I am fortunate to get relief from just half a tablet.
Hi Jamie:
If you have trigeminal neuralgia, if I were you, I’d work to get rid of it, not just take drugs to “manage” it and wreck your ears (and career) in the process. If you are interested, the professional to go to is Dr. Michael Burcon in Grand Rapids MI. He is an upper cervical chiropractor that specializes in successfully helping people with both Meniere’s disease and trigeminal neuralgia. You can get his contact information from his website at http://www.burconchiropractic.com/ .
Cordially,
Neil
I’m from the UK and have been taking 800mg of modofied release and up to 400mg of regular carbamazepine for three years for severe chronic neuropathic pain. It’s given some relief, so I haven’t wanted to switch back to other meds that just don’t work, but I too have experienced a drop in perceived hearing pitch. Mine varies dependent on dosage, between 3 and 5 semitones. Like others, after a few days building up the dose I heard familiar music, voices and TV theme tunes reduced in pitch and, after thinking one device was broken, realised the cause. I’m a trained musician too, and have been trying to add to my repertoire by playing the guitar recently, but tuning it has been amusing at best. It takes an electronic tuner to know how much is the strings and how much is me on any given day. Been a bit of a farce really.
I can absolutely confirm that this happens to some people at least. I’m 27, started taking very small doses of taro-carbamazepine to treat a muscle twitching problem I’ve been experiencing for over 2 years now.
I’m a very auditory person, and over the past few days, I’ve noticed that music I listen to sounds off key. Music I know as well as I know my own face. I looked up this sensation of lowered pitch perception, and started panicking, thinking it was a serious hearing problem. I booked an appointment with my audiologist, and my hearing was completely normal. Got home, added “carbamazepine” to my google search, and found this page.
I’m noticing it right now, and a Google search brought me here. The chime on my wall clock sounds flat. I thought it just needed some maintenance, but then the tones on my phone and tv also sounded off. I started tegretol on Saturday. I’m not a musician, and I noticed the change in tone.
I started taking this medicine 2 days ago twice daily for mood swings and anger management. I woke up this morning and opened up a game I play on my phone every day and noticed the song had changed slightly. I wouldn’t consider myself a musician, but I do know a fair bit about music. I assumed they changed it a bit for the holidays and I ignored it. Later, I opened a game by the same creators and the song was also slightly different. Once again, assuming it was a temporary change, I ignored it. Now, this evening, I opened my front door and heard the “beep beep beep” of my ADT alarm and it was lower than I expected. Automatically looked up “medicine side effect everything lower pitched” and found this article… thanks for reassuring me that I’m not *too* crazy x)
Anyway, is this something I should worry about or call my doctor about? I don’t want to lose my hearing and this is definitely the strangest side effect I’ve ever had.
Hi Heather:
Since it is affecting your pitch perception, I’d ask your doctor for a different drug. You also risk a lot of other ototoxic side effects including hearing loss, tinnitus, auditory hallucinations, and all sorts of balance problems. In my opinion, it’s not worth the risk, because I’m sure there are other solutions available.
Cordially,
Neil
This is happening to me right now! It’s horrible, and weird. Music doesn’t sound nice and even sounds out of tune.
I also get hand twitches, loss of balance and nausea and I sleep through the night but also kinda like I am drugged to sleep if that makes sense.
Hallelujah!!! I just started taking this 2 days ago, and yesterday I noticed something odd…today, every single song was either 1/2 or 1 full note lower than I absolutely KNEW it should have been! I panicked for a few hours, thinking that this was the beginning of me losing my hearing due to being in a rock band for 10 years. When I found this, just pure relief. Going back to my doctor on Monday and asking for a switch. Thanks so much for this article!!!!
I noticed the music I know by heart being off key for two days. I took carbamazepine for three days prior this but this never happened to me before. Now I know this is not good for my hearing as I have a constant buzzing in my ears that knocks me out for 10-15 seconds. I’ll be avoiding this med from now on.
I began to take Carbamazepine around May to June of 2014 at the age of thirteen. After the day of first taking it at 100mg, I noted a change in how I heard everything, mainly with music. I was not musically trained and am still not, but the change was very noticeable. Now at 500mg day and night, I missed one morning dose due to sickness and everything sounds worse than before.
I don’t understand. If you lower the pitch of a song by a semi-tone, not a lot of people are going to hear it (only the pitch perfect ones and they are very rare). I regularly play songs in a different key and the listeners don’t realize it.
Now if you tell me that the sounds are distorded, why not. But everything just half a note? You wouldn’t know it. It’s easy to test with some musical software (free one: audacity).
I’m an amateur musician and I can very easily distinguish half a step. It’s the difference between B and C, or between E and F. I can tell those apart quite readily, even without perfect pitch (but with excellent relative pitch). Your listeners might be able to tell that there is a difference, even if they can’t tell “what exactly” is different. But someone who’s a musician, or simply good with pitch… a half step is certainly noticeable. And that is exactly why I fought to change off the Tegretol!
Very fascinating. I’ve noticed over time that when I listen to different songs on the radio or just sit back and listen on my computer, I notice that I’m hearing them in a different pitch than what I heard them in as a kid (I’m 26 years old). The strange thing is that I’ve only noticed this with a few specific songs thus far, and from what I’ve noticed, the pitch sounds higher than what it should be. I ran a little test in Audacity (a sound-editing software) with two songs; I had to lower the pitch about 3 percent with the first song and about 2 percent with the second to get them to what I’ve been used to hearing them. The differences can be obvious at some parts and very subtle at others, but they’re still there if you’re paying attention. This has been going on for a while now, but I dismissed it as “oh, this could just be a thing that happens as you get older” since I only remember it happening in very specific circumstances.
Since carbamazepine an antiepileptic drug, it made wonder about the drugs I’m taking and if they could be having an effect. I have epilepsy, and I take topiramate and lamotrigine. I was diagnosed when I was 23, so I’ve been taking these meds for a while. I couldn’t find anything on Google regarding a connection between lamotrigine and possible effects on pitch perception, but I still can’t help but wonder about topiramate and whether or not that could be having an effect.
Hi Liz:
I have no information on either Lamotrigine or Topiramate causing pitch distortion–but that’s not to say they can’t/don’t. A lot of people may not make the connection so never report it. Maybe you are the first to notice this connection.
Cordially,
Neil
I switched from Tegretol to Lamotrigine (Lamictal) for exactly that reason. I didn’t experience any pitch issues while on Lamictal, but I sure did when I was on Tegretol. I can’t say for the Topamax because I have no experience with it. But I do with Tegretol, and with Lamictal… and my experience with Tegretol has been as others have reported… but no such side effect with Lamictal.
I was prescribed Carbamazepine for my manic depression. I play guitar and I have been a musician for 23 years. I was in my car and I was listening to music. it sounded a half step down. It sounded like when you play with the speed control on your record player. I havent played guitar cause I have been busy so today I was playing my guitar and I tuned it to Eb with my tuner started playing and it sounded wrong. I play alot of hendrix so I know standard and Eb tunning like no other. I looked up hearing side affects of Carbamazepine and I found this page. My outlet for my condition is music and this medicine is not helping. I’m gonna try to get new meds.
I started taking carbamazepine 3 days ago and i noticed the lower pitch when my phone alarm went off. Then when i started listening to music i thought there was something wrong with my phone because everything was half a pitch lower. I don’t notice it too much when people talk, just music and certain noises.I was diagnosed with trigeminal neuralgia but this article says the lower pitch perception goes away after you stop taking the med so i hope that is true.
Hi Ty:
From the information I’ve received, it seems that the pitch distortion indeed does go away after you stop taking Carbamazepine. So that’s good news. Hope it does the same for you.
Since your have trigeminal neuralgia, you might be interested in reading/knowing that if your upper cervical vertebrae are out of proper alignment, this can be a result. Going to an upper cervical chiropractor can fix this condition according to Dr. Burcon who discovered this. The treatment is much the same as it is for Meniere’s disease. You can read my article on Meniere’s and at the same time read between the lines for how it applies to trigeminal neuralgia. The article is at http://hearinglosshelp.com/blog/atlas-adjustments-alleviate-menieres-disease/ .
Cordially,
Neil
TY, the pitch perception changes didn’t go away for me while I was on Tegretol, nor did the wonky balance problems. For some, these issues may resolve over time… but that wasn’t the case when I was on it. I finally was able to convince my doctor to change my meds and things got much better rather quickly.
After 12 years of taking Tegretol (off and on… because of dizziness and foggy vision) I am now completely deaf. I stopped taking it 25 days ago… and just pray my hearing returns. My doctor never suggested that this drug might be the cause of my hearing loss. This drug has caused a disability.
Hi Gwen:
The vast majority of people that tell me of their ear problems resulting from taking Carbamazepine complain of it altering the pitch of the sounds they hear, not causing hearing loss. However, numbers of people have reported to the FDA database that this drug caused them hearing loss. This may be minor loss or more severe loss–it doesn’t say.
If your hearing loss was caused by this drug, and none returns in the first 30 days, I rather doubt your hearing will return. Of course, it is always possible that your hearing loss is due to something other than the Carbamazepine.
Cordially,
Neil
I began taking Tegretol a couple of weeks ago. The first time I noticed the difference in pitch was when I opened my phone to play a game I’m very familiar with before bed on the 4th night. From that point on, I noticed everything sounded different. It isn’t just music. It’s voices, notifications from my phone, the microwave beeping, my cat meowing, etc. Music is a huge a coping mechanism for me, so I’m beginning to get frustrated. This is on top of having to adjust to one of my senses being altered in every aspect. I told my doctor about this. He didn’t seem to understand what I was telling him. He upped the dosage of Tegretol and told me he believed the side effect was caused by undertreating me with the medication. I go back in a week. I’m showing him this article and telling him to prescribe something else.
Hi Des:
I fail to see how taking a drug and getting a known side effect (change in pitch) is the result of undertreating you. Increasing the dose is just going to make the pitch difference worse, if anything. The solution is obviously getting off that drug so the side effect can go away.
Cordially,
Neil
i took like 900 mg last night and everything is in a way lower pitch.
I took 1x400mg tablet of Tegretol per day for 2 days, to try to treat Neuralgia and Bipolar. I noticed the pitch shift immediately, this morning I checked on my piano and I had to tune it up to A=449Hz to make it sound ‘right’.
Does Tegretol cause tinnitus (ringing) that “reacts” to sounds (like a resonance) in only one ear?
I would presume it causes the problem with both ears?
I have faint tinnitus in both ears now. I started taking 200mg twice daily in March 2019. I weaned off it in October 2020, so it’s no longer in my system and all the withdrawals (some mild depression) stopped.
However, my right ear has a funny type of tinnitus where it “resonates” at certain frequencies, mostly at 1.2kHz.
My hearing is otherwise pretty good, and I doubt I have any hearing loss within the 20 to 8kHz. Not sure about higher frequencies. I’m nearly 42 years old, so I’m not so young any more.
But reading about the Tegretol otoxicity has me concerned.
It should be called Regretol. LOL.
Hi Benjamin:
Carbamazepine (Tegretol) can cause tinnitus and hyperacusis. Reactive tinnitus is where the hyperacusis and tinnitus react together such that louder sounds make the tinnitus louder too.
You would think that drugs that mess up one ear would mess up both at the same time, but that is not always the case. So sometimes it only affects one ear for some reason.
What is done is done, so don’t worry about it, which can make things worse. Just ignore it and hopefully it will fade away in time.
I love the name Regret-ol! I’m sure there are many people that will agree with you.
Cordially,
Neil
I’ve been taking carbamazepine (1x400mg once a day) for three days now to treat my bipolar.
I’m a musician with perfect pitch, and the first piece of music I heard today immediately sounded off. At first I thought it was the result of broken headphones, so I used a different pair. Same result. I then pulled up Audacity and compared a 440 Hz tone to one at 448 Hz. 448 Hz sounded closer to correct.
Luckily a quick search of the internet lead me to this article to assuage my fears that this was permanent.
Along with pretty awful nystagmus and ocular migraines, my inability to play my instrument means I need to get off of this ASAP.
Hi Michael:
I’m sure your doctor can suggest a different drug that will do the job without messing with your pitch perception like Carbamazepine does.
Cordially,
Neil
I was on carbamazepine/Tegretol for years. after my neurologist took me off the truck, and switched me to another my pitch has gone up three-quarter tones to one whole tone. And has never return to normal! as an instrumentalist I can no longer play. Fortunately I do have a second career as a DJ to lean upon.
Hi John:
Which drug do you take now? Perhaps it is the one that is messing with your pitch.
Cordially,
Neil
Hi John:
Interesting that all of the people that have contacted me and mentioning the direction of their pitch shift have all noted that it was lower, not higher like in your experience.
Numbers of people didn’t specifically mention pitch shift, just that music and other sounds were “off” or “different”–probably all non-musicians.
The other thing that seems unique to you is that their pitch changes reverted to normal in a few days after they stopped taking the Carbamazepine. Yours seems to be stuck permanently “off”.
I wonder why you have both of these anomalies.
Cordially,
Neil
Hello, i have a friend who recently take Carbamazepine and is currently having a lowered pitch perception (for the 4th day consecutive) He stopped taking the drug 2 days ago but still have the lowed pitch perception; so i have 2 questions: Can this effect somehow stay permanently? And is there some way to cure this side-effect faster?
Hi Felipe:
Often, the music sounds normal again after a few days. I don’t know any way to speed this up. But I’d give it at least two weeks before worrying about it being permanent.
Cordially,
Neil