by Neil Bauman, Ph.D.
December 29, 2015
A number of people believe that drugs ending in “–mycin” (and “-micin”) are all members of the extremely ototoxic Aminoglycoside class of antibiotic drugs and should be avoided so they don’t damage their ears. This is not totally true.
It is true that about half of the generic drugs ending in “–mycin” and “–micin” are indeed members of the Aminoglycoside class of drugs. However, it is just as true that about half of the drugs ending in “–mycin” and “–micin” are not Aminoglycosides. Furthermore, some Aminoglycoside drugs do not end in “–mycin” or “–micin”.
Complicating things further, not only do a number of generic drug names end in –mycin and –micin, but so do a number of brand names—again about half of which are Aminoglycoside drugs, and half are not.
Therefore, when you come across a drug name ending in “–mycin” or “–micin” don’t automatically assume it is an Aminoglycoside drug. (You’d be wrong about 50% of the time if you do.)
Below is a list of all the drugs (generic and brand names) that end in “–mycin” or “–micin” of which I’m aware. All of them are ototoxic to some degree—ranging from mildly ototoxic to extremely ototoxic. Generic names ending in “-mycin/-micin” are in bold. Brand names are in bold italics and drug class names are in UPPER CASE.
- AMINOGLYCOSIDE drugs ending in “–mycin”
- Capreomycin
- Dihydrostreptomycin
- Hygromycin B (and brand name Antihelmycin)
- Kanamycin
- Neomycin (also known as Fradiomycin)
- Paromomycin (also known as Aminosidine)
- Ribostamycin
- Spectinomycin
- Streptomycin (and brand name Pan-Streptomycin)
- Tobramycin
- Viomycin
- AMINOGLYCOSIDE drugs ending in “–micin”
- Astromicin (and brand name Fortimicin)
- Gentamicin (and brand names Cidomycin and Garamycin)
- Isepamicin
- Micronomicin (and brand name Sagamicin)
- Netilmicin (and brand name Netromycin)
- Sisomicin (and brand name Extramycin)
- AMINOGLYCOSIDE drugs that do not end in either “–mycin” or “–micin”
- Amikacin
- Dibekacin (and brand name Panimycin)
- Framycetin (and brand name Soframycin)
- Non-aminoglycoside drugs that end in “–mycin” or “–micin”.
- GLYCOPEPTIDE antibiotics
- Vancomycin
- KETOLIDE antibiotics
- Telithromycin
- LIPOPEPTIDE antibiotics
- Daptomycin
- MACROLIDE antibiotics
- Azithromycin
- Clarithromycin
- Dirithromycin
- Erythromycin (and brand name E-Mycin)
- Roxithromycin
- GLYCOPEPTIDE antibiotics
- Drug class names that end in “–mycin”
- ANTI-NEOPLASTIC (anti-cancer) drugs
- Bleomycin
- Dactinomycin (and brand name Actinomycin-D)
- Mitomycin (and brand name Mutamycin)
- LINCOMYCIN antibiotics:
- Clindamycin
- Lincomycin
- RIFAMYCIN antibiotics (no generic drug names in this class end in –mycin
- URINARY ANTI-INFECTIVES
- Fosfomycin
- ANTI-NEOPLASTIC (anti-cancer) drugs
- Brand name drugs (not listed above) that end in “-mycin”
- ANTHRACYCLINE drugs
- Doxorubicin (brand name Adriamycin)
- ANTI-BACTERIAL drugs
- Novobiocin (brand name Albamycin)
- ANTI-MYCOBACTERIAL drugs
- Cycloserine (brand name Seromycin)
- POLYPEPTIDE drugs
- Colistin (brand names Coly-Mycin M and Coly-Mycin S
- TETRACYCLINE antibiotic drugs
- Chlortetracycline (brand name Aureomycin)
- Demeclocycline (brand name Declomycin)
- Methacycline (brand name Rondomycin)
- Tetracycline (brand name Achromycin)
- ANTHRACYCLINE drugs
Thank you so much for the valuable information. I experienced hearing loss gradually starting when I was very young. I was given streptomycin as I was sick a lot. As I got older I was having a terrible reaction to alot of drugs and they were always mycin related. My hearing loss really bad by the time I was 30 or younger, but never had hearing tests. I am now 76 and have been wearing hearing aids since that visit. It has got very extreme. Close to a cholear implant, which I never would have done. There a some topical medications that make me break out in a rash also.
Every doctor I went to wanted to know what caused it. The use of streptomycin answered the reason for both ears losing hearability. I need a list as not all mycins are listed as mycins and I get prescriptions and get sick and experience the other symptoms. Also have car sickness, vertigo and related aspects. My hearing is at 40% even with the aids. behind and in the ear. Thank you again for the list.
I always thought Fosfomycin was added to chemo therapy drugs to decrease their ototoxicity,
Every drug that ends with my sin.These meds are used to try to cure diseases we got from our sins.
Is tetracycline ototoxic?
Hi Evelyn:
Yes tetracycline is ototoxic and can cause hearing loss, tinnitus, ataxia, dizziness and vertigo in some people. I classify it as a 2 out of 5 in regards to ototoxic risk (mildl to moderate ototoxic risk).
Cordially,
Neil
Thanks Neil for the info, I’m having to take it now, have 8 more days to go.
Thank you for the helpful list! So, if I am reading this right, Clindamycin is not otoxic?
Hi Mrs. K.
You’re not reading it correctly. All of the drugs on this list are ototoxic to some degree. Clindamycin is listed under section 5.2.
Cordially,
Neil
https://www.dizziness-and-balance.com/disorders/bilat/ototoxins.html#safe
At the same time, this article says that there is no reported hearing
loss from clindamycin. I dont know what to believe anymore.
Hi Andi:
I hear your confusion. I think your question deserves a more complete answer than I would give here. As a result, I have written a whole article on the subject to help you figure out the truth as much as you can. You can read this article I’ve entitled “Is Clindamycin Ototoxic or Not?” at http://hearinglosshelp.com/blog/is-clindamycin-ototoxic-or-not/ .
Cordially,
Neil
Hello- I have to get a 300 mg dose of Clindamycin in my IV during my surgery and then take it orally for about 7-days. Will this be ototoxic you think?
Hi Tami:
Clindamycin is moderately ototoxic and has caused hearing loss in hundreds of people as well as tinnitus and various balance and other problems. Something of which you want to be aware.
Will you get any of these ototoxic side effects? I can’t foretell the future, but you can put the odds in your favor by taking the lowest dose possible for the shortest time possible. And watch for any signs of ototoxicity developing and dump the drug if that occurs.
Sorry, I can’t be more specific. You may well not have any ototoxic side effects, but I can’t guarantee that.
Cordially,
Neil
My doctor prescribed Clindamycin with prednisone for my sinus infection. I experienced only an uptake in the loudness of tinnitus so far which I can ignore. However, when the prescription ended, I broke out in the most painful and itchy reaction with a welty rash over my entire body, even where a drug should never go. I had to go on yet another steroid to cope with it.
Is vancomycin ototoxic and nephrotoxic?
Hi Chris:
Vancomycin is definitely ototoxic. Hundreds and hundreds of people have lost hearing from taking it.
I don’t know whether it is Nephrotoxic but I wouldn’t be surprised if it were. I just keep track of ototoxicity.
Cordially,
Neil
Hi, is Azithromycin ototoxic ? My ears are ringing after 2 weeks of 500mg Per day
Hi Alex:
You betcha. Hundreds and hundreds of people have reported both tinnitus and hearing loss (among other ototoxic side effects) after taking Azithromycin. I list it as moderately ototoxic.
Cordially,
Neil
I understand that if they end in -mycin they’re not necessarily an amino glycoside but are they all antibiotics?
Hi Lorvena:
Yes, all drugs ending in -mycin are basically antibiotics one way or another.
Cordially,
Neil
Can a person with Bilateral vestibulopathy (from gentamicin toxicity) take IV Daptomycin?
Hi Shawnda:
Daptomycin belongs to the Lipopeptide class of antibiotics, not to the Aminoglycosides as is Gentamicin. If you need an antibiotic and daptomycin will do the job, it’s probably a reasonable choice. It is nowhere’s near as ototoxic as gentamicin. Since all antibiotics are ototoxic to some expent, you just need to choose one of the least ototoxic–and daptomycin fits the bill (as far as I know at this point).
Cordially,
Neil
Thank you so much. I appreciate your site.
I have mild prostate discomfort. I also have tinnitus and hearing loss. Nothing in urine sample. Bactrim prescribed as precaution. Please compare likely adverse effects on tinnitus versus fosfomycin, Macrobid, or Ceftriaxone and . particularly whether effects likely permanent or end after dosing is finished.
Hi Lee:
Personally, I don’t agree with prescribing drugs “just in case”. But if you want to take one of the 4 you list as a preventative, the one with lowest risk of ototoxicity for tinnitus (and hearing loss) is Fosfomycin, followed by Nitrofurantoin (Macrobid), and Ceftriaxone with Triemethoprim (Bactrim) bring up the rear.
Cordially,
Neil
Thank you so much.
What I was prescribed is Sulfamethoxazone-TMP DS.
A web site tagged it as Bactrim. Please let me know if that changes your list any. Thanks again.
Hi Lee:
Bactrim is a combination of Trimethoprim and Sulfamethoxazole. Sulfamethoxazole is only mildly ototoxic so it doesn’t really change anything in my opinion.
Cordially,
Neil
I am trying to get a better test to confirm I have an infection, instead of prostatitis, before I try any of the antibiotics. All of them have risk of allergic reactions and, aside from fosfomycin, the side effects are scary. Pharmacist says fosfomycin has not been tested for effectiveness in men so it would be an unsanctioned use for the doctor to prescribe it. Any others to suggest?
Hi Lee:
No, that would be something to ask your doctor. Then I can tell you how ototoxic any of them are. I don’t know what all drugs your doctor might prescribe. That’s his job. Mine is to help you understand their possible ototoxicity.
Cordially,
Neil
Hello, I have preexisting tinnitus and have an infected ingrown toenail/skin infection.
I had surgery on it and have been taking Cloxacillin 500mg/4x daily.
I am on day 4, it is not doing the trick. What can I ask my Dr. to try in terms of an oral antibiotic that is NOT OTOTOXIC for toenail/skin infection?
Thanks a lot!
Hi Vincent:
As far as I know, ALL antibiotics are ototoxic to some degree or other so the trick is to find the least ototoxic antibiotic that will do the job.
Since I’m not a medical doctor, I don’t know what antibiotic will kill the infection you have, so can’t recommend any specific one. You can ask your doctor for two or three possibilities and I can tell you which is the least ototoxic in my opinion.
Cordially,
Neil
Hello! I took neomycin 500mg for 10 days. On my 10th day I got extreme vertigo. I’ve been bedridden because of how bad my vestibular issues are since taking the neomycin. No hearing loss that I. Office but I do have tinnitus(I already had a little before the neomycin)….I know neomycin can affect heading but could it be affecting my dizziness too with such a short course/snap dose of oral neomycin that I took for SIBO?
Hi Bella:
Neomycin can cause dizziness, vertigo and other balance problems, and as you have found, it can happen quite fast. That is why I suggest people only take Neomycin for life-threatening conditions.
Cordially,
Neil
I have been offered oral xifixan (Rifaximin, based on rifamycin) for small intestine bacteria overgrowth, SIBO). I see rifamycin in your list of damaging antibiotics, above. Is the xifixan derivative also ototoxic? If so, do the effects go away if you stop taking it? I am already deaf in one ear from acoustic neuroma surgery and about 40% down in the other, cause undetermined. You can see my concern. The other option is Cipro, isn’t that one clearly ototoxic?
Hi Lee:
Of the two, Cipro is MUCH more ototoxic than Rifamycin. Actually, Rifamycin is just mildly ototoxic so I don’t think you should have any problems with your ears from taking it. There are no guarantees of course, but the odds are definitely in your favor.
Cordially,
Neil
Thanks, Neil. I really appreciate your being there.
Hi, Neil. What can you tell me about Remeron and ototoxicity? I got tinnitus from too high of a dose of Wellbutrin, then I was put on Prozac, which made it worse. Then I got an eye infection that was so bad I had to take something or lose the eye possibly. I told the dr. to NOT give me anything with Neomycin. Well, there was some mixed in the eyedrop prescription (unbeknownst to me), and on the 5th day I had high-pitched very loud tinnitus. SO now I live in terror of taking any drugs. I am severely depressed. I have read and been told that Remeron (Mirtazapine) would be the best antidepressant for me to use with the least chance of causing the tinnitus to worsen. Do you have an opinion on this? I have been through hell and am scared. I am so afraid of ever needing another drug in my life as it may worsen my tinnitus, and I’m young! A horrid way to live.
Hi Debbie:
Mirtazapine (Remeron) is a tetracyclic antidepressant drug. It is mildly to moderately ototoxic. When compared to Bupropion (Wellbutrin) and Fluoxetine (Prozac) it is about half as ototoxic as Prozac and only one quarter as ototoxic as Wellbutrin–so it is definitely an easier drug on your ears than those two.
Numbers of eye drop prescriptions have Neomycin or Tobramycin in them so you want to watch out. They can definitely damage your ears.
If I had to take an antidepressant, I wouldn’t go the prescription drug route. Rather, I’d take St. John’s Wort. It is not ototoxic, is available without a prescription at many drug stores, health food stores or On-line.
A number of studies have shown that it works as well as, or better, than prescription drugs for mild to moderate cases of depression.
If you choose to get it, just be sure it says on the bottle “standardized” and then give what it is standardized to. You want something that says, “standardized to 0.3% (or up to 0.7%) hypericin” which is the active ingredient.
Cordially,
Neil
Neil, thank you for answering my above question. Now that I have this tinnitus, I am TERRIFIED every day of my life about ever having to take another drug again. And you know I will need to – Propofol for my colonoscopy, getting eyedrops put in my eyes to dilate them for an exam, getting sick and needing anything, etc. I refuse to get a flu shot or Shingrix injection. I am terrified every single day. My drs. tell me I am being over-reactive. After Wellbutrin caused my tinnitus, the Prozac they put me on worsened it (even though I had taken it for years with no problem), and the eye drops for my eye infection had a tiny bit of Neomycin in it (I TOLD the dr. DO NOT give me anything ending my “mycin” but he did and I did not realize it as it was a mixture of drugs. The Neomycin gave me high-pitched Tinnitus. I have hearing aids that pipe in masking sounds — and that really helps. Neil, the problem is NOT the Tinnitus. The problem is the terror of needing a drug and the Tinnitus getting worse. What do people like me do? Is it possible that I can never take another drug again in my life without worsening the Tinnitus? I thank God that since I last wrote to you, my depression seems to have leveled off. Thank you so much and sorry this is so long.
Hi Debbie:
You need to calm down and not get so worked up over tinnitus. (or anything else) or it will become a self-fulfilling prophecy.
Many, many drugs can cause or exacerbate tinnitus. Thus the trick is to use the least ototoxic ones and often you will fly under the tinnitus radar. For example, I’ve had to take a number of drugs in the last 2 or 3 years, but I try to choose drugs that are only mildly ototoxic if possible. So far, I’ve not had any ototoxic side effects show up. None of them has made my tinnitus worse. So there is hope for you too.
For example, Propofol can cause tinnitus, but it only does so in relatively few people. I don’t think it will affect your tinnitus.
I haven’t heard of the eye drops they use for dilating your eyes as affecting tinnitus–so you shouldn’t have any trouble there.
Bupropion (Wellbutrin) is quite ototoxic as you have found out. That is one drug to stay away from in terms of ototoxicity. Fluoxetine (Prozac) is much less ototoxic than Bupropion–and the proof is that you took it for years without any problems. However, your fear of tinnitus messed up things and it made your tinnitus worse the second time round.
Eye drops (or anything) with Neomycin is a no no as unless it is a matter of life and death. There are other eye drops that do not have such dangerous drugs in them that your doctor could have prescribed. You need to be more forceful and refuse all these drugs that are quite ototoxic. Make your doctor find something that is not very ototoxic if possible. When my doctors try to give me something that I feel has too high a risk, I just flatly refuse to take it and they have always come up with another drug that does the job and yet (so far) has flown under the tinnitus (and ototoxic radar).
As you say, it is not the tinnitus, but your terror of your tinnitus getting worse that is your real problem.
When you have such a fear or phobia, you probably need professional help from someone skilled in helping people with a fear of drugs overcome that fear. You need to desensitize yourself to your fear of drugs causing you tinnitus.
I think you can do that by checking out ahead of time which drugs your doctor is proposing giving you. Ask him for 3 or 4 alternatives that will also work. Then you can check them out in my drug book, “Ototoxic Drugs Exposed” or email me the list and I can give you my opinion using the latest data available–I’m working on the 4th edition and it is far more comprehensive than the 3rd edition so I can give you an even better idea as to the risk of tinnitus from any given drug–until I get that 4th edition out.
As you see that not all drugs will negatively affect your tinnitus, I think you’ll be able to get your fear of this under control (especially with professional help).
And for conditions such as depression, there are many alternative treatments besides drugs–but few doctors use them. As I’ve often said, drugs should be your LAST line of defense, not your first line of attack. I practice this myself and rarely take drugs–and then only when all the other means I’ve tried haven’t done the job.
You CAN overcome your fear, but you’ll need to work on it.
Cordially,
Neil
What you
I have Mercer and I was prescribed vancomycin. The vancomycin read my chest hurt and my ears feel so they were about to burst I’ve now been prescribed baptomycin. I’ve noticed now I have music in my ears will I didn’t have before and I do believe my hearing has decreased a little. I had hearing loss before due to a c-spine injury. I have noticed that I can hear a little less each time I get the Daptomycin. Daptomycin is not ototoxic oh, so then why am I a little less and now hearing music in my ears that I didn’t before?
Hi Tajuania Bell:
Daptomycin is somewhat ototoxic, but I don’t have many reports on it. But I do have a handful of reports of people getting hearing loss from taking it–so it does happen–and you could be one of them.
Vancomycin, on the other hand, is quite ototoxic. Hundreds upon hundreds of people have reported getting hearing loss from taking it.
So switching from Vancomycin to Daptomycin was a step in the right direction (on the average). But if you are particularly sensitive to Daptomycin, you should ask your doctor to switch you to a different drug if that is possible.
The phantom music you are now hearing is called Musical Ear Syndrome. It can be caused by the drug, or as a secondary cause due to your hearing loss. You can learn more about it in my article at https://hearinglosshelp.com/blog/musical-ear-syndrome-the-phantom-voices-ethereal-music-other-spooky-sounds-many-hard-of-hearing-people-secretly-experience/
Cordially,
Neil
Hi Neil,
My doctor prescribed me some throat lozens to swallow daily, composed of 1mg tyrothricin, 15mg benzocaine and 5mg chlorhexidine.
Reading on the web, I see listed all of these components as ototoxic, but mostly when applied in the ears. I also read that if ingested, gastro-intestinal absorption is very low.
I don’t really know what to do. Do you think these could lead to hearing loss when taken as lozens for a short amount of time?
Thanks,
Damien
Hi Neil, posted in another thread but I was wondering if you’ve seen ototoxicity (tinnitus increase) in people taking aminoglycoside eye drops?
Neither of the prescribing doctors have heard of this side effect of the eye drop, just systemic dosing. I know I’m not crazy though, my tinnitus is louder. I was wary and I should not have taken them!
Hi Megan:
Yes, I’ve heard from enough people that have wrecked their ears from taking eye drops containing Aminoglycosides. The most common one seems to be Tobramycin (Tobradex), followed by Neomycin (Neosporin) and then Gentamicin.
I’m sure you are correct in assuming that your tinnitus is a result of these eye drops. Note that you took two different eye drops–one with Gentamicin and one with Neomycin–so it is hard to know which one is the culprit (or maybe both contributed).
I’m wary too and refuse to take any eye drops with any Aminoclycoside antibiotics in them. I don’t like the risk.
Cordially,
Neil
Hi Neil,
I am an audiologist and saw a pediatric patient with history of Adriamycin and dactomycin. Hearing appears to be normal at this time and he is no longer taking the medication. I am curious about your thoughts about follow up recommendations for these meds?
Hi Emily:
If he has stopped taking the drugs and you don’t see any hearing loss, I rather doubt that these drugs will cause hearing loss in the future from this episode. I don’t have any reason to believe otherwise. If you want to be sure, you could schedule a follow up in 6 months or so, but I’m betting his hearing will be stable. The follow-up would just prove it (or not).
Cordially,
Neil
Thanks a lot for the article. I was just wondering if “CLINDAMYCIN” is ototoxic ? Don’t know if you still answer to question but I will try anyways. Have a nice day !
Hi Chance:
As far as I know ALL antibiotics are ototoxic. The only question is how ototoxic is any given antibiotic. I rate Clindamycin about a 2.5 out of 5–moderately ototoxic. Side effects seem to be permanent.
Cordially,
Neil
Hi Dr. Bauman,
I have developed what I believe to be strep throat. I have a doctor’s appointment coming up very soon where I expect to be prescribed antibiotics for this. I have severe tinnitus and am nervous about antibiotics making it permanently worse. I’m guessing a prescription of amoxicillin. Is there an alternative that you could suggest that would be less ototoxic? Or should I just try to avoid them all completely.
Hi Dave:
Before you take an antibiotic, your doctor needs to know exactly which “bug” you have, and then select an antibiotic that fights that bug. At that point, he should be able to suggest 2 or 3 antibiotics that would do the job. If you then tell me those drugs, I can tell you which one, in my opinion, is the least ototoxic, and what I’d likely do if I were in your shoes. But first you have to know what bug you have.
Cordially,
Neil
I was put on Bactrim for prostatitis some weeks back and it did not work for me because it caused horrible side effects. Now I am left with either trying Amoxillin or Fosfomyacin for my prostatitis. Which one would you recommend? I already have mild tinnitus had it for pretty much my whole life but I really dont want to make it worse because it has been bothersome to me before. I also did take Doxycycline before and as far as I can tell it did nothing for my tinnitus over a 28 day period.
Hi Michel:
Given the choice between Amoxicillin and Fosfomycin, I’d choose Fosfomycin for sure. Some doctors prescribe Nitrofurantoin and that would be my second choice. Doxycycline would be my third choice and Amoxicillin last.
Cordially,
Neil
I have a case of Non specific urethritis. We tried waiting the infection out, but since it has been there for over a month now my doctor suggests I should start antibiotics.
I`ve had tinnitus for a couple of years now, induced by a SSRI. I`m a little bit worried about taking an antibiotic.
Doxycycline and Tetracycline are the standard drugs for this condition in the Netherlands, but are there any other drugs I could ask by doctor about that are safer or you think I should be fine with either of those ?
Hi Daan:
Tetracycline is less ototoxic than Doxycycline according to my information. Another possibility is Nitrofurantoin–it’s ototoxicity lies between the two above drugs.
Cordially,
Neil
Hi Neil,
Thank you for your comment. Unfortunately, my doctor now prescribed me Ciprofloxacine. After reading your information, I assume this is definately a no go for me when I`m worried about Tinnitus ?
I`m going to go back on thuesday, hoping I can get a subscription. Do you have any other suggestions and can you confirm that Cipro is not a good idea in my case ?
Thank you again. So grateful that there is some information out there because my GP doesn`t seem to know much about this.
Hi Daan:
I wouldn’t take Ciprofloxacin (or any of the fluoroquinolone drugs) unless it was a matter of life and death. Typically, there are other less ototoxic drugs that will also do the job.
I can’t tell you what other drugs to take because I’m not a medical doctor and don’t know what “bug” you have. If you get your doctor to give you a list of 2 or 3 other drugs in different classes, I can tell you which I believe is the least ototoxic.
Cordially,
Neil
I have had prostatitis for over a year now and I have tried both Doxycycline 100mg(full course 30 days) and Bactrim(Only 4 days due to alregic reactions). Now my doctor wants me to try Fosfomycin for 6 weeks. I should take 3g daily for 1 week and then 3g every other day for 5 weeks. Should I be worried about otoxity since dosing is so extreme?
Hi Michel:
I don’t have a lot of ototoxic information on Fosfomycin, but the little I do have doesn’t indicate it is very ototoxic so it looks like a good drug to take if it works. Of course, there are no guarantees so you always want to keep your eyes open so to speak.
Cordially,
Neil
Thank you Neil. What is the first signs I should be aware of? I have taken 4 courses already and I am about to take my 5th tonight. I already have tinnitus I had it for as long as I can remember it does not usually bother me but it can vary in strength. Unfortunately I am a weak induvidual and taking medication before has not been a problem for me. But when I got to try Bactrim for the first time a couple of months ago my perception on this changed. I had horrible side effects and suffered badly for 2 weeks after I stopped taking the drug. I was most likely algeric but the experience scared me and made me worry a lot more about my health and side effects of drugs.
Hi Michel:
Ototoxic side effects to watch for are an increase or change in your tinnitus, any change in hearing and any balance problems.
Cordially,
Neil
Dear Dr Bauman, I’ve had severe tinnitus for 25 years. I have trouble urinating and am having a corrective procedure early February. What is the least ototoxic antibiotic I can take during and after the surgery? (The doctor prescribed Alfuzosin, which has serious side effects.) Thank you.
Hi Anthony:
You have the wrong drug if you are looking for an antibiotic. Alfuzosin is not an antibiotic. Alfuzosin is an alpha blocker that is used to treat benign prostatic hyperplasia. It works by relaxing the muscles in the prostate and bladder neck, making it easier to urinate.
In my opinion, antibiotics that are less risky for tinnitus and work for UTIs include Nitrofurantoin, Cephalexin and Doxycycline, but all of these are ototoxic–just like all other antibiotics so there are no guarantees they won’t mess with your tinnitus, but I think it unlikely.
Cordially,
Neil
Dear Dr. Bauman:
I am curious about ototoxic sequelae of previous chemotherapy with 5 FU and Mitomycin. I completed cancer treatment using the Nigro Protocol in March, 2009. I have just recently developed (11/2021) relentless tinnitus and mild bilateral hearing loss on audiometric screening. Is it unusual or out of the realm of possible for hearing loss and tinnitus to manifest so long (12.5 years) after the completion of these chemo agents’ use?
Hi Denise:
I’ve never heard of drugs causing ototoxic side effects a long time after stopping using them. Some of the aminoglycoside antibiotics can still cause such side effects up to a year later, but that is because they can persist in the inner ear for that long.
So to answer your question, I think the answer is “no” or at least it is extremely unlikely. I’d look for a more recent cause for your tinnitus and hearing loss.
Tinnitus almost always accompanies hearing loss, so it could be a result of your mild hearing loss. The hearing loss could be due to any number of things, and exacerbated by the previous use of the drugs you took which could have killed some hair cells back then–but not enough to notice any hearing loss. Now, if something else kills some additional hair cells, the result seems worse because this is added to the ones already dead and the combined result shows up as a mild hearing loss.
Cordially,
Neil
hello what are the antibiotics that can give hyperacusis? and can estrogen be ototoxic? thank you
Hi Paula:
You need to narrow it down for me. What antibiotics is your doctor thinking of giving you, or gave you that you think might affect hyperacusis? Typically your doctor only gives you 3 or 4 choices and I can relatively easily look that up.
Yes estrogen can be ototoxic. That is why hearing can vary depending on where you are in your cycle. And birth control pills are all ototoxic to some degree–typically a mild risk.
Cordially,
Neil
hello is cefuroxime dangerous? thank you
Hi Paula:
Cefuroxime is one of the lower risk antibiotics, but it is still ototoxic. I rate it as a 1.5 out of 5 in terms of ototoxic risk. I’ve taken drugs of this class with no problems. You probably won’t have any problems, but there are no guarantees.
Cordially,
Neil
Hi ,
I took oral vancomycin and have bad tinnitus as a result . I don’t get how this happened as oral vancomycin isn’t meant to be ototoxic. I don’t have hearing loss at all even in extended audiogram. Will the tinnitus go away ? And how did this damage my ears if it’s not systematically uptaken
Hi Nick:
Vancomycin can and does cause tinnitus. Sure, it may be more common in people taking this drug intravenously, but there’s no proof that it cannot cause tinnitus when taken orally or any other way and you are a case in point. If it happened to you, you know that it has happened to others like you too. So take such notifications with a grain of salt.
I don’t have any specific information on whether tinnitus from Vancomycin is temporary or permanent. Hopefully, it will prove to be temporary. You can help ensure this by not treating it as a threat to your well-being, but as a totally useless background sound that is safe to ignore–then ignore it and focus on the loves of your life. This gives your limbic system permission to let it fade away into the background.
What is really different whether you take a drug intravenously or orally? Either way it eventually gets into your blood supply and is transported throughout your body, including to your ears. The basic difference is that you can get a higher dose much faster intravenously than orally, so resulting side effects tend to be more common, but that doesn’t preclude any side effects from occurring from taking a drug orally.
Cordially,
Neil
Thank you for your response. Vancomycin orally isn’t meant to be systematically absorbed unless there is a gi pathology issue . Hence why it’s meant to be bulletproof of ototoxic occurrences . However it happened to me after two days and I don’t know how as I haven no yet detected any gi pathology which would have allowed me to absorb it . I just say I also experience on and off shooting ear pain. Is this common with ototxicity. This has left my ents confused.
Hi Nick:
Maybe you have leaky gut syndrome and the Vancomycin snuck into your blood stream that way. Who knows?
Ear pain is a fairly common ototoxic side effect. I’ve identified 659 different drugs that report ear pain as a side effect. For Vancomycin, ear pain occurs about 1.5 times as often as does tinnitus for example.
Cordially,
Neil
Thanks again . I’ll get tested for leaky gut . If I come back negative is it possible that it’s not the vancomycin ? Does the ear pain go away . It’s been 3 months and it’s still here . I’m only very young and I can’t imagine this pain for the rest of my life .
Hi Nick:
If it’s not the Vancomycin, then it could be another drug you might have taken–or are you saying the ONLY drug you took near this time was Vancomycin?
If it’s not physical pain caused by something like a pinched nerve, and since the Vancomycin is long since gone from your body, then barring some other source of real pain, it has to be a pain loop in your brain like phantom limb pain that can result from a missing limb. There are ways to deal with such pain somewhat similar to the ways you habituate to tinnitus.
Thus there is hope for you, once you find the basic cause of your pain.
Cordially,
Neil
Hello, is vaginal provames ototoxic?
Can bio-identical progesterone be ototoxic too? Thanks
Hi Paula:
Provames is Estradiol and yes, Estradiol is ototoxic. I rate it as moderately ototoxic.
I don’t have any specific information on the ototoxicity of bio-identical progesterone, just on progesterone (so probably both synthetic and bio-identical are mixed together). Progesterone is less ototoxic than Estradiol, and my gut feeling is that bio-identical progesterone is less ototoxic than synthetic progesterone.
Cordially,
Neil
Hey Neil , sorry to bother you but one my question .
I saw my ent again . And he said he would bet his life that my ear issues are not ototoxic damage . His reasoning is because I have perfect hearing , 0-8 and 9-18 freqnecy testing is perfect as good as a baby my ent said . My oaes came back normal . He said if there’s any possibility of ototoxic damage that it would show even the slightest loss at high frequencies . And claims that this is tmj or tts from anxiety . Upon research I believe this would be true through amino glycosides. As it damages hair cells directly. Is this the same for vanco . And therefore does his statement have some substance to it . Or does the vancomycin affect the ear differently
Hi Nick:
Your ENT is probably correct. My information shows that dizziness is the most common side effect of taking Vancomycin and hearing loss is the second most common side effect. However, there is always the possibility it is due to ototoxicity. Incidentally, ear pain is the 5th most common ototoxic side effect and tinnitus is the 7th. So it’s possible that Vancomycin could still be the culprit.
Since your tinnitus began just 2 days after taking the Vancomycin seems too much of a coincidence, unless there were other factors at that time such as severe stress and anxiety.
It’s also possible that your anxiety together with the Vancomycin had a synergistic effect resulting in your tinnitus.
I don’t know the specific mechanism that glycopeptides such as Vancomycin have on your ears in contrast to aminoglycosides. That’s not something I specifically study.
Cordially,
Neil
Hello, thank you for the response . what kind of trouble can the provames cause? as an ototoxic symptom? thank you 🙏🏻
Hi Paula:
Estradiol comes in different formulations and strengths. Here are the most common ototoxic side effects (there are a number of others) in order of most common to least common.
Dizziness
Ataxia/gait disturbance
Vertigo
Balance disorder
Hearing loss
Tinnitus
Ear pain
Cordially,
Neil
All macrolides and ketolides end with “thromycin” and generally less ototoxic in comparison to the aminoglycosides.
Hi Neil,
Do you understand why an ototoxic drug causes ear fullness? I have ear fullness from gentamicin but I don’t have any hearing loss.
Thanks,
Jess
Hi Jess:
As I understand it, a feeling of ear fullness can come from 3 sources. First, you ears are congested from “gunk” in your middle ears/Eustachian tubes. So they really are “full” and thus you have this feeling. Second, anything that messes up the action of your trigeminal nerves (that innervate your Eustachian tubes) so that they do not open properly to relieve changes in air pressure will give you this feeling. Third, you may have a psychological feeling of ear fullness if you have some degree of sudden hearing loss. Your brain doesn’t hear the sounds it used to, so it assumes your ear is full or “blocked” else it would hear those sounds, wouldn’t it? Thus you have the perceived feeling of your ears being blocked.
Interestingly enough of all the 283 ototoxic drugs I’ve collected statistics on for the feeling of ears being “full”, “blocked” or “congested”, Gentamicin isn’t one of them. Furthermore 319 drugs have reported Eustachian tube dysfunction as a side effect–but again Gentamicin isn’t one of them either.
Thus, are you sure it was the Gentamicin that caused this feeling of ear fullness? You say that you have no hearing loss, but it could be that the Gentamicin caused hearing loss in the frequencies above 8,000 Hz which audiologists seldom test. So it could look like your audiogram says you don’t have a hearing loss, but you could have a massive loss in those high frequencies. You might not notice this, but your brain does and gives you this feeling.
Another possibility is that you have another kind of hidden hearing loss that handle loud sounds have a lot of damage, while the nerves that handle soft sounds are all just fine. Since audiograms only test hearing loss using the “soft sound” nerves, it wouldn’t show this kind of hidden hearing loss. But again, your brain knows this.
Do you know for sure that your Eustachian tubes are not clogged. One possibility is that the Gentamicin killed off the good guys in your middle ears/Eustachian tubes and opportunistic “bad guys” have taken over and clogged them up.
Cordially,
Neil
Hi Neil,
Do you know why gentamicin could cause ear fullness? I don’t have any hear loss at all, but the fullness started at the same time as treatment.
Thanks,
Jess