Neil Bauman, Ph.D.
June, 2018 (revised October, 2024)
People have asked me which are the least ototoxic non-steroidal anti-inflammatory drugs. For example one man asked:
If you have a product that offers advice on the “best of the bad choices” for NSAIDs, I would be glad to purchase it. I really need advice in this respect, as the lists show nearly every drug as ototoxic, and I need to choose something for my upcoming surgery.
To which I replied, “This special report shows the relative ototoxicity of the various NSAIDs by class. Now you have a guide to help you choose the least ototoxic one that will do the job.”
As you already know, 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, 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 inflammation. 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 inflammation, so the below lists may not be complete.
However, having said that, there are seven classes of drugs doctors typically use to try to control inflammation. These seven classes of drugs come under the general heading of non-steroidal anti-inflammatory 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 drugs from different drug classes—so the combined effect will reduce your inflammation by one means or another.
These seven classes of non-steroidal anti-inflammatory drugs include the:
- Acetic Acids. The generic names in this class of drugs typically end in “ ac” or “—in”, e.g. Diclofenac, Indomethacin.
- COX-2 Inhibitors. The generic names in this class of drugs typically end in “—coxib”, e.g. Parecoxib.
- Fenamates. The generic names in this class of drugs typically have the letters “fen” in their names, e.g. Meclofenamate.
- Oxicams. The generic names in this class of drugs typically end in “—oxicam”, e.g. Meloxicam.
- Propionic Acids. The generic names in this class of drugs typically end in “—profen”, e.g. Ibuprofen.
- Salicylates. The generic names in this class of drugs typically end in “—late”.
- Miscellaneous NSAIDs. The generic name in this class of drugs typically end in “—zone”.
In order to help you quickly eliminate the most ototoxic drugs in each class, and, at the same time, zero in on the least ototoxic drugs in each class, I have prepared a special report on the above seven classes of non-steroidal anti-inflammatory 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 7 non-steroidal anti-inflammatory 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 non-steroidal anti-inflammatory drugs (NSAIDs), 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.
Would like to find out more.
Hi Beverley:
Read the special report mentioned in this article. The information is all laid out in this report. The link to it is right at the bottom of this article.
Cordially,
Neil
I have stomach inflammation and tinnitus in the right ear and tinnitus and left ear I met several doctors of the nose and ear and throat and each doctor told me different and different diagnosis. I did not have an ear buzz before and ate acidic pills. I read on your site the negative effect of acid pills on ear and tinnitus and I stopped the acidity pills. Now, Doctor, I have done a hearing test and this test low hearing on the high frequencies with I hear well and there write what in the outer ear left and right What is your advice and is possible to
tinnitus go forever
I have 3 problems in my ears
I tinnitus
Eczema with ears
Pain in the ears
Hi Mark:
If you have been taking proton pump inhibitors for your stomach, then this could be the cause of your tinnitus. It’s also possible it’s the cause of your high frequency hearing loss.
Since tinnitus commonly accompanies hearing loss, you may find that your tinnitus will be permanent. But that doesn’t have to be a problem if you learn to habituate to your tinnitus. Basically, you forget about your tinnitus and focus on the loves of your life and let your tinnitus fade into the background where it isn’t a problem. It is just “there”. Then hours may go by without your even being aware you have tinnitus. For example, before I began answering this comment, I wasn’t aware of my tinnitus, but now that I am thinking about it, my ears are ringing away. But since I am habituated to my tinnitus, within 5 minutes of finishing this comment, I won’t even be hearing my tinnitus–unless the next comment I answer is on tinnitus too. You don’t have to let your tinnitus bother you.
Cordially,
Neil
Hello – I just purchased your report on the NSAIDs. Unfortunately for me (50 year old male with no underlying), I was prescribed Diclofenac for lower back pain. I immediately stopped taking the drug after only 6 days when a 24/7 ringing in my left ear developed. It’s really difficult to get through the day with this! It’s been 3 days and still ringing as loud as ever. Is there a good chance in your view this is permanent? What a shame that someone with perfectly good hearing will have it destroyed after only 6 days….
Hi Todd:
There is no way to tell whether your tinnitus will be permanent or not, but I’ve heard from other people that have had similar experiences as yours and their tinnitus seems to be permanent. On the other hand, I typically don’t get reports from people that just have a transitory side effect so I don’t have any information on what percentage of people that get tinnitus from this drug only have it temporarily.
Since it has been so recent, you might want to try four supplements that may really help your tinnitus drop in volume and maybe fade away. They are zinc (zinc picolinate is the form I use), magnesium (magnesium threonate is the form I use), N-acetyl-cysteine (NAC) (up to 1,800 mg/day for a couple of weeks) and Arches Tinnitus Formula (ginkgo biloba) (480 mg/day–this is the only ginkgo formulation of which I know that has enough of the active ingredients to do the job. You probably need to take it for 90 days to give it a fair chance to see if it works for you.)
Cordially,
Neil
Dear Neil,
I just bought your report as I have no choice but trying different NSAID for a Spondyloarthritis.
Thanks for your tremendous job on gathering all these info.
By the way 2 remarks :
– I see Aceclofenac is ranked low risk with almost no report. This NSAID is frequently used in Europe but is it approved by FDA in the US? Because I cannot find it on the FDA approved drugs website (https://www.accessdata.fda.gov/scripts/cder/daf/).
This could explain why there is no report for this drug if not use in the US.
According to my doctor safety profile and aderse effects (like tinnitus…) should be the same as for Diclofenac since same family.
Maybe it is the same for other NSAID listed with 0 reports in your document? Could it be they have no users because not approved in the US?
– In your report you explain that we miss the population taking a given drug. Despite this, you say that we can assume a drug with fewer reports are generally safer to risk taking than those with many report.
I do not fully agree here. This is all a matter of %.
If a drug has 1000 reports but with 1 000 000 users meaning a risk of 0.1%, it looks safer to me than a drug with only 10 reports but for only 1000 users (which would be equivalent to 10 000 reports on he same 1 000 000 users basis). Or the 2nd one will be ranked with lower risk in your table.
We can hardly draw conclusions on tinnitus safety based on the n° of reports except to compare drugs which are similarly commonly used.
– You always talk about hearing loss or tinnitus but we should not forget hyperacusis. I have hyperacusis and tinnitus (from accoustic trauma). My tinnitus has never been impacted by any drug hopefully… but when I tried Diclofenac recently, my hyperacusis increased a lot following the first pills… it went back to normal 2 weeks after I stopped taking diclofenac. Never had this experience with Ketoprofen or Meloxicam also tried in the past (but unfortunately not effective on my Spondyloarthritis, that’s why I have to try other ones)
Thanks again
Cheers,
Hi Nicolas:
Regarding Aceclofenac, I have little information on it–and what I have is largely from the UK drug book. So it may have far more ototoxic reports than is indicated by the information I have.
You can assume that it has similar side effects to Diclofenac, but even drugs in the same class have differences. So taking the side effect reports of Diclofenac as a guideline is probably a safe bet.
The reason for the 0 reports is probably they are not used much in the USA, or I just haven’t been able to find a source that gives more complete information. The information I have available to me is by no means complete, so you have to take all reports with a gain of salt (and sometimes the whole saltshaker), but it is the best information I had available to me at the time I compiled that report.
I totally agree that we need to know the number of prescriptions given in a year vs the number of ototoxic side effects reported to get a “apples to apples” comparison percentage.
But even then, the accuracy is not all that great because the reports come in over a number of years, and you’d have to know the prescription figures for those years in order to make an accurate assessment–and I don’t have those figures. So take what you want from what I have compiled and be aware (as I explain in the report) that the results are somewhat “hairy”.
That report you have only singles out tinnitus and hearing loss, then bunches together all balance ototoxic side effects.
If you want to know about other side effects by drug, you’ll find this information in my book “Ototoxic Drugs Exposed”.
In the upcoming (in a couple of years) 4th edition of the above book, I have hyperacusis listed as a side effect of Diclofenac, so you came by it “honestly”.
Incidentally, in the new edition, I have hyperacusis listed as an ototoxic side effect for both Ketoprofen and Meloxicam as well.
Cordially,
Neil
Dear Neil,
Thanks again for your work and the time spent to answer to us all.
Really, being with a serious disease (like Spondyloarthritis or rheumatoid arthritis) and at the same time alreading having damaged ears (with tinnitus and hyperacusis) is a nightmare to handle…
I always try to avoid taking any drug to protect my ears (and also because all NAID have also nasty side effects on other body organs) but sometimes I have no choice… And everytime I try a drug to control the disease, I take the risk to worsen my tinnitus/hyperacusis which are already quite painfull to handle.
My rheumatologist doctor is really trying to help me by giving the choice of the drugs I want to try.
She tells me everytime “if you notice something wrong with your ears, just stop immediately and we try another one”.
As said previously, I have already tried Ketoprofen and Meloxicam which did not work on my Spondyloarthritis (but no impact on my ears).
I have also tried Diclofenac which temporarily worsen my hyperacusis.
I now have to say to my doctor which one I am ok to pick up among the following for a new test :
Aceclofenac
indomethacin
Niflumil Acid
Celecoxib
Etoricoxib
Tenoxicam
Flurbiprofen
But I am now lost with all the info gathered on the internet, in your report, the various testimonies found in dedicated forum, our above exchanges…
and by the way I know there is a huge personnal sensitivity to drug so it is not because one is said highly ototoxic that it will hurt me and on the other hand, a drug known to be “safer” for tinnitus can be bad for me…
So I will just try and stop in case of any issue popping then move to another one…
But I would love to get your view. If you had no choice but trying some of the above list, and in case you would be tinnitus/hyperacusis sufferer, how would you rank them for your testing order (from the 1st one you would test to the last one)?
thanks again
Nicolas
Hi Nicolas:
Ok, I’ll try to put them in order of best to worst in my opinion as regarding affecting ears.
This is going to be very “iffy” because I don’t have any information on 1, only very limited information on 3 of them, limited information on 1 and good information on 2
Niflumil acid Don’t have any information on this drug.
Aceclofenac Very limited information on this drug
Etoricoxib Very limited information on this drug
Tenoxicam Very limited information on this drug
Flurbiprofen Limited information on this drug
Indomethacin 2nd worst
Celecoxib Worst
So, of the 7 drugs, this is my very rough assessment of how I would rate them based on very little information. So basically, you have to take your chances on the first 5.
Cordially,
Neil
I had mild tinnitus in both ears until recently when I took 2 pills of glucosamine sulphate and chondroitin, total 1000 mg glucosamine sulphate and 800 mg of chondroitin. 1 pill at lunch andv1 at dinner. Within hours I woke up in the middle of the night with SCREAMING tinnitus and its never stopped. High pitch and new tones in my ears. I’ve now read that glucosamine Is a Cox 2 inhibitor and as strong as Celebrex and just as ototoxic. Is this true. Is this now permanent damage?
I am so scared…the tinnitus is unbearable and it doesn’t seem to be getting less and even worse. I can’t even sleep Your input and knowledge on glucosamine sulphate is appreciated. Is it the same as Celebrex side effects to hearing?
Hi Marlene:
Glucosamine and chondroitin are natural substances that your body makes. So as such, they are not bad–you need them. But taking anything in large amounts and separately from all other nutritional factors that would normally accompany them means that they can put your body out of proper balance. When that happens, side effects such as tinnitus show up.
Both glucosamine and chondroitin are reported to cause tinnitus in some people. It seems that you are one of the unfortunate people that gets tinnitus from taking them.
Although glucosamine acts as a COX-2 inhibitor to some extent, it has a number of other functions. Celebrex is a synthetic drug and thus has a harsher action on your body that natural substances and does not have the accompanying factors that natural substances have so they work properly in your body without causing side effects.
Celebrex has ever so many more reports of tinnitus than glucosamine–but it is probably taken much more too.
Has your tinnitus calmed down in the past 3 days? And have you calmed yourself down? Anxiety is a key component in how you perceive your tinnitus, so calming down is necessary to control it.
Cordially,
Neil