Neil Bauman, Ph.D.
January, 2018 (revised October, 2024)
People often ask me which are the least ototoxic beta blockers (or other classes of anti-hypertensive drugs) to take for high blood pressure (hypertension). For example one man asked:
I have some questions about the ototoxicity of medications for high blood pressure. My primary care physician and I have been searching for a medication to treat my high blood pressure and so far have not been able to find one that is not associated with ototoxicity—specifically tinnitus. Are there some suggested ones that we can explore? I have had tinnitus for 15 years and am concerned about taking any drugs for an extended time that could permanently intensify my tinnitus.
I understand your concerns. As you are probably aware, all the drugs used for reducing high blood pressure are ototoxic to some degree or other. I’m not aware of a single one that is not ototoxic.
Therefore, since some drugs in any given drug class are much more ototoxic than others, the trick is to find the least ototoxic drug that will do the job of reducing your high blood pressure, and at the same time, reduce your risk of getting any ototoxic (or other) side effects.
For example, you want to avoid getting:
- tinnitus or making your existing tinnitus worse
- hearing loss, or making your existing hearing loss worse
- balance problems such as ataxia, dizziness, vertigo, nystagmus, etc.
- other ear problems
- side effects elsewhere in your body
Note: I just focus on ear-damaging (ototoxic) side effects (the first four points above). There are hundreds, if not thousands, of other side effects reported for any given drug. You have to be cognizant of these other side effects as well, since they all can affect your body. Thus, you have to do your own “due diligence” and search them out so you can avoid those side effects too. In this report I just zero in on those drugs whose side effects can damage your ears.
I can’t tell you in advance all the drugs doctors may prescribe to reduce blood pressure. This is because doctors are free to prescribe whatever drugs they want, from whichever drug classes they want, if they think it will do the job. Therefore, I don’t know specifically which drugs your doctor may, or may not, choose to use for treating your hypertension, so the below lists may not be complete.
However, having said that, there are five classes of drugs doctors typically use to try to control hypertension. These five classes of drugs come under the general heading of anti-hypertensive drugs. The drugs in each class work a little differently from the drugs in the other classes in order to accomplish the same job. That is why doctors sometimes prescribe 2 or 3 drugs—each from a different drug class—so the combined effect will bring down your blood pressure by one means or another.
These five classes of anti-hypertensive drugs include the:
- Angiotensin-converting enzyme inhibitors. (Commonly referred to as ACE Inhibitors.) The generic names in this class of drugs typically end in “‑pril”, e.g. Perindopril.
- Alpha-adrenergic blocking drugs. (Commonly referred to as Alpha blockers.) The generic names in this class of drugs typically end in “‑osin”, e.g. Prazosin.
- Angiotensin-2-receptor blocking drugs. (Commonly referred to as ARBs). The generic names in this class of drugs typically end in “‑sartan”, e.g. Irbesartan.
- Beta-adrenergic blocking drugs. (Commonly referred to as Beta Blockers.) The generic names in this class of drugs typically end in “‑olol”, e.g. Pindolol.
- Calcium channel blocking drugs. (Commonly referred to as CCBs.) The generic names in this class of drugs typically end in “‑ipine”, e.g. Nicardipine.
In order to help you quickly eliminate the most ototoxic drugs in each class, and zero in on the least ototoxic drugs in each class, I have prepared a special report on the above five classes of anti-hypertensive drugs.
The information in this report comes from tens of thousands of ototoxic side effects reported to the Food and Drug Administration (FDA) for these drugs.
Note: these data come from reports filed with the FDA during the 9-year period between January, 2004 and October, 2012. If all the reports had been available to me between 1980 and the present, these figures would have been much higher.
However, the relative number of reported incidences between the various drugs probably would have remained much the same. Thus, it is unlikely that the ranking order of the drugs concerned would change much, if at all.
For the drugs in each class, this report lists the drugs in ascending order of ototoxic risk with the lowest risk drugs at the top and the high risk drugs at the bottom of each table.
In each of the 5 hypertensive drug tables I list the reported incidence under the following headings.
- Generic Drug Name.
- Tinnitus: The number of people in the FDAs database reporting tinnitus as a side effect of taking this drug.
- Hearing loss: The number of people in the FDAs database reporting hearing loss as a side effect of taking this drug.
- Total T & HL: The total of the tinnitus and hearing loss reports combined for each drug (the total of columns 1 and 2)..
- Total Prescriptions (2020): The total number of prescriptions written for that drug in the USA.
- Relative Risk Assessment: The relative risk assessment is a way of comparing the relative risk between drugs, and between drugs in other classes (when that information is available). It is calculated by dividing the Total Prescriptions (2020) by the Total T + HL (column 5 divided by column 4). Larger numbers indicate LESS risk, while smaller numbers indicate GREATER risk.
- Risk Class Low to High: The risk classes range from 0.5 (very low) to 5.0 (very high).
Obviously you want your doctor to prescribe a drug with a zero, or a low value so you have the least risk of damaging your ears. At the same time, you definitely want to avoid those drugs with high values as much as possible, as the risk of getting ototoxic side effects from taking them is enormously greater.
You can access this special report (eBook in pdf format) by clicking on the below link. In just 10 minutes, you can be reading which anti-hypertensive drugs are the easiest on your ears.
If you are already taking one of these anti-hypertensive drugs, you can see how it ranks—and whether you might want to ask your doctor to switch you to a less ototoxic drug.
Note: due to the enormous amount of time and effort required to extract and compile the valuable information in this special report, I’m requesting a nominal contribution of $15.00 to help further the work of the Center for Hearing Loss Help.
Hi this is good information, I am 41 and I have been on blood pressure meds since I was25 and I’m not sure what all I have been on…I have been dynosed with Meniere disease and have all symtoms and I need to find a blood pressure med and anxiety meds that don’t cause tinnitus to worsen…its terribe sometimes, I take Wellbutrin and I think it does some and I also take losartan 50 mg in morning and at evening…I think it does make it worse, I’m on low salt diet and I take diuretics for fluid but not every day….please help me…..I have been suffereing from this for 6 months….I need the right blood pressure med and if u know a good anxiety and depression med but does not cause weight gain on blood p or anxiety….I was on valsartan 320 mg but ithink it was making my hair shed more? do u think ?
Hi Gina:
How do you KNOW you have Meniere’s? The reason I ask is that Bupropion (Wellbutrin) as an example of one drug you are taking can cause ALL the symptoms of Meniere’s. In fact, Meniere’s is listed as one of the side effects of this drug.
Personally, I don’t think this drug causes Meniere’s, but it produces the four side effects that constitute classic Meniere’s. So they blame Meniere’s as the culprit, rather than this drug.
If you want to know whether you really have Meniere’s disease, read my article at http://hearinglosshelp.com/blog/atlas-adjustments-alleviate-menieres-disease/ and then get yourself checked out.
If this proves you don’t have Meniere’s, then you know it is the drugs that are causing the Meniere’s-like side effects. You want to get off those drugs.
As for non-ototoxic anti-depressants, if I were you, I wouldn’t take prescription drugs since the herbal St. John’s Wort has been proven to be just as effective.
What is it that is keeping your blood pressure so high? My concept is to root out the cause and fix the underlying problem rather than trying to reduce your blood pressure via drugs that only treat the symptom, not the underlying cause.
Cordially,
Neil
St John’s Wort can actually cause tinnitus, or worsen what you already have. I’m a big fan of herbal medicine, but I won’t touch this in any form. Got tinnitus from Mobic and it took years before it calmed down to a level I could live with
Hi Sea:
Where did you find information that taking St. John’s Wort can cause tinnitus? If you won’t touch it, how do you know it will cause tinnitus in your case? I have only seen a handful of cases where St. John’s Wort causes tinnitus–so it does happen, but I think it is very rare. Can you point me to a source that says otherwise?
Cordially,
Neil
Wellbutrine couse me tinnitus 3rd day when i woke up in morning
Hi Gina! My mom didn’t get meniere’s until she started metoprolol (for b/p) and Eliquis (blood thinner) around the same time. She lost hearing and was dizzy and nausea and vomiting for 2 years. Miserable for her. Stopped both. First the metoprolol still had dizzy symptoms and nausea vomiting then stopped eloquis and changed to warfarin. FANTASTIC. Has only had a mild dizzy spell x2 in the last 2 years. Keep a journal. If menieres like symptoms started when around the time you started a new med then change to something else. Everyone is different and it is easier for a doctor to diagnose you with menieres than get to the root cause and attribute it to big pharma. Now with that being said, my brother takes eliquis without issue. Your medication needs to be tailored . Get Ativan/lorazepam for the anxiety. If nausea gets too bad that ondersetron doesn’t help then get the phenergan suppository for nausea. It will make you sleepy and rest well. God bless. Sorry for the years worth delay of a response. I just happened upon your post
Hi Cynthia:
Meniere’s is not caused by taking drugs. Just because the drugs happen to have 4 of the same side effects that are signs of Meniere’s does not mean you have Meniere’s.
The four classic symptoms of Meniere’s disease are periodic episodes of vertigo, a fluctuating hearing loss–typically two steps down, one step back, tinnitus and a feeling of fullness in the affected ear.
Numbers of drugs can cause these same 4 symptoms but won’t have the periodicity of Meniere’s and the hearing loss won’t tend to be stepwise.
Metoprolol has all four of these side effects. Apixaban (Eliquis) has 3 of the 4, but they are not near as common as side effects from taking Metoprolol. So likely the Metoprolol had the major effect.
Meniere’s root cause is your C1 and C2 vertebrae out of proper alignment. It has nothing to do with drugs and big pharma (much as you might hope it did).
For more on the real cause of Meniere’s disease see my article at https://hearinglosshelp.com/blog/atlas-adjustments-alleviate-menieres-disease/ .
Cordially,
Neil
Hello, I’m going through tapering off clonazepam, I’ve had Tinnitus for thirty years i went off the first two mg with heavy withdrawal symptoms, My doc wanted to put me on clonidine I have it but afraid to take it because of making my tinnitus louder do you have any advise on a BP med I can use just for four or five months till I get off this drug my BP is about 145 over 87 with pulse of about the same 87
any advice would be most helpful
Thanks
Jim
Hi Jim:
What does your doctor expect the Clonidine to do? You want to KNOW it will help you before you take yet another drug and I fail to see how it will help your blood pressure.
What is your blood pressure when you are not taking any drugs? If it is only 145 personally, I wouldn’t worry too much about it–depending on your age. If you are 65+ that could be normal for you. My BP has been around 140 for the past 20 years and I’ve not had any problems, and I don’t take any medications for it. You can probably control your BP with diet and exercise, etc. without taking any drugs. Doctors typically want to keep your blood pressure too low for your age so put you on BP meds unnecessarily in my opinion. Remember, this is just my opinion and I’m not a medical doctor. So you need to decide what you want to do for you.
Cordially,
Neil
I have atrial fibrillation diagnosed a year ago. I have been on a few beta blockers bec of it, though I do not have high BP. I feel I have experienced more trouble hearing, some minor balance issues not present before, etc. Problem mainly is also that I have an intracochlear schwannoma being watched in one ear, which has caused total deafness in that ear. Cannot use a hearing aid, cannot get a cochlear implant bec of location of tumor. I do not want to do damage to my “good ear” now. What would you advise?
Hi Madeline:
Beta-blockers can cause hearing loss, tinnitus and balance problems in some people. thus, the trick is to take the lowest dose of the least ototoxic beta-blocker that does the job. You can find this information in my special report at http://hearinglosshelp.com/shop/the-relative-ototoxicity-of-anti-hypertensive-drugs/ . Changing your Beta-blocker may be very helpful if you are one one of the high risk beta-blockers.
Cordially,
Neil
I have been taking a daily 5mg dose of lisinopril for over 30 years ( I am 65 yrs old) and have had a very minimal amount of tinnitus over the past few years. This past month my tinnitus has got much worse. If Lisinopril is the culprit and I stop taking Lisinopril will the tinnitus lessen or stop?
Hi Doug:
What happened a month ago that might have caused your tinnitus to change? Any changes in medications? More anxiety, depression or stress? Any loud noises? etc.
It may not be the Lisinopril at all, or it may be. However, if the increased tinnitus is from the Lisinopril, there are no guarantees that stopping it will make your tinnitus go away or revert to its old level. The only way to know for sure is to stop taking the Lisinopril and see what happens to your tinnitus in the following month or so. Somehow, my gut feeling is that it is not the Lisinopril, but that’s just my feeling. I don’t know near enough about your situation to really hazard a guess.
Cordially,
Neil
I am 65 years old. I had a hearing test at work in 2016 which showed the 500-8K thresholds for the left ear were 20,20,25,25,40,55,65 and for the right ear were 20,20,20,25,25,40,55. I may have had a low level of tinnitus for several years but it didn’t really bother me much.
The past two months I was very physically and mentally stressed. About a month ago I went to the dentist to have two crowns installed on two rear teeth on the right side of my upper jaw which required the drilling down of both teeth. After the teeth were drilled down (high speed) a temporary crown was installed on the teeth for 3 weeks while the permanent crown was being made. My jaw was very sore after the visit because my mouth had to held wide open for a long time. At least a week prior to getting the crowns installed I noticed some tinnitus which didn’t bother me that much. I thought the hissing and ring may just go away. At the 2nd visit to install the crowns, the crowns didn’t fit properly and drilling was done on a rear bottom tooth and the crowns were sent back for adjustment. Upon arriving home after the 2nd visit the tinnitus was more noticeable and it made it difficult to sleep even with the ceiling fan on.
With the 3rd visit, I mentioned to the dentist that my ears started ringing and hissing after the 1st visit and got worse after the 2nd visit. He stated “that drilling was probably not the cause of the ring and hissing”. Since the adjusted crowns still didn’t fit properly the dentist wanted to do additional drilling on the bottom back tooth. I told him I was very concerned about any additional drilling. So he proceeded with short bursts of drilling to get the proper fit-up. It’s been 5 days and the tinnitus has not improved or worsened.
I forgot to mention that I started getting a slight ear ache in both ears a few days after the last visit to the dentist. Also, yesterday I went to the doctor and had my ears cleaned. I had a lot of wax in both ears (narrow ear drums). I have a slight ear in both ears today.
I forgot to mention: A few days later I had a slight ear ache in both ears. Yesterday I went the doctor and had the wax removed from both ears with a syring. The nurse was very careful not to apply to much water pressure. There was a lot of wax in the ears and took a while to remove.
So today the ears are still hissing and the tinnitus has not improved or worsened, and I still have a slight ear ache in both ears.
Thanks for your comments.
Hi Doug:
As you probably know, anxiety and stress can bring on tinnitus or make existing tinnitus worse. So I think your stress was a big component in your developing worse tinnitus. Furthermore, just going to the dentist is stressful in itself. Dental work done on upper molars–which are close to your inner ears–can cause tinnitus and other ear problems. So that is probably what happened in your case.
Wax in your ears can cause some degree of hearing loss that can cause tinnitus. It was good that your nurse was very careful not to apply too much pressure when syringing your wax out. Thus, I don’t think any of your tinnitus was from the wax removal.
Personally, I’d just ignore your tinnitus and focus on the loves of your life and let your tinnitus fade into the background over time. If you worry about your tinnitus and focus on it, you will just make it worse.
Cordially,
Neil
I started propranol 60mg for my graves dieasease and the resting heart rate being in the high 90’s to 115, but normal blood pressure.
Shortly after about a week of taking it, i started having tinnitus, only to come across your page and see an aha moment. My psychologist wants to put me on prozac and i also take xanex for the anxiety. Ive never had an issue with xanex, but i feel i do need a beta blocker right now until my thyroid levels become stable. but im deathly afraid of the ringing becoming worse.
Hi Elizabeth:
If the Propranolol is causing your tinnitus, then maybe you could take one of the other beta blockers that have a lower risk of getting tinnitus. Some good choices in this respect include Betaxolol, Acebutolol, Nadolol, Labetalol and Nebivolol. See if your doctor thinks any of these will work for you.
Why take Prozac AND Xanax? Fluoxetine (Prozac) and Alprazolam (Xanax) both can cause tinnitus. For your information, switching from Xanax to Prozac will reduce your tinnitus risk by a factor of 3 times so that would seem to be a step in the right direction. But adding Prozac on top of the Xanax just increases your risk. Personally, I’d not do that.
Cordially,
Neil
I’ve been having a buzz in my left ear that wasn’t consistent for the last four months. It would only happen when i move my neck to the right or move my body up and down with my head facing the ground and I was tolerating it as it wasn’t a big deal.
After two months this buzz started happening when I sleep on my right side and it would wake me up from my sleep so i was forced to sleep on my left side, the buzz is not constant, it follows a rhythm and sometimes i feel like i can feel my pulse in my ear. But that wouldn’t happen everyday.
Shortly after that I started getting heart palpitations and started taking Concor 2.5mg (Bisoprolol hemifumarate) two times daily (I had wolff parkinson syndrome and catheter ablation 15 years ago) and the buzz was still troubling me while sleeping but while sleeping only not all day. After three weeks using concor, my doctor changed it to a beta blocker Sotalol HCL 80mg once daily and I’ve on it for three weeks.
I went to an ENT doctor who said there is nothing wrong with my ears, just some wax that he cleaned and he asked for an audiogram and he told me to live with this buzz and ignore it and that he doesn’t consider it a problem since it’s not happening all the time!
The audiogram result was 100% in right ear and 96% in left ear and normal ear pressure. The doctor who made the audiogram said to avoid loud noises and ototoxic drugs.
For the past week, i started feeling dizzy and i am still having this buzz in my left ear but it started happening while sleeping on my left or right side not right side only and i started having this high pitched constant ringing in my left ear all day and it doesn’t go away.
Could the beta blocker Sotalol HCL 80mg that i’ve using for three weeks make this buzz and ringing worse than before? It’s the only medication i’ve been using.
Appreciate if you can help me .
Hi Mohamed:
For your information, Sotalol only has less than half the reports of ototoxicity as does Bisoprolol. Both are beta-blockers. So your doctor theoretically did you a favor by switching from a more-ototoxic drug to a less-ototoxic drug.
From everything you have said, I think your tinnitus is due to your head/neck/shoulders/jaw (they are all inter-related) being out of proper alignment. If I were in your shoes, the first thing I’d do is go to an upper cervical spine chiropractor and get things all aligned properly. Hopefully, that would take care of most of your problems if not all of them.
I suggest you investigate treatment from a special kind of chiropractor that specializes in the upper cervical spine (UCS). These people are able to work wonders for certain ailments and they are very gentle–not the bone cracker kind. They focus mostly on your top two vertebra (C1 (Atlas) & C2 (Axis). If this joint is “off” then you could have some of the symptoms you are experiencing such as the ear problems.
You can find a chiropractor specializing in UCS by going to the following URL and entering your location. You can also read about the things these special chiropractors can do for you at this same website. Here is the URL.
http://www.upcspine.com/
Choose the “Practitioners” link along the top to find the one closest to you.
Cordially,
Neil
Onset 3 months ago with periodic self-limiting episodes of unilateral loss of hearing/aural fullness (sudden sensorineural hearing loss?);
can only detect higher frequencies;
most noticeable when on the phone;
sometimes with very mild vertigo;
with and without noticeable tinnitus;
dissipates w/i a few hours.
Other sxs: palpitations, orthostatic hypotension (transient lightheadedness upon standing up)
Dx testing thus far:
– audiometry/tympanometry showed normal function and structure; no incidence of ETD
– MRI scan pending to rule out tumors/cysts – doubtful?
Co-morbidities:
– hypothyroidism
– moderate hypertension
– PVCs/palpitations
– TMJ/TMD-
venous insufficiency
Rx: beta blocker carvedilol for last 5 years + ARB telmisartan for last 3 years.
After discovering your blogs, am uncertain, but suspecting ototoxicity of one or more of these meds. Question is, if ototoxicity, why after years of relatively no noticeable side effects? Perhaps titrate to lower dose, and if no improvement, replace carvedilol with nebivolol?
Thoughts?
Hi Mark:
Switching from Carvedilol to Nebivolol would seem to be a step in the right direction as Nebivolol only has 11% as many ototoxic reports as does Carvedilol. Telmisartan as compared to Carvedilol only has 26% as many reports.
I don’t know why sometimes side effects show up very fast (the fastest I have heard is 7 minutes for one drug–Furosemide) and other times with other drugs it can take 5 or 10 years to show up. It could have a lot to do with a person’s body chemistry, lifestyle, emotional state, or other co-factors changing.
Reducing the dose is another possibility. Often there is a “magic” threshold below which ototoxic side effects don’t show up, but as soon as your raise the dose above this threshold, there they are.
Cordially,
Neil
Hello.
I have started taking amlodipine 10 mg for 8 weeks. Then i developed acute pharyngitis confined to one side. I started taking azithromycin for about 7 or 8 days with no improvement in pharyngitis. Then few days later i started developing hissing in my ear that was more obvious on waking up and was not continous. I still did not figure out the cause of pharyngitis and doctors told me the hissing is probably secondary to pharyngitis. The hissing used to alternated between both ears and sometimes both ears together and was associated with sense of full ear or same feeling you get in a plane while your eustachian tubes get blocked and re open. The tinnitus worsened on waking up and all that time i have been on amlodipine (note i have been on amlodipine for 2 whole months before all that started to happen). I went for hearing tests and audiograms that twice that were perfectly normal. I was told by other doctors that my sore throat was probably due to reflux and that tinnitus may be related. Now i have been suffering from sore throat for 6 weeks and tinnitus for a month. At the beggining was more obvious in the right ear but now more in the left and still with that sense of full ears some times and when it goes away it usually happens by the end of the day (sometimes persists all day) and i do get sensation of eustachian tube blocked and opens when it happenes. I did indirect laryngoscope and doctor said i only have mild nasopharyngitis . He stated i might have post nasal discharge (which i dont feel and i dont have nasal symptoms). I shifted to felodipine only 4 days ago and my tinnitus is still there more on waking up. Is it relates to drugs? I read felodipine was less likely to cause ear problems. Could amlodipine cause that even after 2 months and not earlier? If it is amlodipine, how long should i wait after shifting to felodipine to recognize change in tinnitus? Thanks and sorry for long comment
Hi Ahmed:
Amlodipine is one of those drugs that can cause ototoxic side effects months or years later. I’ve heard from several people who go their side effects 2 months later, and some who got their side effects 3 years later.
The good news is that numbers of people report that their ears get better–at least to some degree–when they go off the Amlodipine.
Felodipine has far fewer reported side effects than Amlopidipine–something in the order of 14 TIMES fewer reports. So it should be far easier on your ears.
If you are going to have changes in your tinnitus, you should certainly notice them within 2 months and hopefully sooner.
Cordially,
Neil
Dr. Bauman,
Fist of all, thank you for taking the time to help us tinnitus suffers. I only developed Tinnitus 6 months ago after taking HBP drugs for 10 years.
I was on Exforge ( 10mg amlodipine, 160mg Valsartan ) for 9 years.
The cardiologist then switch my meds to Twynsta ( 10mg amlodipine , 40mg Telmisartan ) 6 months ago
Unfortunely, the ear buzzing still continues.
I would be grateful if you could recommend me 2 new “less” ototoxic meds. Thanks.
Daniel
Hi Daniel:
Are you saying that you developed tinnitus 6 months ago when your doctor switched you to Twynsta? Or that he switched you to try to get away from the tinnitus you had developed while on the Exforge?
I’d try to stay off any drug that has Amlodipine in it as you can see by the last page on my Special report that Amlodipine is the worst of the Calcium channel blockers.
You and your doctor should decide what drugs will do the job and find the least ototoxic combination that works for you based on this special report.
Cordially,
Neil
Sir,
Thank you for your expeditious reply.
I was on Exforge ( Amlodipine 10mg / Valsartan 160mg ) for almost 9 years. I was naive enough to just take it as I trusted my doctor.
I developed Tinnitus 6 months ago and I suspect this could be one of the causes. I decided to be diligent and started checking on the medication and found out this 2 component are the most “lethal” cocktail of Ototoxic drugs. My doctor doesn’t think this is the cause of my tinnitus but I beg to defer. BTW, I bought your special report and your report confirmed it ( Thank you for compiling it. It’s worth more than the $10 bucks I paid )
So, he switched me to Twynsta thereafter but the buzzing still continues.
According to your report, Temisartan is on the medium risk category and has very low tinnitus cases (60) and a Grand total of 1,441. In your opinion, do you think it is OK to continue with Telmisartan ? I can’t find much information on Eprosartan. Maybe it’s a new drug?
I am definitely going to drop Amlodipine . In your personal opinion , which CCB would you recommend as a substitute ?
I cannot undo what has been done in the past but I am trying to prevent any further damage by taking the right medication
Thanking you in advance for your advise
Best Regards,
Daniel
Hi Daniel:
If one drug causes tinnitus, just because you stop taking it and/or switch to a different drug doesn’t mean that your tinnitus will go away. With some drugs that typically happens, and with other drugs the tinnitus is typically permanent. It is hard to know in advance what will happen.
On the back page of the special report I’d substitute any of the Low or Medium risk CCB drugs that your doctor thinks will do the job. They are all presumably very low risk for tinnitus. I don’t have any specific opinion on which of these drugs would be best. Work with your doctor on this.
Cordially,
Neil
Dr Bauman,
I’m 35 years old and I’m taking 25 mg Atenolol for 10 years. Few weeks ago I woke up with a ringing in my right ear… Is it possible taht after all this years Atenolol triggered mt tinnitus? Would it help after such a long period of time to switch to other drugs instead of Atenolol?
Thank you for taking the time to help us tinnitus suffers.
Hi Irek:
It’s very possible that your tinnitus is due to the Atenolol. I’ve heard from numbers of people whose ear problems with Atenolol began 2, 3, 4, 8 and 10 years later so it does happen.
The good news is that those that get off the Atenolol find their tinnitus, hearing loss, etc. improve even after that long a time. So switching to a less ototoxic beta-blocker may work in your case too. It might be worth a try. It may take up to a month to notice any changes in your tinnitus if it is going to improve after you get off Atenolol.
Cordially,
Neil
i have been taking this drug betcard 25 which is atenolol and cortel ln combination of telmisartan and cilnidipine 40mg and 10mg, from last 2018 recently i have noticed balance issues and loud tinnitus in my right ear can u please suggest is it because of the drugs or something else
Hi Mukul:
My guess is that the Atenolol is the culprit. One of the weird things about Atenolol is that you can take it for several months to several years before side effects begin–then you can have tinnitus, hearing loss and balance problems. You have been on it about 2 years and now you have these problems. I’ve heard from numbers of people in the same boat–often around 3 years later.
I’d suggest you stop the Atenolol and see whether your tinnitus drops and your balance problems resolve. If so, you know it is the Atenolol. Maybe your doctor can suggest another beta-blocker.
One woman who had troubles with Atenolol found that switching to taking Nebivolol solved her problems. Another lady switched to Metoprolol and largely solved her problems.
Cordially,
Neil
I’m currently in the hospital and took Sotalol. After the second dose I noticed a slight uptick in my Tinittus. After the third dose it got extremely bad and the doctor stopped the dosage. I’m not sure what I’m going to do but I need to know whether the hearing damage is typically permanent with beta-blockers or is it usually temporary. I am afraid I just suffered a 1 year set back in my progress of overcoming severe tinnitus and hyperacusis. Can you help? This just happened today.
Hi Bill:
As you probably know, Sotolol has fewer reports of causing tinnitus that a number of the other Beta Blockers, but that doesn’t mean that you can’t be one of the unlucky people for whom Sotolol causes tinnitus.
You many not have suffered any “physical” damage to your hearing, but any setback to getting your tinnitus and hyperacusis under control is definitely discouraging. Don’t let this derail you–just continue on your program of reducing your tinnitus and hyperacusis, because that is the only way to succeed.
I don’t know whether stopping the Sotolol like you did will let you quickly get back to your old level or not. Hopefully you’ll know within a couple of weeks. In any case, remain calm and don’t let your anxiety run away because that is the biggest part of the battle for control.
Cordially,
Neil
What do you think of Buspirolol as a beta blocker?
Dee Dee
Hi Dee Dee:
I think you mean Bisoprolol–As far as tinnitus goes, based on the number of reports to the FDA’s data base divided into the number of prescriptions issued, is at the bottom of the list. So it would be my last choice, not my first choice.
Cordially,
Neil
I have too many side effects with generics so I stick to name brands. Four years ago they started do something different with my lisinipril & hctz that made them terrible. I noticed the pills were smaller and I thing whatever they did doesn’t agree with me. Was it the process to make them changed or something else? I ended up with prinivil & it was ok. After the pandemic started I could no longer get PRINIVIL & tried 8 or 9 different beta blockers. Bystolic had least side effects accept I have a lot of sinus drainage. I am taking bystolic & hctz & loratidine. I recently started having tinnitus in one ear. It is getting worse. what can I do?
Hi Bonnie:
The active ingredient is always supposed to stay the same. What makes the difference is the “inactive” ingredients they put in the pill. However, sometimes they put in “inactive” ingredients that are anything but inactive. They can do this as they are “inactive” for the main purpose of the pill–not that they are benign. So the difference between a brand name and a generic pill lies in these “other” ingredients.
Lisinopril (Prinivil) is probably the least ototoxic of the ACE inhibitors. Too bad you can’t get it, or get the generic.
Nebivolol (Bystolic) is the third least ototoxic of the Beta Blockers according to my information so it is a good choice, but theoretically Labetalol is the least ototoxic–on par with Lisinopril. The second place goes to Carvedilol.
Since you tinnitus came on recently and you changed drugs recently, perhaps on of the drugs is the culprit. I’d rank them from most ototoxic to least ototoxic as Loratadine, HCTZ, Nebivolol (Bystolic) with Loratadine about 2 times as ototoxic as HCTZ and 3 times as ototoxic as Nebivolol. So maybe you might want to eliminate Loratadine and see what happens with your tinnitus.
Of course, your tinnitus could be caused by factors other than the drugs you are taking.
Cordially,
Neil
Hi Neil.
I’m a 50 year old & I was currently on Quinapril 10mg for around 8 – 10 years with no problems. It seemed to hold my BP reasonably low. But a few months ago I experienced anxiety from a traumatic event. So I started getting anxiety attacks etc. It’s now been nearly 3 months and my anxiety attacks are nearly non existent & I’m on the road to fully recovering from anxiety. BUT, when I was into my 2nd month of anxiety, my GP changed my Quinapril to Atenolol 50mg to help maintain my “fight or flight” emotions and control my rapid heart palpitations & heart racing etc. It done that well, but after 4 weeks on Atenolol, I started getting bad tinnitus in my ears. It’s starting to bother me even during the day. Other than the tinnitus, I’m getting no other side effects and it’s been good. Do you think I should try another beta blocker (and which one would you recommend?) or maybe try Atenolol at 25mg?
Your advice would be greatly appreciated.
Kind regards,
Howie.
Hi Howie:
Since your anxiety is now basically under control and the Atenolol is causing you bad tinnitus, and since the Quinapril didn’t cause tinnitus, even after a number of years, to me the obvious solution is to get off the Atenolol(because presumably you no longer need it) and go back on the Quinapril at its former dose or one of the other ACE inhibitors such as Lisinopril which has an even lower risk of tinnitus than does the Quinapril. That’s what I’d do if I were in your shoes.
Cordially,
Nei
Thank for your reply Neil.
I’ve just messaged my GP to ask about weaning myself off Atenolol and starting again on Quinapril (as I already have some on hand) or Lisinopril. I’ll see what he comes back with.
Kind regards,
Howie.
Hi Neil.
My GP came back with:
“I did a medical data base search for medications that can cause tinnitus and beta blockers were not on the list. ACE inhibitors (like quinapril) are on the list and have been found to cause/worsen tinnitus. However, if you would like to transition from atenolol to quinapril, start the quinapril at your usual dose and reduce the atenolol to one half tablet (25 mg) daily for about 5 days, then stop”
So I’ll wean myself off Atenolol & go back on Quinapril.
I think I might also have Somatosensory Tinnitus as well. I had been wearing a Snore RX mouthguard for Sleep Apnea for 2 months holding my jaw forward in an unnatural position. (Stopped wearing it a week ago). It was sore on my jaw everyday. And still my jaw area (TJM) gets sore when I’m eating a good meal. I get headaches regularly, neck pain as well. I looked at the website you highlighted http://www.upcspine.com and found only 1 person here in New Zealand 2 hours away. I have emailed him tonight & will try get in for an upper Cervical &/or jaw alignment.
Thanks again for your advice and replies. Very much appreciated.
Kind regards,
Howie.
UPDATE:
Hi Neil.
My GP came back with:
“I did a medical data base search for medications that can cause tinnitus and beta blockers were not on the list. ACE inhibitors (like quinapril) are on the list and have been found to cause/worsen tinnitus. However, if you would like to transition from atenolol to quinapril, start the quinapril at your usual dose and reduce the atenolol to one half tablet (25 mg) daily for about 5 days, then stop”
So I’m on my 2nd to last day now of Atenolol and looking forward to stopping it in a few days.
I think I might also have Somatosensory Tinnitus as well. I had been wearing a Snore RX mouthguard for Sleep Apnea for 2 months holding my jaw forward in an unnatural position. (Stopped wearing it a week ago). It was sore on my jaw everyday. And still my jaw area (TJM) gets sore when I’m eating a good meal. I get headaches regularly, neck pain as well. I looked at the website you highlighted http://www.upcspine.com and found only 1 person here in New Zealand. I have emailed him tonight & will try get in for treatment. UPDATE: Apparently he’s no longer in business. So I Google searched and found a Dr Graham Dobson in New Zealand who’s been doing UPC for 50 years. I’ve talked with him & made an appointment.
Kind regards,
Howie.
what is beta blocker that doest casuse tinnuut
Hi James:
As far as I know, all the beta-blockers can cause tinnitus so the trick is to take the one with the least risk that will do the job. My choice for the least ototoxic commonly-prescribed beta-blocker would be Labetalol with Carvedilol as my second choice and Nebivolol as my third choice.
Cordially,
Neil
Hi Dr. Buaman,
I started taking high blood pressure medication June 2021. I was allergic to Metoprolol. I developed itching and rashes. My cardiologist switched me to Diltiazem ER 180 mg. I have developed moderate hearing loss and tinnitus. I now have to wear bilateral hearing aid. I also have lupus. Do you have any suggestions or recommendations?
Hi Roz:
How about trying Lisinopril. According to my calculations, it has the lowest risk of getting tinnitus. This is what I use myself.
Cordially,
Neil
Dr. Bauman,
My cardiologist changed my medication to 30mg Nifedipine and 5mg Nebivolol and my tinnitus spike.
In your opinion, which of this (or both) medication is the cause of the spike? Can you recommend a substitute for either one or both of these medication that has a lower chance of spiking my tinnitus ? I know there is no guarantees, but your recommendation is high appreciated.
Thanking you in advance for your advice
Daniel
Hi Daniel:
Of the two, in my opinion, the Nifedipine has about 3 times the risk for tinnitus as the Nebivolol. See whether your doctor will substitute Amlodipine for the Nifedipine and maybe your tinnitus will go back down.
I take Lisinopril (20 mg) and Amlodipine (5 mg) and it hasn’t bothered my tinnitus at all. That might be another good combination.
Cordially,
Neil
Thank you sir. By the way, the books I bought on your website is super useful. Thank you again for helping all of us tinnitus sufferers
I only have a cheap phone for internet,and cannot download your book. Very high blood pressure. I take carvedilol 25 mg and sacubitril 97mg/valsartan 107mg . I am desperate have not slept for days and fear for a heart attack please help
Hi Larry:
I’m not a medical doctor and don’t know how blood pressure affect your sleep. I can only tell you how they affect your ears.
For example, when talking about tinnitus as a side effect, Carvedilol is the beta-blocker that has the second-lowest risk of causing tinnitus according to my information. The only one better is Labetalol. You might want to ask your doctor to switch to it if he thinks it will do the job.
Of the ARBs, Losartan is a better choice for tinnitus risk than Valsartan. I don’t have any information on Sacubitril as it is always prescribed with Valsartan so I can’t separate the side effects.
Cordially,
Neil
You said before Lisinopril is the best medication for high blood pressure. What are your second and third choices (of medication) for high blood pressure?
Hi Tom:
Remember, this is my own opinion based on incomplete information and is always subject to change as I find more information. Furthermore, this is just my assessment of ototoxic risk, not how well these drugs do the job they are supposed to do.
With that in mind, currently I’d rate Labetalol as No. 1 and Carvedilol as No. 2, both ahead of Lisinopril.
Cordially,
Neil
I’ve been taking Labetalol 200mg twice a day for a few years. It has not raised my tinnitus; however it isn’t quite doing the job overnight as my waking blood pressure is too high. My doctor wants to add another medication at night. She suggested Losartan. Fortunately, she is open to my suggestions. Is the Losartan a good compliment to the Labetalol, or would you suggest something else? I want something that will hopefully have the least impact on my tinnitus.
Hi Janet:
Labetalol is a beta blocker and is more mildly ototoxic meaning that not many people have reported from taking this drug. So it is a good drug in relation to your ears. Since I am not a medical doctor, I can’t speak to its effectiveness regarding bringing down blood pressure.
My waking blood pressure is also quite high–but that is to be expected as you get older. Since I am an “old goat”, if I had my blood pressure down to the ideal 120/80, I’d feel faint a lot. I NEED my blood pressure to be up at 140 or higher–then I feel good. So don’t slavishly stick to the “ideal” BP for young people if you are a senior.
Losartan is actually a good second choice. It is a bit more ototoxic than Labetalol in my opinion, but it is still a relatively low ototoxic risk.
Another possibility is Lisinopril. That is what I take along with a beta blocker. But, even so, I think Losartan has less risk than Lisinopril. So your doctor has made a good choice.
Cordially,
Neil