by Neil Bauman, Ph.D.
A man wrote,
I saw your list of ototoxic drugs on the American Tinnitus Association website. Since I take 8 mg of Atacand daily and have moderate to severe tinnitus I was wondering if there is a non-ototoxic medication comparable to Atacand. The medication works well to control my blood pressure, but my tinnitus seems to be getting worse. Any comments will be greatly appreciated.
Candesartan (Atacand) can cause tinnitus in some people—somewhere between 0.5 and 1% according to the PDR and CPS—although the real figures will be higher since not all side effects are reported by any means.
All the Angiotensin-2 receptor blockers, which includes all the “sartan” drugs such as Candesartan, are listed as causing tinnitus.
There are several scenarios you have to consider before you blame your increasing tinnitus solely on Candesartan.
1. You did not have tinnitus and taking Candesartan resulted in tinnitus.
2. You had tinnitus before you began taking the Candesartan, and the Candesartan made your tinnitus worse.
3. You had tinnitus before you began taking Candesartan, and taking it made no difference to your tinnitus.
4. The longer you are on Candesartan, the worse you tinnitus is getting.
If Numbers 1, 2 or 4 apply to you, then you might want to try changing drugs to see if it affects your tinnitus. If No. 3 applies, then it appears that Candesartan doesn’t affect your tinnitus so there is no reason to change medications.
At the same time, you have to rule out any other possible causes of your tinnitus apart from this drug. There is nothing to say that you couldn’t have been exposed to two or more tinnitus triggers. For example, your tinnitus could have been caused by loud noise exposure, or anxiety, but you attribute it to the Candesartan.
There are over 200 prescription and over-the-counter medications that can cause or worsen tinnitus. In many cases, it is impossible to avoid them. In this situation there are supplements that will help reduce or eliminate the ototoxic effects of these drugs. All ototoxic medication cause harm by potentiating glutamate receptors in the cochlea. This results in degradation of the hair cells and neurons which leads to a cascade of oxygen free radicals which further damages the hair cells. NAC (n-acetyl cysteine) is an antioxidant which neutralizes the free radicals and prevents hearing loss and increased tinnitus.
Increase tinnitus???????
Or decrease?
Hi Erlina:
You need to read that last sentence carefully. Barry wrote, “and prevents hearing loss and increased tinnitus”. He said it “PREVENTS…increased tinnitus”, NOT that it INCREASES tinnitus.
Cordially,
Neil
To Neil Bauman, Ph.D, I was just wondering if you could supply any references to support your statement that Candesartan can cause tinnitus? Thanks in advance.
Hi Zoe:
Tinnitus as a side effect of Candesartan is mentioned in the PDR (Physicians’ Desk Reference) and the CPS (Compendium of Pharmaceuticals and Specialties) for two major books, not to mention that a number of people have reported to the FDA (Food and Drug Administration) that they got tinnitus from taking Candesartan. So there’s three sources.
Cordially,
Neil
My tinnitus get very bad since I start to take candesartan 3 weeks ago
can you tell me if the hearing loss caused bay candesartan is reversible when we stop taking this medication or not?
Hi Sami:
I have no information to indicate that Candesartan causes hearing loss, nor any of the other drugs in this class, but they all can cause tinnitus. The tinnitus may be temporary or permanent.
Cordially,
Neil
I am experiencing moderate to severe tinnitus in both ears for the last 6 months or longer. I have been taking candesartin 16 mg twice a day, along with atorvastatin 20 mg. once a day for a little over three years, starting after the insertion of three stents. I am also taking nifedipino 30 mg and xarelto 10mg once a day. I understand that the first two can cause tinnitus, but with what can they be replaced?
PS. I live in retirement in Central Mexico (Chapala, Jalisco) and went to a ENT specialist in Guadalajara who prescribed piracetam 800 mg once a day at bedtime for three months. It will take care of the tinnitus, he promised, and does not interfere with the other medications. It seems a bit scary so I am holding off. What do you think?
Hi John:
Candestartan can cause tinnitus in some people. So can Atorvastatin. Since you have been taking them for 3 years, it is not too likely that they are the source of your tinnitus beginning 2.5 years later. It’s not impossible, but I think there may be other more likely factors at work here.
Nifedipne can also cause tinnitus in some people.
Rivaroxaban (Xarelto) is probably not ototoxic.
I looked up Piracetam, since I am not familiar with this drug. I’ve not come across it before as a treatment for tinnitus, so I doubt that it will work, or work much. But when reading the side effects and anecdotal reports from people taking it, I certainly wouldn’t be too eager to take it.
You might want to ask your ENT how many people he specifically knows who had tinnitus that went away as a direct result of taking this drug before you decide.
As for me, from what I know about this drug, I wouldn’t take it for tinnitus. There are other less risky treatments.
What I’d zero in on is what happened between 6 and 7 months ago before your tinnitus became so loud. What happened back then that may have cause this? Once you figure out the cause, you can see whether the drugs are the likely culprits or if it was something else.
Cordially,
Neil
I started getting tinnitus after starting Candesartan. I never experienced tinnitus before. Now I’ve been off Candesartan for a month, but the tinnitus and low blood pressure persist. Is there anything I can do to stop the tinnitus caused by this medication?
Hi Dawniel:
Since a month has gone by, some of the things you could have done such as taken NAC probably won’t help now. One thing you can try is taking Arches Tinnitus Formula. This is an extract of Ginkgo biloba and it can help in cases of tinnitus caused by drugs.
Apart from that, you need to learn to ignore your tinnitus by focusing on the loves of your life. The more you think or worry about your tinnitus, the more permanent and louder it becomes. If you totally and completely ignore your tinnitus, it will tend to fade into the background over time and will not bother you–even if you do hear it.
Cordially,
Neil
Hi I developed Tinnitus 2 years ago soon after I was put on candestartan . My tinnitus is unilateral and after a hearing test I do have slight HF hearing loss on both ears more on my left ear where I developed Tinnitus. Is it worth changing medication to see if theres any improvement.
Hi Mike:
If you wanted to try a different ARB class of drug, the only two I know of that are less ototoxic than Candesartan are Eprosartan (very low risk) and Telmisartan (about 30% less risk than Candesartan).
Apart from that, you’d have to switch to a different class of drug.
If your tinnitus is not bothering you, you may not want to bother changing if the Candesartan is doing the job. But the Candesartan could also be causing your hearing loss (or not), so that is another consideration.
Cordially,
Neil
Thanks Neil, I will see my Gp and enquire on another drug.
What other class of drugs are avaliable , the first I had was Ramipril, It worked really well but it gave me a cough.
Hi Mike:
Anti-hypertensive drugs include the following classes:
Alpha-Adrenergic Blocking drugs (Alpha Blockers). The generic names typically end in “sin”.
Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors). The generic names typically end in “pril”.
Angiotensin-2 Receptor Blocking DRugs (ARBs). The generic names typically end in “sartan”.
Beta-Adrenergic Blocking Drugs (Beta Blockers). The generic names typically end in “olol”.
Calcium Channel Blocking Drugs (CCBs). The generic names typically end in “ipine”.
My special report “The Relative Ototoxicity of Anti-Hypertensive Drugs” gives you a good idea of the ototoxicity of all of these classes of drugs so you and your doctor can decide which ones you might want to try. You can get this Special Report at http://hearinglosshelp.com/shop/the-relative-ototoxicity-of-anti-hypertensive-drugs/ .
Cordially,
Neil
My head has been constantly ringing. I have been taking candesatan for a bout a year now and it is getting worse by the day.
Hi Zeljka:
If you think the Candesartan is the culprit, get your doctor to switch you to a different class of drugs, or stop taking this drug–but run it by your doctor of course.
Cordially,
Neil
I am avoiding NSAIDS, aspirin, mints but am taking benicar for blood pressure. Tinnitus is bilateral and severe. What dose on NAC do you recommend?
Hi Mary:
If the Olmesartan (Benicar) is causing your tinnitus, ask your doctor to switch you to a different drug.
Taking NAC (N-acetyl-cysteine) may help, but it is no guarantee. Better to switch drugs if possible. If you choose to take NAC, I’d suggest you stay under 2,000 mg per day. If you are going to take it every day, I’d take a single 600 mg tablet, which is what I do (but not for my tinnitus, but for overall good health). Too much of a good thing can become a bad thing.
Cordially,
Neil
Hello,
I am recently diagnosed Vestibular Migraine and was given Candesartan 16mg a day. I have been keeping a diary.
After 3 weeks I developed bilateral tinnitus, something new to me.
I temporarily ran out for 4 days and tinnitus remained, but was less loud.
I restarted Candesartan and the noise grew again. I did not know about any links until I started googling and found websites like this.
I decided yesterday to get some NAC (I know, maybe too late) and stop Candarsartan.
My ENT doctor has prescribed serc-16 and prednisolone. Is it wise to stop Candesartan and start these new meds, and the NAC at the same time?
My science brain says to keep taking the Candesartan so that I know if the new meds fix the issue, but reading here, it seems faster action means more likely tinnitus is reversable.
Any advice?
Hi Paul:
Changing/starting/stopping a bunch of meds at the same time sure confuses the issue of which ones are causing side effects and which ones may be efficacious. Much better to do one thing at a time.
You already know that Candesartan causes tinnitus and my information confirms that. You also know that your tinnitus reduces in volume when you stop taking the Candesartan. So stopping the Candesartan will get your tinnitus down to a manageable level, even though it may prove to be permanent.
NAC helps your body make glutathione which zaps free radicals in your inner ears that drugs cause. I don’t know that it will have any affect on your tinnitus, but can help prevent any hearing loss.
What does your doctor think the Betahistine (Serc) and Prednisolone will do? I have no information that indicates they help with tinnitus, so if it were me, I wouldn’t take more drugs in the hopes they might help, when, at the same time, these drugs also have ototoxic side effects.
It was taking drugs that started your tinnitus in the first place. You never mentioned if the Candesartan helped your vestibular migraines or not. If there was no change, why even consider continuing taking the Candesartan?
What was the cause of your vestibular migraines? Ideally, you want to treat the cause to eliminate this condition, not treat the symptoms which does nothing to fix the cause. Is the Candesartan acting on the cause or on the resulting symptoms? This is something you want to know before taking any drug.
Cordially,
Neil
Hello Neil,
Apologies for the late response, I did not notice it 🙁
Thank you so much for your response, it is really useful. I am visiting a neurologist again soon, hence I ended up back here.
I am on Betahistine for vertigo/ear fullness related issues due apparently to the vestibular migraine.
The VM was definitely helped by the Candesartan. I felt great for the couple of weeks before the tinnitus kicked in, I believe it reduces or calms the electrical flow in the brain.
Betahistine has done a good job at stopping my dizziness (it increases blood flow in the inner ear), but I have terrible headaches instead. Not at all sure why the VM started, but it seems it is here to stay for the time being.
The good news is that I am mentally able to cope with the tinnitus and ignored it enough that it is noticeable really at night or very quiet places, and that when I do hear it, I shrug and move on.
I would like to go back to Candesartan as it did the best job overall, and reduced by BP which is high anyway.
However, I am extremely scared to try Candesartan again as I don’t think I could forgive myself if tinnitus came back worse or louder.
Can you recommend something else in the same family that might work for VM, but has less risk of ototoxicity?
Another option maybe to go back on candesartan but a much lower level, maybe whilst using NAC, to see if it still helps.
Hi Paul:
Based on what I now know about the “sartan” drugs, I think that Losartan is the drug with the lowest risk of tinnitus. So you might want to try that, but it could still raise your tinnitus so you want to be careful. If you try it and your tinnitus starts to go up, you could dump it immediately and hope the increase in tinnitus isn’t permanent.
Cordially,
Neil
Hi Neil, I am on Candesartan and 12.5 mg of Hydrochlorothiazide. I bought your report on ototoxic drugs and see that Candesartan is more than likely the cause as it started when Dr. raised my 8 mg to 16mg. But I did not see Hydrochlorothiazide in your report. Can HTCZ also cause tinnitus?
Thank you in advance.
Mary
Hi Mary:
Hydrochlorothiazide is also moderately ototoxic according to my latest data, but I think you have zeroed in on what caused your tinnitus. Many people find that their initial dose of a drug does not cause tinnitus. You might think of it flying under the ototoxic radar. However, when your doctor raises the dose (typically doubles it) as in your case, all of a sudden you are in the ototoxic radar’s beam and wham–you get hit by tinnitus.
If you drop back to your old dose, you may find your tinnitus goes away or lessens, but there are no guarantees it will do this.
Cordially,
Neil
Thank you for your respose Neil. I should have mentioned that I cut my candesartan back to 8 mg and I still have ringing in my ears, not as bad as it was on 16 mg. I have Dr. appointment coming up to discuss my meds. That is why I was wondering if HTCZ could also cause tinnitus. Do you have a updated report with your latest data one could buy? Thank you again.
Hi Mary:
That’s sort of what I expected–your tinnitus would drop down, but not go away entirely.
HCTZ can certainly cause tinnitus.
HCTZ is a bit more ototoxic than Candesartan and causes tinnitus in hundreds and hundreds of people. So taking it could certainly cause tinnitus or make existing tinnitus worse.
I just finished updating the risk classes of drugs for my new book. Haven’t had a chance to update the special reports yet. I want to wait until I get this book finished and out. Then I’ll update the special reports. In the meantime I’d be glad to answer your questions.
Cordially,
Neil
I acquired a little tinnitus with enalapril, then because of that I stopped taking any medication… about 3 years passed and I continued to have very mild tinnitus… but it got worse after 3 weeks of using candesartan 8 mg per day… Is there an alternative that is safer to treat hypertension?
Hi Karlos:
I rate Enalapril as a risk class of 3.5 out of 5–so it is moderately ototoxic. Ask your doctor what other drugs might do the job and I can tell you which of them has the lowest risk of making your tinnitus worse.
Cordially,
Neil
After a high blood pressure crisis in februar 2024 I tooked a week Candesartan 8mg per day and in march started to have strong tinitus with dizziness, feeling like something electrical si discarging in my brain and neck and the most painfull is the nystagmus :(. I changed my life style eating full vegan for the moment and I got read of the hypertension somewhow but how to fix tinitus, nystagmus and that electrical discharging in the neck ? MRI and other blood test are all good, doctors doesn’t find anything wrong. Please help me.
Hi Ilis:
Candesartan is reported as causing tinnitus, dizziness and nystagmus (among other ototoxic side effects). So those can all likely be due to the Candesartan. However, I don’t track other side effects like the brain zaps you are experiencing. But looking it up on-line “pain or discomfort in the arms, jaw, back, or neck” is another side effect. But I didn’t see anything relating to electrical discharges such as brain zaps.
What caused your high blood pressure back in February?
I’ve not heard of nystagmus being painful. It can be related to your dizzy side effects. If your balance system is damaged on one side, that can result in nystagmus. I’d suggest you go to a tinnitus and balance clinic if you can and see what they say about your condition.
Cordially,
Neil
Hello, diagnosed with dyslipidemia low HDL under 40, I changed drastically my life style, eating vegan and not too much with sports unfortunately because of dizziness that I encounter recently. Seems that from time to time period like 1 week or two have some high blood pressure crises (usually diastolic over 100) that make me feel really strange with panic attacks and need some medication then. Unfortunately late I discovered that Candesartan induce me that tinnitus starting from 10.03.2024 and other stuffs, felt low mood second day and many other nasty sensations. What do you recommend me to take to treat this tintitus? currently I take NAC and Serc but don’t help that much, for high blood is there any other safer medication on needs to take? Like Irbesartan or other type with less side effects? please recommend me all you know 🙏 thank you soo much.
Unfortunately here where I am in this part of Europe, no one have a clue why are those symptoms tinnitus/nystagmus/dizziness, all of the doctors where I have been said that all blood tests are fine and don’t suspect that the Candesartan is the issue here 🤦♂️ they concluded that it’s psychological, I cancelled intake of Candesartan, pray to not be need of any blood pressure meds in the future, hope to make a difference, start adding some natural zinc supplements, ginkgo biloba tea and also continuing with Serc medications. I feel hopeless what I can do to be back in normal how I was before?
Hi Ilis:
Most reports I see related to taking Candesartan mention the nasty tinnitus that results. Apparently, you are no different in this respect. I suspect you’ll be sensitive to tinnitus from any of the “sartan” drugs, but Losartan is likely the least likely “sartan” drug to cause tinnitus.
You might want to change the class of blood pressure drugs to the drugs ending in “pril”. Two that have less risk of tinnitus are Lisinopril and Benazepril. I take Lisinopril and it doesn’t affect my tinnitus. Or of the class of drugs ending in “lol” you might want to try Labetalol or Carvedilol.
These 4 drugs do cause tinnitus or make existing tinnitus worse, but the risk is lower than taking Candesartan, so it could be a step in the right direction. See what you doctor thinks. Maybe one of them will work better for you.
Over here doctors are also largely ignorant of the ototoxic side effects of the drugs they prescribe, so we have to educate them as to what risks we are prepared to take and those that we are not prepared to take.
In any case, I’m all for making lifestyle and dietary changes to get your blood pressure under control so you don’t need to take any drugs.
Cordially,
Neil
Hello, I don’t know why my recent comments were deleted. Anyway, please provide me an advice for tinnitus treatment, what kind or drugs there are or homeopathic herbs to take? I really want to get rid of the current symptoms that are very bad 🥲
Hi Ilis:
None of your comments have been deleted by me. I merely combined your previous two comments into one.
You don’t effectively treat tinnitus by taking more drugs–especially when you got the tinnitus from taking drugs in the first place. In my experience, overall the most effective tinnitus treatments focus on habituating you to your tinnitus so it no longer bothers you, rather that trying to eliminate it.
To habituate to your tinnitus, first you must not think of your tinnitus as a threat to your well-being and thus your limbic system brings it to your active attention. Rather, you need to think of your tinnitus as a totally useless, unimportant background sound that it is safe to ignore–then ignore it by focusing on things other than your tinnitus. I tell people to focus on the loves of their lives and thereby ignore their tinnitus.
When you do this, you will slowly find your tinnitus becoming less and less intrusive and also slowly becoming less and less loud. Eventually, you may go hours or days without being aware you even have tinnitus, and when you do hear it, it doesn’t bother you–it is just there like any other background environmental sound.
To help you achieve this state of habituation, many people combine the above emotional/psychological therapy with sound therapy. The purpose of sound therapy is two-fold. First, to reduce the contrast between your tinnitus and silence so you perceive your tinnitus as less loud and to help distract you away from focusing on your tinnitus.
Second, you learn to ignore the sound therapy sound and as you do this, you also learn to ignore your tinnitus at the same time.
Typical sound therapy sounds are continuous random sounds that include white or pink noise, fractal music and water sounds such as rainfall, waterfalls, babbling brook, waves on the beach and similar sounds.
Note: you do not try to drown out your tinnitus sounds. Rather you set the therapy sound to a level a bit lower than the volume you perceive your tinnitus so it mixes with your tinnitus to become basically one sound. You learn to ignore this sound. When you achieve this, you lower the therapy sound a bit more to your new tinnitus mixing sound level as you perceive your tinnitus sounding less loud.
You keep on repeating this and over time you reach a point when you realize that your tinnitus is no longer an issue. This is not a quick treatment–so expect it to take from 6 months to 3 years or so depending on your psychological make-up.
Cordially,
Neil