Ototoxic Drug Side Effects: Put the Odds in Your Favor

by Neil Bauman, Ph.D.
© September 2025

Have you ever worried about losing more of your hearing or balance, or getting worse tinnitus from taking a drug that your doctor prescribed for you? If so, you are not alone. A lot of people contact me with exactly this concern even though I am not a medical doctor, pharmacist or audiologist.

The good news is that in this article I’m going to show you how you can put the odds in your favor so that you’ll seldom, or maybe never, develop ototoxic side effects from the drugs your doctors may prescribe if you choose to use this information to your benefit.

You see, as we get older, we typically take more and more drugs for the various ailments from which we suffer. This seems to be a fact of life. However, did you know that almost all drugs can be ototoxic and thus can affect your ears one way or another? This is also a fact of life, although few people, doctors included, seem to appreciate this fact.

Ototoxic Drugs—What Are They?

Drugs with side effects that can damage your ears, particularly your inner ears, go by the name of ototoxic drugs. Technically, this word should be pronounced OH-toe-TOKS-ik, like it commonly is pronounced in the USA, but often it is pronounced AWE-toe-TOKS-ik like many do in Canada.

Oto refers to ears, and toxic means something that is poisonous. Therefore, technically, the word ototoxic really means ear poisoning. However, it is seldom used in quite that literal a sense.

The American Heritage Dictionary currently defines ototoxic as “having a toxic effect on the structures of the ear, especially on its nerve supply”. Consequently, when using this definition of ototoxicity, ototoxic refers to drugs and chemicals that damage your inner ears and/or your hearing/balance nerve fibers (called your vestibulocochlear nerve).

However, Stedman’s Medical Dictionary simply defines ototoxicity as “the property of being injurious to the ear”. This definition includes damage to your outer, middle and inner ears.

Therefore, your view of ototoxicity depends on which dictionary’s definition you use. If you or your doctor use the American Heritage Dictionary definition, then you believe that there are relatively-few ototoxic drugs because this definition eliminates any outer or middle ear side effects.

However, if you or your doctor use the Stedman’s Medical Dictionary definition of ototoxicity, then you will realize that there are many, many ototoxic drugs.

The same holds true for the number of ototoxic side effects a drug may have. If you hold the former view, you may define ototoxicity as causing hearing loss, and vertigo, and maybe tinnitus.

In contrast, if you hold Stedman’s view, you will accept that there are at least 30 different ear-damaging (ototoxic) side effects.

Incidentally, if you hold the former view, you often also think of ototoxic side effects as typically rare, mild and temporary. This is the view of many doctors. Thus, they rationalize away most reports of ototoxic side effects. That is why your doctor will often “reassure you that the drug in question is not the cause of your ototoxic side effects.”

In contrast, if you hold to Stedman’s viewpoint, you realize that numbers of ototoxic side effects can be relatively common, severe and permanent.

These two opposing views of ototoxicity give rise to some confusion as to exactly what constitutes an ototoxic drug or an ototoxic side effect.

For example, one lady asked me if a certain drug was ototoxic. I replied, “It can cause hyperacusis, tinnitus, ataxia, dizziness, vertigo and ear pain”. She shot back, “But is it ototoxic?”

You see, to her, ototoxicity was hearing loss and nothing else. Other people consider tinnitus also to be an ototoxic side effect. To me, all of the above are symptoms of ototoxicity and there are at least 20 more ototoxic side effects I’ve not mentioned here.

Doctors typically don’t seem to hold to Stedman’s definition of ototoxicity like you think they would since Stedman’s dictionary is a medical dictionary. Therefore, be aware that many doctors restrict their use of the word ototoxic to mean causing hearing loss and maybe also including some kinds of tinnitus and hyperacusis and some balance problems. This is why when you ask your doctor if a given drug is ototoxic, he may say “no” even though it can cause damage to your ears because they are using such a restricted definition of ototoxicity.

One patient of a doctor that took this approach is now stuck with irreversible tinnitus. He lamented:

Three years ago, after taking Wellbutrin for six months, I woke up with tinnitus and a few days later with vertigo. I was told by my doctor that taking this drug had no connection to my tinnitus, but I stopped anyway. I have had tinnitus ever since. A few weeks ago, I started taking Wellbutrin again, believing it wasn’t related, and now my tinnitus is a louder shrieking sound. This is not fair as I made sure to ask my doctor about that side effect before going on this drug and he assured me it was not an issue.

In truth, the vast majority of drugs are ototoxic to some degree. For example, in the 4th edition of my book Ototoxic Drugs Exposed I list the ototoxic effects of 1,604 drugs, 64 herbals and 144 chemicals. This means that there is a good chance that any drugs you are taking could affect your ears in some way or other.

Now, note this well. Just because a drug is listed as being ototoxic does not mean that if you take that drug, you will automatically damage your ears. Ototoxic drugs do not always (or even mostly) cause ototoxic damage—that depends on a number of factors—but be warned, they can and do at times, so you need to be cautious until you know how a given drug affects your ears. Note that side effects can show up within days, but some only show up months or years later.

Factors Affecting Ototoxicity Vary from Person to Person

The good news is that you don’t have to let the side effects of ototoxic drugs flip your world upside down. With a bit of knowledge and by exercising some foresight, you can take four steps to greatly reduce your chances of experiencing ototoxic side effects.

Before we get into these four steps, I need to emphasize that we are all different. Thus, it should be no surprise that we all react differently to drugs. For example, the degree to which each of us absorb a drug varies significantly. Furthermore, the degree to which we eliminate a drug also varies significantly.

As a result, if you receive too high a dose for your body, it can result in your experiencing an ototoxic side effect that otherwise would not appear. That is why one person can take an ototoxic drug with seeming impunity. Another person can take one dose of that same drug and wham—there goes their hearing.

For example, “Betty’s” doctor told her that a certain antibiotic he prescribed would only damage her hearing if taken in large doses for a prolonged time. What happened to her? The very first (relatively low) dose permanently damaged her hearing. As a result, for the past thirty-five years she has had to wear two hearing aids just to be able to understand what people say.

Here’s another example, Marcia had been taking Diclofenac (which is one of the many non-steroidal anti-inflammatory drugs) for 15 years and did not experience any noticeable ototoxic side effects, although this drug can cause hearing loss, balance problems and tinnitus.

In contrast, “Sylvia” took Diclofenac for just 15 days when she developed, severe tinnitus, severe vertigo and severe hearing loss in her right ear. That’s how different ototoxic reactions can be between people taking the same drug. It doesn’t seem fair does it? But that’s just the way it is. That’s how different we all can be from each other in relation to experiencing drug side effects.

Incidentally, ototoxic side effects can appear in just one ear or in both ears. However, some doctors think that if you experience side effects in just one ear, it couldn’t possibly be due to the drug because they logically assume that when a drug enters your bloodstream, it will affect both ears more or less equally. As a result, they may attribute ototoxic side effects to other factors and brush you off. However, ototoxic side effects can and do affect just one ear or both ears for whatever reason.

There are a number of factors that affect why drugs can be so harmful to some people’s ears and not to others, and also why the severity of any resulting side effects can vary from mild to severe between different people.

A major reason for this variability is that the appropriate drug dose varies significantly from person to person. One reason for this is that there are three basic body constitutional archetypes. Each of these archetypes has a different degree of susceptibility to the results of taking any given drug. These three types have fancy medical names—ectomorph, mesomorph and endomorph respectively, but to make them easy to understand and remember, I’ll simply refer to them as body types 1, 2 and 3.

Type 1 people tend to be intelligent and gentle, but self-conscious, introverted and anxious. Physically they tend to have a less solid or thin body type and personality. They are much more sensitive to their environment and surroundings, including to drugs.

Type 2 people tend to be competitive, extroverted and tough. Physically, they tend to be muscular. They tend to be passionate, active and in motion and are less sensitive to drugs.

Type 3 people tend to be outgoing, friendly, happy and laid-back. Physically, they tend to be stocky/overweight and have a much denser and thick body type and are much less sensitive to the things around them, including drugs.

Because of their differences, each of these types requires a somewhat different drug dose for their ailments than the other two types. It is not that “one size fits all”. Unfortunately, this is typical of the way doctors often prescribe drugs.

For example, the appropriate drug dose for a Type 1 person should be drastically less than the appropriate dose for a Type 3 person because Type 1 people tend to be much more sensitive to drugs and thus more often develop side effects if given the “standard” drug dose, whereas Type 3 people are more resistant to drugs and consequently develop few side effects when given the same standard dose. Type 2 people are somewhere in between.

This concept is generally misunderstood, and as a result, the drug sensitivities of Type 1 people are often interpreted as being psychiatric in nature, especially if they are taking psychotropic drugs.

Unfortunately, too many doctors assume the side effects that Type 1 people experience are due to the dose being too low, not too high, thus they increase the dose. This is especially true when they take drugs for anxiety or depression. However, in reality, the dose was already so high that their bodies reacted to the drug causing the side effects to appear. The proper thing to do in such cases is to lower the dose, not to raise it.

In like manner, if you have been on a drug such as one of the many SSRI drugs for months or years and now want to taper off this drug, often side effects appear. Unfortunately, doctors typically interpret these side effects as a relapse and a sign that the withdrawn medication had been “working” (hence you need to continue taking the drug). Consequently, they reinstate the original dose or even increase the dose.

Unfortunately for Type 1 people, since many Type 3 people respond quite well to standard doses, it is easy for doctors to remember these positive responses and assume that everyone will react the same way. Thus, Type 1 people suffer more ototoxic side effects as a result. This is why you and your doctor need to know your archetype and adjust your drug dose appropriately so you don’t suffer from ototoxic (and other) side effects.

Further compounding the dosage issue is the fact that few drugs can be precisely targeted to the specific tissues your doctor is trying to treat. Instead, most medications are systemic, meaning they can travel freely around your body. Thus, they can get into your ears and cause ototoxic side effects.

For example, if you are treated with the antibiotic Neomycin for a cut on your leg, you could end up with hearing loss and tinnitus as the drug is absorbed into your bloodstream and travels to your ears. This happened to one young man in his twenties. He wrote:

I have experienced ototoxicity following a single application of Neomycin on a large, deep cut on my leg. I covered the cut completely with Neosporin and soon thereafter experienced tinnitus and dizziness. My hearing has worsened, and I have experienced a dramatic change in the way I perceive sounds.

Here are three other factors related to how given drugs vary in the side effects they produce between different people.

• Age—as you age, your body becomes less able to tolerate toxic drugs. For example, your liver and kidneys are responsible respectively for metabolizing and clearing drugs from your body. Since their function declines with age, if you are a senior (over age 60) you often cannot tolerate the standard dose of a drug that you could when you were younger since drugs tend to stay in your body longer. As a result, drug concentrations can build up to toxic/ototoxic levels in your blood and side effects appear. Likewise, as you age, your arteries become less able to reflexively bring blood to your head. Therefore, if your doctor medicates you down to a blood pressure level appropriate for younger adults, far too often as you stand up, you will become lightheaded and fall and maybe break your hips. I even wrote an article on this topic called Don’t Let Ototoxic Drugs Break Your Hips In addition, as you age, you tend to take more and more drugs. How these drugs interact with each other affects the frequency and severity of the resulting ototoxic side effects you may experience, especially when taken at higher doses.
• Gender and Race—significant differences exist in how different genders and races respond to many medications. It is a rare drug trial that will note gender-specific differences to a drug. It is rarer still that a drug trial will record and evaluate racial differences. Furthermore, as one doctor explained, in the name of diversity, equity and inclusion (DEI), there has recently been a push in the medical field to remove many of the metabolic differences that had been observed between different races (and affected their appropriate medical management). Thus, you can receive an inappropriate drug dose depending on your gender or race.
• Genetic factors—genetic variations can affect how you respond to a drug. For example, certain drugs can alter the function of your Cytochrome P450 3A4 enzymes. Thus, for these drugs, simply drinking grapefruit juice can affect whether you end up with too small a dose to be effective or end up with a massive 1,500% drug overdose as can happen when you take Simvastatin (Zocor) for example. This is almost certain to result in ototoxic side effects appearing, and yet it is still the “standard dose.” For more on this see Chapter 18 in Ototoxic Drugs Exposed.

The Four Main Ways to Put the Odds in Your Favor

With this background in mind, let’s look at the four main things you and your doctor can do to put the odds in your favor so that hopefully you will not experience any ototoxic drug side effects.

1. Try Non-Drug Solutions First

Obviously, if you don’t want to risk having any ototoxic (or other) side effects, don’t take any drugs in the first place. Use other (non-pharmaceutical) means to treat whatever conditions you may have. If this is not practical, limit your use of ototoxic drugs to those that are absolutely essential. In other words, take prescription and over-the-counter drugs as a last resort, not as your first line of attack.

The truth is that Americans take a lot of prescription drugs. Any way you look at it, Americans are a nation of pill poppers. I think the motto of many Americans is “A pill for every ill” and “A drug for every bug”. It is the rare person who doesn’t take any drugs at all.

As a result, each year more and more people are damaging their ears from taking ototoxic drugs. Why? People are taking more and more drugs, and the law of averages says that the more drugs you take, the greater your chances of having adverse side effects.

Dr. John Abramson of the Harvard Medical School explained, “It is no secret that Americans take many drugs unnecessarily, and when drugs are needed, people often take the wrong ones”. The late Dr. Sidney Wolfe, the Health Research Group founder and the former senior advisor of Public Citizen’s Worst Pills, Best Pills News lamented:

So often, drugs are prescribed unnecessarily, especially to older adults. The result is that what might have been minor problems become major problems.

As a result, we need to realize that there is an unavoidable degree of risk attached to all drug treatments. This is why many people have noticed that their tinnitus or other ototoxic side effects began while they were taking some form of medication. For example, one person explained:

I was recently prescribed Atomoxetine (Strattera). I asked my doctor if it could bother my tinnitus because I don’t want to take anything else that could make it worse.

He pointed out (truthfully, I might add):

All medications have the potential to cause tinnitus. There isn’t any medication that you can categorically say with 100% certainty that it won’t cause tinnitus.

The most you can say is that certain drugs are unlikely, or highly unlikely to cause tinnitus (or other ototoxic side effects), but there is still a chance that any given drug may cause a side effect such as tinnitus if given the right conditions.

Most doctors prescribe drugs because they think it’s in their patients’ best interest to do so because that is what they have been taught (brainwashed) to believe. They are trained in drug therapies—how to use drugs to suppress the symptoms of whatever condition you have—not in treating the underlying cause so you regain your health and thus don’t need to take drugs.

Here’s an easy way to separate the medical doctors who can truly help you from the doctors that are just going to try to manage your symptoms. It’s based on the astute observation of J. Apley who, back in 1978, wrote:

Doctors who treat symptoms tend to give prescriptions.

Doctors who treat patients are more likely to offer guidance.

You see, your health is your responsibility. You, and you alone, are responsible for the body God gave you, not your doctor. Therefore, although you may go to doctors for help, the final decision on any treatment, including any drugs your doctor may want you to take, is up to you.

Always ask yourself before choosing to take any medications or receiving any medical procedure, “Do the benefits outweigh the risks?” You may be extremely glad you did!

Since doctors seldom are reliable sources of ototoxic drug information, you need to check things out for yourself. If you don’t, it is your ears that will suffer—not the ears of your doctor, nor the ears of your pharmacist.

There are three main factors that result in your having poor health and thus having to see your doctor.

The first one is diet. Did you know that around 75% to 80% of health problems can be traced back to poor diet? Since you and you alone are responsible for everything you put into your mouth, you can really improve your health by changing your diet.

Chapter 18 in my book Ototoxic Drugs Exposed explains how you can clean up your diet. For example, it shows you how to substitute the 10 most unhealthy foods for the 10 most health-giving foods. You don’t have to do this all at once or else you’ll give up on these dietary changes as fast as you dump your New Year’s resolutions.

The easy and most successful way to change your diet for the better is to dump one of the worst foods (pick the one you will least miss) and put one of the healthiest ones in its place (pick the one that you think will be the easiest one to incorporate into your diet). Once you are comfortable with that change, which may take a week or a month or longer, then dump the next easiest and substitute it with one of the healthy options on the list. Continue to do this until you have changed over to a healthy diet and notice how much better you feel.

The second factor is not getting enough exercise. Most of us are woefully lacking in health-giving exercise. Don’t sit down so much. Get up and get moving! You don’t have to spend hours at the gym. Just getting out and walking in the fresh air can do wonders for your health. Start out with maybe walking a block or two depending on your condition and work up to walking 5,000 to 8,000 steps per day (2 or 3 miles).

The third cause of poor health is lack of enough refreshing sleep. Arrange your schedule so that you get between 7 and 9 hours of solid sleep every night.

Furthermore, instead of relying on drugs, use alternative or complementary medicine practitioners. For example, some medical doctors have learned a lot about good health and practice various alternative and complementary therapies. In addition, seek out naturopathic doctors (ND), chiropractors (especially upper cervical spine chiropractors), massage therapists, herbalists, acupuncturists, counselors and kindred health professionals. These professionals learn a lot about health during their training. In contrast, medical doctors focus on disease and various disorders.

Therefore, if you want to get and stay healthy, choose your health care professionals wisely. If you are sick, who would you rather go to—a health care professional who is an expert in health and can teach you how to become and stay healthy, or a doctor who is an expert in sickness and treats the symptoms of your condition with drugs and/or surgery, but never treats the fundamental underlying cause, so you never really get well but have to take drugs for the rest of your life to manage your condition?

Just following these guidelines can eliminate many health problems without your having to take a single drug.

The question is, why don’t we do this. The answer is simply this—we choose to take drugs because we are lazy when it comes to protecting our health and like to indulge in poor food choices, lack of exercise and poor sleep habits. Then, when something goes bad, we rush to our doctor and want him to prescribe a “magic pill” that makes everything right again. There is no question that many people would rather take a pill than change their lifestyle. However, life just doesn’t work that way. We have to take responsibility for our own health.

Therefore, if you want to get healthy, you need to do your homework before you decide whether to take a drug for a given condition, or whether you should look for an alternate solution that is not harmful to your ears (and the rest of your body) and also one that has the potential to make you truly healthy again.

You need to ask yourself, “Are natural therapies a better alternative to some drugs?” If you look at the data rather than listen to the drug ads, you will see that natural alternatives, such as improved diet and routine exercise, often are far more effective than drugs at achieving real health improvements such as less heart disease and longer life.

Therefore, instead of worrying whether a certain drug is ototoxic or not, you should be questioning whether a drug is really necessary or not, and whether it can cure you or not. When the answer is “no”, you should be actively looking for better alternatives.

For example, if you need help with your depression, instead of taking prescription drugs you can use herbals. For example, you could try the herbal, St. John’s Wort, rather than using ototoxic anti-depressants. (Just be sure to look for the words “Standardized” and “Hypericin” and “0.3-0.7%” on the label so you know you are getting an effective standardized dose.) Numbers of studies have shown St. John’s Wort to be as effective as prescription drugs for mild to moderate depression, but without their numerous side effects.

Better yet, just get outside and walk. A recent study revealed that exercise such as walking is as effective for depression as anti-depressant drugs. Furthermore, in this case there are no ototoxic side effects at all.

Thus, if you truly value your health, make sure that any drug you take is absolutely necessary before you take it. Remember, the vast majority of your health issues are determined by the way you live your life, and for better or worse, no pills can change that.

2. Take the Least Ototoxic Drug That Will Do the Job

If you do have to take drugs or choose to take drugs for whatever reason, here are my three rules of thumb that generally will let you fly under the ototoxic drug radar and thus not experience any ototoxic side effects even though the drug may be listed as being ototoxic.

My first rule of thumb is “Take the least ototoxic drug that will do the job”.

That begs the question, “How do you know which drug is the least ototoxic?” You can painstakingly do you own research as I have done over the past 35 years or so, or you could turn to table 19-1 beginning on page 1445 in my Ototoxic Drugs Exposed book and see the relative ototoxicity of each of these drugs, then turn to the detailed listings for these drugs and make your decision as to which ones you are prepared to risk taking.

For example, let’s say your doctor wants to prescribe the skeletal muscle relaxant Baclofen. You turn to section 53.36 in Table 19-1 (page 1482) and see that Baclofen has a Risk Factor of 3 (out of 5—a moderate risk).

You note that another drug in the same class—Dantrolene—has a very low risk factor of only 0.5. This looks like a better choice to avoid ototoxic side effects appearing. Next you turn to the individual drug listings to see which drug has the least risk, specifically for hearing loss and tinnitus.

Under the Baclofen listing (page 527) you see that there are 101 cases of hearing loss reported and 401 cases of tinnitus.

Then you turn to page 697 to see the equivalent risk for those same side effects if you took Dantrolene. You note that there are no reports of either hearing loss or tinnitus. At the same time, you note that Baclofen lists 22 different ototoxic side effects versus Dantrolene’s 6. This confirms that Dantrolene seems to be a wiser choice, thus you ask your doctor whether Dantrolene could do the job instead of Baclofen as you’d like to take it since it has much less ototoxic risk.

There is one caveat. This book only gives you the risk factors for ototoxicity. This is great for your ears, but this book says nothing about the overall toxicity of this drug for the rest of your body, and you want to know this too.

You should be aware that the average drug has between 100 and 300 different reported side effects you could experience. If you read the “Patient Product Information” sheets that come with your drugs or if you read some drug information sheets on an on-line drug website, you likely are not getting much if any of the information you are really wanting on ototoxic side effects.

These information sheets are “dummied down” for the layperson, and also greatly shortened. Thus, if a source only lists 10 or 20 side effects, you know it is not a complete listing by any means! This means a lot of the information you want regarding ototoxicity is left out. For example, at the bottom of one Drug Information Sheet was this warning. Be sure to heed it! It said:

The side effects described above do not include all the side effects reported with this drug. Do not rely on this leaflet alone for information about side effects. Your doctor or pharmacist can discuss with you a more complete list of side effects.

Thus, when considering a drug, always look at all the side effects (ototoxic and otherwise) you may experience.

That is why you need to carefully weigh the good the drug is supposed to do you against its potential for causing permanent damage to your ears (and the rest of your body). This is because not only do drugs typically not cure diseases, but they also often introduce a whole host of other side effects. Therefore, according to Dr. Paula Rochon, if you experience new side effects, especially if you are an older person, consider them drug-related until proven otherwise.

Make your choice of any drug you are considering taking based upon how much risk you are willing to accept. Only you, yourself, know what you are willing to endure in order to avoid the risk of losing any more of your hearing or balance, or causing other ear damage from taking drugs.

Note: Your informed decision needs to include researching whether the drug you are considering taking will even do a good job in helping you, or if it is basically just a ploy to make the drug manufacturers richer at your expense with only minimal improvement in your condition. As Dr. Robet Steinbrook warns:

A study found that from 2015 to 2021, fewer than one-third of the most common drugs featured in direct-to-consumer television advertising were rated by independent health technology assessment agencies as “having high therapeutic value,” which the researchers defined as “providing at least moderate improvement in clinical outcomes compared with existing therapies.”

In other words, at least 67% of the most popular drugs currently advertised on your television are basically almost worthless—they do not give you much relief/improvement and for this privilege, you pay the big bucks and often suffer from debilitating side effects. Thus, you will likely be better off making the lifestyle and dietary and supplemental changes mentioned previously in order to achieve improvements in your condition.

3. Take the Lowest Dose That Will Do the Job

Once you have decided on the drug or drugs you are willing to risk taking, my second rule of thumb comes into play. It is simply this—take the lowest dose that will do the job.

Doctors typically want to make sure the drug they prescribe does the job, so they may prescribe a higher dose than is really necessary—and when they do that—you are more likely to be hit by ototoxic side effects. If they had prescribed a lower dose, you may not have had any apparent side effects surface.

Doctors need to take to heart the words of Dr. Peter Selley when he explained that the aim in medicine should always be “to find the lowest dose of a drug that is effective, as most side effects are dose-related.”

I often tell people they have a “magic threshold” below which they do not experience ototoxic side effects. Thus, the trick is to keep your dose below this “magic threshold”. The problem is that you don’t know exactly where this threshold is—that’s why I call it a “magic threshold”. Furthermore, everyone can have a different magic threshold because we are all different.

For example, before we were married, my wife was on a certain drug without any ototoxic side effects appearing. Then her doctor chose to increase the dose and immediately her tinnitus got much worse. She had just crossed her “magic threshold” for that drug. I suggested she ask her doctor to reduce the dose and when she did, she dropped back under her “magic threshold” and her tinnitus returned to its old level.

Likewise, I have received numerous reports from people who found that their side effects appeared when their drug dosage was increased, or conversely, went away when doctors reduced their drug dosage. Thus, taking lower doses of drugs can help you avoid many ototoxic side effects.

The safe way to do this (if there is time) is to start with a lower-than-normal drug dose, then evaluate what happens. If no side effects show up and you experience no harm to your body, yet the benefits are not sufficient to treat your condition, gradually increase the dose.

Unfortunately for us, doctors typically seem to simply double the dose (like they did with my wife—and this can cause ototoxic side effects to appear.

The slow approach is much less likely to create ototoxic side effects, but it is also much more time-consuming to do. Consequently, doctors seldom do it, but don’t blame it all on your doctor. Numbers of doctors have had cases where they escalated a dose for a desperate patient faster than they had originally planned to and then regretted doing this when the patient had significant side effects to a still relatively-low drug dose.

At the same time, doctors need to carefully observe their patients for subtle signs of any changes when slowly increasing the dose. This is because subtle signs that the person’s body is not tolerating a medication typically emerge before more overt side effects appear.

Due to the many factors influencing how your body utilizes drugs, how can your doctor determine what the correct dose is for you? As one knowledgeable doctor explained, “Probably the single most important thing is simply to be aware that the dose they assume you should take probably is not correct and needs to be adjusted (typically downward)” to fit your specific body factors.

Standard Dose

This brings us to the concept of the standard dose. During the drug approval process, researchers determine the safe dose of each drug. This is called the standard dose. The above quoted doctor explained why doctors just default to this standard dose. He explained:

It would be very difficult to run a medical system which quickly sees a large volume of patients (e.g., it would take much more than 30 seconds to prescribe the correct dose of a drug), but at the same time, it also makes a large demographic exist for which standard medicine care simply does not work.

It is revealing how this standard dose is determined. Since it is often impossible to have an effective dose which is low enough so that it does not also create side effects in some people, the drug companies do their best to downplay the toxicities that occur in their trials.

In order to do this, generally the drugs in clinical trials are often only tested on the healthiest members of the population (typically college age males). This is because college-age males are the least likely to experience adverse side effects to the trial medications.

Drug trials would be more truthful if they tested the new drugs on the people most likely to be taking them (such as older people) and thus would be more likely be injured by them. As one doctor explained:

This is a longstanding issue in clinical trials (e.g., we rarely test drugs on the elderly—who are typically the most likely to suffer adverse reactions to them, but once the drugs go to the market, those are the groups they are most frequently pushed upon).

Ideally a pharmaceutical company wants the standard dose of its drugs to have minimal side effects, and at the same time, it wants the majority of people taking them to experience the intended benefits of this standard dose. So if you are a Type 1 person, taking the standard dose will almost certainly be too much for you.

Therapeutic Index

Some drugs are fairly safe and highly unlikely to cause side effects at normal doses in most people. However, other drugs are much more likely to cause side effects for some or many of the people that take them. Again, this is especially true if you are a sensitive Type 1 person.

The gap between the effective (standard) dose and the toxic dose where side effects appear is called the therapeutic index or therapeutic window. A broad therapeutic index lets you know that the effective dose is well below the toxic dose. Thus, your doctor has a lot of “wiggle room” in which to adjust the drug dose before side effects typically appear.

The good news is that when a drug has a broad therapeutic index, it is relatively unlikely that you will experience side effects if you take this drug at the prescribed standard dose.

On the other hand, a narrow therapeutic index tells you that the therapeutic dose is close to the toxic dose. In this case, your doctor doesn’t have much “wiggle room” to adjust the dose. Thus, unless your doctor carefully tailors your dose to your body’s characteristics, you could inadvertently be prescribed a toxic dose and thus have a high risk of experiencing serious ototoxic (and other) side effects.

That is why in such cases, even a slight drug “overdose” just due to changes in the water or fat content of your body at the time you take the drug can cause ototoxic side effects to appear—for example, you are dehydrated. Examples of drugs with narrow therapeutic indices include lithium and various cancer drugs.

Therefore, all things being equal, having your doctor choose a drug with a broad therapeutic index will typically also reduce your risk of experiencing ototoxic (and other) side effects.

Getting the Dose Right to Minimize Drug Side Effects

When you do experience drug side effects, often you may find your doctor insists that many of your reported side effects have nothing to do with the medications they prescribed but are from something else. They tend to attribute them to pre-existing conditions you may have had or to coincidence because the dose they gave you was supposedly “appropriate” because it was the “standard dose”. Furthermore, they do this in spite of the fact that hundreds or thousands of people have reported precisely this same side effect to the FDA’s adverse drug reporting system.

Therefore, if you experience an adverse side effect or something simply feels wrong to you, you should consider the possibility that it is due to the drug and not coincidence or something else and report it to your doctor. It’s better to be safe than sorry! As one doctor explained:

Many patients who developed chronic injuries from a toxic pharmaceutical have told me that one of their greatest regrets was listening to their doctor instead of their intuition or their body when they decided to go forward with taking the pharmaceutical that then ruined their lives.

As you can now see, in order to prevent side effects from occurring, it is critical for you to receive the right drug dose that is specifically tailored to your body type—not just the standard dose you likely received.

Therefore, don’t let your doctor railroad you into taking his recommended course of drugs without first doing your own research. Your body may react differently than he expects.

Also, be aware that many of the side effects doctors attribute to medications are actually the result of drugs causing critical nutritional deficiencies. Here are just three examples. Esomeprazole (Nexium) depletes your body of magnesium while Acetaminophen (Tylenol) depletes your body’s stores of glutathione, your body’s most powerful antioxidant, and Atorvastatin (Lipitor) depletes your body of co-enzyme Q10.

4. Take the Drug for the Shortest Time That Will Do the Job

Finally, my 3rd rule of thumb is to take the drug for the shortest time that will do the job. When you do this, again you can often avoid experiencing ototoxic side effects.

Drug usage guidelines are published in the PDR (Physicians’ Desk Reference) in the USA and in the CPS (Compendium of Pharmaceuticals & Specialties) in Canada, so doctors know the standard dosage and safe time limits. Do doctors always heed these guidelines? Not on your life! For example, a 1996 report by the FDA found that for a certain drug they had specifically warned doctors about, 85% of the prescriptions were still for longer periods than were safe! This really increases your chances of experiencing ototoxic (and other) side effects.

For example, the longer you take an antibiotic, the greater your chances of having ototoxic side effects surfacing. Doctors want to be sure to kill all the bugs so they prescribe a standard dose of antibiotics and tell you to be sure to take all the pills. This way you will prevent the bugs from building up resistance to the antibiotic. This was the conventional wisdom. However, recent research has shown that just the opposite is true.

This research reveals that just taking an antibiotic long enough to kill the bug but no longer seems to be the better way to go to avoid building up antibiotic resistance. Thus, you don’t have to finish the prescription like they so often tell you. What I do is take the antibiotic until the infection is dead and give it one more day for insurance. Thus, if I had a prescription for 10 days but I see the infection is killed by day 4, I take it for one more day and stop. By doing this, I have avoided any ototoxic side effects although all prescription antibiotics are ototoxic.

In a similar vein I never take an antibiotic “just in case”. I want to know that there is a real infection that needs to be treated before I take any antibiotic. I don’t want to be like the man who completed a course of an antibiotic without any side effects. However, his doctor then prescribed a second course of the same antibiotic “just in case”. By the time the man completed this second course of antibiotics he was essentially deaf. That’s the risk you take when you take antibiotics for longer than is absolutely necessary.

The same holds true for other classes of drugs. For example, many people take anti-anxiety drugs such as the benzodiazepines. Benzodiazepines are only meant to be taken for short periods of time, no longer that 2 weeks or so. They were never meant to be long-term solutions. You should just take such drugs to give you temporary relief while you seek other treatments. A good solution in the case of anxiety would be counseling to show you how to successfully deal with your anxiety rather than trying to drug it into submission, which ultimately doesn’t work. Unfortunately, doctors allow multitudes of people to stay on these drugs for months, and in many cases, for years.

When you do this, ototoxic and other side effects show up and get worse and worse as time goes by. Then, when you determine to get off these drugs, researchers estimate that between 50% and 80% of the people who have taken benzodiazepines continually for 6 months or longer will experience horrible withdrawal symptoms when reducing the dose or stopping completely.

When I mentioned to one lady that she likely would be shocked to learn that almost all of her symptoms, both ear-related and otherwise, were known side effects of taking the benzodiazepines she replied, “I’m scared. Everything you have said about the drugs I take really hit home”.

Thus, I can’t stress this enough—benzodiazepines and other psychotropic drugs are not for long-term use. If you use them long-term, be prepared for nasty ototoxic and other side effects to arise.

To be sure, some people seem to be able to take benzodiazepines with seeming impunity, however many people have such bad experiences they sincerely wish they had never taken the first pill. For example, a lady explained:

About 15 years ago I started having panic attacks and began taking Alprazolam (Xanax) at 1.5 mg/day and have been on it ever since. Two years ago, I had some really bad panic attacks so my doctor doubled my Xanax medication to 3 mg/day.

Now everything is out of control for some reason. In the past year or two, in spite of the increased dose, things have been getting much worse to the point where I don’t feel normal anymore.

My hearing is a lot worse. I have vertigo and balance problems. I feel unsteady on my feet. My ears are ringing. They are also supersensitive to sounds [loudness hyperacusis]. As a result, I can’t wear a hearing aid in one ear anymore.

I feel like I am only 50% here—kind of like living in a dream state. I feel shaky and out of sorts and panicky. I feel weird and feel like I am going to pass out. I can be fine one minute, then bam—all of a sudden I feel this odd feeling coming on as if my hearing gets very quiet. I feel as if I am chilled. I get a tingly feeling in my head, and then I feel a sort of darkness and closed-in feeling about to happen. I start to shake and sweat, and I just feel as if I am drifting away.

I have always thought that my medications could be hurting me more than helping me. Why did the doctor do this to me? My neurologist feels I won’t be able to stop taking the Xanax as my body is now dependent on it. If I would go off this drug, he feels I would spin out of control—but I’m already out of control!

For some time I have wanted to try to taper down, or get off the Xanax, but I am scared I will feel worse. How am I going to live my life without the Xanax? I want to be able to get through the day, but not like this! I would love to be free and be me again!

This is why you want to be sure to take a drug for the shortest period of time that will do the job.

In Summary

In summary, in order to avoid experiencing ototoxic (and other) nasty side effects:

1. Try non-drug solutions first. In other words, take prescription drugs as a last resort, not your first line of attack.
2. Take the least ototoxic drug that will do the job.
3. Take the lowest dose that will do the job; and,
4. Take the drug for the shortest time that will do the job.

By just incorporating these four factors into your health protocols you, will have gone a long way towards putting the odds in your favor. The result? Typically, you will prevent ototoxic drugs from flipping your world upside down.