Neil Bauman, Ph.D.
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 each drug in each class, this report lists the drugs in ascending order of ototoxic risk, They are broken down into three groups—low risk, medium risk and high risk.
For each generic drug name, I list the reported incidence under the following headings.
- Tinnitus: The number of people reporting tinnitus as a side effect of taking this drug.
- Hearing loss: The number of people reporting hearing loss as a side effect of taking this drug.
- Cochlear side effects: The total number of reports of cochlear (hearing-related) side effects which includes the figures from the tinnitus and hearing loss columns as well.
- Vestibular side effects: The total number of reports of vestibular (balance) side effects such as dizziness, vertigo, balance disorders, ataxia, nystagmus, etc.
- Other side effects: The total number of reports of outer/middle ear side effects.
- Grand total: The total number of reports of all ototoxic side effects for this generic drug (the totals of 3, 4 and 5 above). This total ranges from a low of 0 to a high of 16,353. This shows the tremendous variation in ototoxic risk between taking one of these drugs as opposed to another.
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.
Since you want to specifically reduce your risk of making your tinnitus worse, you can focus on the first column. If you wanted to avoid both tinnitus and hearing loss, you’d focus on the first two columns.
However, you’d do well to focus on the sixth column as well—the Grand Total—as drugs with a low grand total will also be low in the incidence of tinnitus and hearing loss as well.
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 $10.00 to help further the work of the Center for Hearing Loss Help.