By Neil Bauman, Ph.D.
© August, 2018
In fiction, sidekicks often accompany the main character. For example, the Lone Ranger had his sidekick Tonto; Batman had Robin; Sherlock Holmes had Dr. Watson. In the same manner, many drugs also travel with an invisible, yet very vocal, sidekick named “Tinnitus.”
If you are unlucky, tinnitus is a stranger that one day suddenly invades your life—unwanted and unbidden to be sure—but there nevertheless—as a sidekick of a drug you took.
How you cope with this stranger is up to you. However, if you are like me, you want to prevent this stranger from invading your life in the first place. To do this, you need to put the odds in your favor in order to reduce your chances of getting tinnitus as a result of taking drugs—whether they are prescription or over-the-counter (OTC) drugs.
There are numerous drugs that have tinnitus as their sidekick. Currently, I know of at least 657 drugs (and still counting) that list tinnitus as a possible side effect. In addition, I know of 10 herbs and 31 chemicals that can do the same.
Two common drugs you may not realize that can cause tinnitus are the anti-inflammatory drug Ibuprofen (Advil, Motrin) and the selective serotonin reuptake inhibitor (SSRI) Citalopram (Celexa). In fact, more people complain to me (via email) about getting tinnitus from taking these two drugs than from taking any other drugs.
The Top 20 Tinnitus-Producing Drugs
Here is my list of the top 20 tinnitus-producing drugs based on the number of reports submitted to the FDA’s database. (Note: these data are incomplete as I have not yet finished compiling the voluminous data I have acquired, so the drugs and their positions on this list may change in the future as I finish this project.) Even so, it gives you a good idea of some of the drugs you should avoid if you want to reduce your risk of getting tinnitus from taking drugs.
These drugs are listed in descending order from most reports (highest risk) to fewest reports (lower risk). The drugs are listed by generic name followed by a common brand name in italics.
- Alendronate (Fosamax)
- Acetylsalicylic acid (Aspirin)
- Paroxetine (Paxil)
- Alprazolam (Xanax)
- Bupropion (Wellbutrin)
- Venlafaxine (Effexor)
- Metoprolol (Lopressor)
- Acetaminophen (Tylenol)
- Hydrocodone (Vicodin)
- Atorvastatin (Lipitor)
- Omeprazole (Prilosec)
- Duloxetine (Cymbalta)
- Clonazepam (Klonopin)
- Gabapentin (Neurontin)
- Amlodipine (Norvasc)
- Ibuprofen (Advil)
- Lisinopril (Zestril)
- Lorazepam (Ativan)
- Sertraline (Zoloft)
- Quetiapine (Seroquel)
Strategies for Avoiding Tinnitus
The following four strategies will put the odds in your favor and typically reduce your risk of getting tinnitus from taking drugs.
1. Only take drugs when they are absolutely necessary
Instead of popping pills, seek to fix your underlying health problems. Most drugs do not do that. Typically, they just mask symptoms. Thus, you end up taking the drug “forever” because when you stop, the symptoms reappear. Instead, by digging down to the root of your health problems and fixing them, chances are you won’t have much (or any) need to take drugs.
Unfortunately, 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.
Drugs are often prescribed unnecessarily, especially to older adults. I didn’t say that. Dr. Sidney Wolfe, the Health Research Group founder and senior advisor of Public Citizen’s Worst Pills, Best Pills News (www.citizen.org) said that. The result is that what might have been a minor problem now becomes a major problem.
Numbers of people have told me that the side effects of the drugs their doctors prescribed were worse than the conditions they were supposed to help.
For example, a man wrote,
Three years ago, after taking Bupropion (Wellbutrin) for 6 months for depression, I woke up with tinnitus. At that point, my tinnitus was a “static” sound—not fun—but bearable. I was told by my doctors that there was no connection between this drug and my tinnitus, but stopped anyway. I have had tinnitus ever since. A few weeks ago, I started taking Bupropion again, falsely believing it wasn’t related to my tinnitus. Now my tinnitus is a louder, shrieking sound. I will never take this drug again because it seems I have to listen to this terrible sound for the rest of my life. I would never have chosen this over my depression, if I had even the slightest idea this could be a side effect. That I took this drug for depression is so ironic.
Another man wrote,
I had an injury to my foot and took Ibuprofen (Advil) for the pain. Shortly thereafter, the ringing in my ears started. I had no idea this could happen and would never have taken the Ibuprofen if I had known this would happen.
Therefore, to reduce your risk of getting tinnitus, go easy on drugs! If you choose to take a drug, make sure you know that the benefits will clearly outweigh the potential side effects. Therefore, make your doctor justify that a given drug is really, really necessary—not the casual “let’s try this and see what happens,” because unfortunately, in some cases, one of the risks is that tinnitus (or other ototoxic side effects) can happen.
Instead of taking drugs, make the lifestyle and dietary changes that will improve your health. In addition, consider alternative and complementary medicine therapies. The goal is eliminate the condition so you don’t need drugs.
Some alternatives for improving and maintaining your health include:
- Change your diet. This is a biggie. Did you know that more than 80% of health problems can be traced back to poor diet. According to prolific author and natural health advocate Dr. Joseph Mercola, D.O., your diet should consist of mostly raw and lightly-steamed vegetables and fruits. Cut way down on all sugars. Ideally, reduce your sugar intake from all sources to less than 25 grams per day—that’s less than 2 tablespoons of sugar from all sources including drinks, processed foods, fruits, etc.
Did you know that you can eliminate Type II diabetes by dietary changes alone, according to Dr. Mercola? Therefore, before you take drugs for Type II diabetes, try the dietary route first. When done correctly, there is a high probability you won’t have to take any drugs. And if you don’t take drugs, you won’t get tinnitus from taking them.
- Supplement your diet with vitamins. (Another biggie.) For example, most people are low in Vitamin D3 and this affects many areas of your body including your mental health. (Vitamin D affects more than 3,000 genes.) To be effective, your optimal blood vitamin D3 levels should be in the range of 60 – 80 nanograms per milliliter (ng/ml). Many people’s levels are down around the 20 ng/ml level—far below the optimal level, and your health suffers as a result. So, go outdoors and absorb the benefits of natural sunlight, which enables your body to make its own vitamin D.
- Use herbals rather than drugs. They are typically not ototoxic and do not have the harsh action on your body that many drugs have.
- Try Chiropractic—my choice is the specially-trained upper cervical spine chiropractors. I’m now realizing that many “ear” (and other) problems are actually the result of the top two vertebrae in your neck (C1 and C2) not being in proper alignment.
- Go to herbalists, naturopathic doctors (NDs), acupuncturists, massage therapists, etc. when appropriate.
- Exercise more. Just get moving. Don’t sit so much.
- Get adequate sleep. This typically means 7 to 9 hours per night. If you short yourself on sleep, both your physical and mental health suffer.
- Consider counseling rather than drugs for depression, anxiety and related issues. The drugs just hide the symptoms. Better to deal with the underlying issues and let them go. Then you won’t need drugs.
There are a number of other things you can also do, but just doing these few things will greatly reduce or eliminate your need for drugs and your risk of getting tinnitus.
My own philosophy is that I use drugs very sparingly. I’ve often said, “Drugs should be your last line of defense, not your first line of attack.” Only take them when all else fails. Unfortunately, too many people take drugs as their first, and only, choice because it is so much easier to “pop a pill” than to make the effort to do any of the above. As a result, their risk of getting tinnitus increases unnecessarily.
2. Choose the drug least likely to be ototoxic
If you choose to take a drug, talk to your healthcare provider about which drugs are least likely to aggravate or cause tinnitus. This may be a different drug in the same drug class, or a drug in a different class, or even a herbal instead of a drug. This, too, can reduce your risk.
For example, a lady asked me,
Do you have an opinion on which antidepressants are the safest for our ears—e.g. Pamelor, Zoloft, Lexapro, Celexa, etc. Is there one that is significantly less ototoxic than the others?
In my reply to her, I explained that personally I wouldn’t use any of the above drugs. Why? Because there is a much safer alternative—the herbal, St. John’s Wort.
You see, numerous studies have shown that St. John’s Wort is at least as effective as prescription drugs in treating mild to moderate cases of depression. Furthermore, St. John’s Wort is not known to be ototoxic in the least. Thus, you can take it for as long as you need to without fear of causing hearing loss or aggravating your tinnitus.
Note: If you are on other medications and choose to take herbals such as St. John’s Wort, you want to run it by your doctor or pharmacist to be sure the herbal doesn’t adversely interfere with any of your current medications.
3. Take the lowest effective dosage possible
Ask your doctor to prescribe the lowest dose of the drug that will treat your condition. This is because many drugs do not exhibit ototoxic side effects when taken in low doses. I often tell people they have a “magic threshold” below which ototoxic side effects do not appear. The trick is to keep your dose below this “magic threshold”. The problem is that you don’t know exactly where it is—it can be different for each person—that’s why I call it a “magic threshold”.
Side effects may become apparent at higher doses. Thus, by keeping your dose low, you can often “fly under the drug radar” and protect your ears from ototoxic side effects.
For example, one woman told me her existing tinnitus became noticeably louder when her doctor put her on a higher dose of Irbesartan to try to control her high blood pressure. When she complained to her doctor, he reduced the dose to its old level again, and her tinnitus dropped back to its old level.
4. Take medication for the shortest time possible
Ask your doctor to prescribe any drug for the shortest effective time possible because some ototoxic drugs do not damage your ears in the short term. However, the longer you take the drug, the more likely it is to damage your ears. Many doctors are quick to prescribe drugs unnecessarily, and conversely, are slow to take you off them. By taking a given drug for only two weeks, for example, you may avoid ototoxic side effects, whereas taking the same drug for several months may cause ear problems.
Can Foods and Herbal Medicines Cause Tinnitus?
A lady asked,
I wondered if you knew about the ototoxicity of various foods. I read that tea is high in salicylates, as are also a lot of fruits. Does this mean that drinking/eating these things can make my existing tinnitus worse?
That’s an excellent question. Yes, certain foods and herbals can cause tinnitus, but typically those you eat/take are not ototoxic, or only ototoxic if you take them in enormous quantities. So, as long as you don’t go off the deep end and consume far more than the recommended dose, you shouldn’t have to worry about getting tinnitus from foods or from taking herbal preparations.
For example, I’ve been asked whether you can get tinnitus from eating foods high in salicylates (the basic ingredient in Aspirin). The truth is, some foods are high in salicylates, but even so, the amount they contain is far less than what you’d need to get tinnitus.
Curry powder is a good example. It has the highest salicylate content of any known food—218 mg. per 100 g. If you wanted to consume the equivalent amount of salicylates contained in 6 adult Aspirin—the amount of Aspirin that you’d typically have to take to cause tinnitus—you’d have to choke down almost 4 pounds of pure curry powder—at one sitting. It’s just not going to happen!
The same applies to raisins. Raisins are relatively high in salicylates (6.62 mg. per 100 g.). To get the equivalent amount of salicylates contained in 6 adult Aspirin, you’d have to gorge yourself on 144 pounds of raisins at one time. By the time you did that, tinnitus would be the least of your worries!
Therefore, for all practical purposes, you don’t have to worry about foods or herbal preparations exacerbating your tinnitus. Herbals typically will not cause tinnitus or make your existing tinnitus worse unless you are supersensitive to salicylates (or other compounds)—but this is rare.
Drug Results Are Unique to Each Person
Each one of us is unique, and so is our response to taking drugs. This means that a drug that gives me tinnitus may not cause your tinnitus to increase and vice versa. As a result, it is hard to know which drugs you should stay away from and which you can safely take if you want to avoid tinnitus or other ototoxic side effects.
What you can do to reduce your risk of getting tinnitus is to look at reports of tinnitus occurrence for each drug. The more people who report getting tinnitus from taking a given drug, the greater your risk is if you take that drug. Thus, only taking drugs with minimal reports of tinnitus is an excellent risk-reduction strategy.
Unfortunately, there is no single source of this kind of information. You can do what I do and search through numerous drug books and on-line data bases to try to ferret out the risk of tinnitus (or other side effects) that are reported for any given drug. This can be extremely time consuming. That is why I have compiled this kind of information into a single source—the book Ototoxic Drugs Exposed—available on the Center’s website or Amazon.com.
You can also go by your past experiences. If you took a given drug in the past and got louder tinnitus, guess what? If you take it again in the future, don’t be surprised if you get even louder tinnitus this time. Furthermore, the resulting tinnitus may prove to be permanent.
Also, be aware that some people who have taken a given drug in the past without experiencing any tinnitus find that for whatever reason, when they take it again some years later, it gives them tinnitus. Thus, you always have to be vigilant.
Will Your Tinnitus be Temporary or Permanent?
People often ask me whether their tinnitus will be temporary or permanent. I tell them that if their tinnitus is secondary to drug-induced hearing loss, then they could expect it to last as long as the resulting hearing loss.
Thus, if you have temporary hearing loss from taking a certain drug (Aspirin is a good example), when you stop taking that drug and your hearing returns in a few days to a few weeks, as your hearing returns, you could expect your tinnitus to fade away. However, if your drug usage results in permanent hearing loss, then don’t be surprised if your tinnitus also proves to be permanent.
When tinnitus is a primary side effect, it is impossible to predict whether your tinnitus will be temporary or permanent. With the use of some drugs, tinnitus will be temporary for some people and permanent for others. It doesn’t seem fair, but that is the way it is.
This may have more to do with your emotional make-up than with the drug itself. Thus, according to Dr. Pawel Jastreboff, who developed the neurophysiological model of tinnitus and its practical application—Tinnitus Retraining Therapy (TRT), if you treat your tinnitus as a threat to your well-being in any way—whether physical, mental, emotional, social, financial, etc.—your tinnitus will tend to be loud, intrusive and permanent.
However, if you treat your tinnitus as an unimportant background sound and not as a threat to your well-being, it will tend to fade into the background in time and will not bother you. In fact, you may go for hours without even being aware you have tinnitus. Thus, even if your tinnitus proves to be permanent, it ceases to be an issue. It is just “there” and is no big deal. As a result, you are free to live a happy and successful life even if you are “stuck” with that “sidekick” of a drug you took.
If your tinnitus bothers you, I recommend that you get and read my comprehensive book on tinnitus—”Take Control of Your Tinnitus“—either the printed book or the eBook version (the text is identical in both).
This article, slightly revised, was published in the Summer 2018 (Vol. 43, No. 2) edition of Tinnitus Today, a publication of the American Tinnitus Association.