Neil Bauman, Ph.D.
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 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 plus any unspecified general ear conditions). This total ranges from a low of 0 to a high of 29,123. This shows the tremendous variation in ototoxic risk between taking one of the drugs in a given drug class as opposed to another drug in the same class.
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 likely enormously greater. (The same holds true if you are choosing an over-the-counter NSAID.)
If you want to specifically reduce your risk of making your tinnitus worse, you can focus on the first column. If you want to avoid both tinnitus and hearing loss, 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 non-steroidal anti-inflammatory drugs are the easiest on your ears.
If you are already taking one of these 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 $10.00 to help further the work of the Center for Hearing Loss Help.