by Neil Bauman, Ph.D.
A lady wrote,
I am 64 years old, and I have had tinnitus since around 1990. I have been taking Propranolol since 1979, which was originally prescribed for my migraines. At this point in my life, I have developed hypertension which is not controlled by this dose of Propranolol. My doctor is trying to find the proper blood pressure drug for me, but unfortunately, she knows little about ototoxic drugs, so I have to make my own suggestions to her. I realize that most ace-inhibitors, calcium channel blockers, and beta-blockers can be ototoxic.
My question is, ‘Are there any blood pressure drugs that do not seem to cause tinnitus or harm our ears?’ I understand that no drug is perfect and may cause other side effects, but I am feeling desperate to find a medication that would help control my blood pressure without worsening my tinnitus.
I sure understand your desire, but I can’t tell you which drugs do not cause tinnitus because I don’t compile information on non-ototoxic drugs, just on ototoxic ones. Thus, I really don’t know if there are other drugs in the above classes that are not ototoxic.
Since I list all known ototoxic drugs in the above classes in my book Ototoxic Drugs Exposed, if you find drugs in these classes that are not in my book, there is a good chance they are not ototoxic (unless they are new drugs just on the market).
If you want to stay on the typical prescription drug blood pressure medications, rather than use natural means to lower your blood pressure, then you need to look for the drugs with the fewest ototoxic side effects—and in your case, specifically for drugs that are not listed as causing tinnitus.
You can quickly and easily find this out if you have the latest edition of Ototoxic Drugs Exposed. All you’d need to do is turn to Table 14-1 and under section 20.8 you’ll find all the ototoxic anti-hypertensive drugs listed by class.
Thus, for example, if you wanted to know whether there are any Beta-blockers (section 20.8.12) that are not known to cause tinnitus, of the 19 Beta Blockers listed there, 3 of them are not listed as causing tinnitus. Therefore, you might want to suggest to your doctor that if you have to take a Beta Blocker, you’d like to try one of these four drugs if he thinks they will do the job—namely Labetalol, Nebivolol or Sotalol—since none of these are known to cause tinnitus.
You can take this one step further and of these 3 drugs find the one that is the least ototoxic by looking each of these up in the main drug listings and compare all their ototoxic side effects. If you did this, you would find that Nebivolol is the least ototoxic. Nebivolol is much less ototoxic in my opinion than the most ototoxic Beta Blockers such as Betaxolol and Propranolol.
However, if you want to bring your blood pressure down by natural means and not use prescription drugs you have other choices.
First you need to determine whether your blood pressure is too high or not. Far too many doctors want everyone to have ridiculously low blood pressure according to complementary medicine standards. You see, some people naturally have higher blood pressure and that is normal for them and is not wrong.
The rule of thumb seems to be that you should keep your blood pressure below 140/90, so if it is lower than that, you probably don’t have to worry about it. The book “Prescription Alternatives” explains that if you are over 60 (which you are), your blood pressure can be up to 180/100 and still be “normal” (although that is a very high “normal”). Thus, trying to get your blood pressure down to 120/80 may be completely wrong for you (but its a good way to sell more drugs).
You want to keep your blood pressure at a reasonable level to be sure. I suggest you first try to do this naturally, and only use drugs as a last resort.
The four main factors that can help reduce your blood pressure naturally are weight loss, exercise, diet and stress reduction. Here are a few examples to get you started.
Weight Loss: If you are overweight, for every 2 pounds of weight you drop, your blood pressure will drop at least 1 point.
Exercise: Just a brisk walk for 30 minutes 3 or more times a week can lower your blood pressure between 3 and 15 points in just 3 months.
Diet: Eat lots of fiber-filled vegetables and whole grains and drink plenty of water. For example, just eating 4 stalks of celery a day can significantly reduce blood pressure. So can taking garlic every day. Another secret to reducing blood pressure is drinking 6 to 8 glasses of clean water a day. It’s so simple that few people believe it works.
Stress Reduction: Getting your stress under control is almost guaranteed to bring down your blood pressure.
There are many natural and healthy ways to reduce your blood pressure if you are so inclined to try. I took much of the above information from the book “Prescription Alternatives” (1st edition) by Earl Mindell and Virginia Hopkins.
If you are serious about reducing your blood pressure the natural way without taking drugs, I recommend you carefully read the chapter “Drugs for Heart Disease and Their Natural Alternatives” in this book.
To find a good price on this book, go to Amazon and in the search box type the words “prescription alternatives”. You will have a number of choices from the 1st to the latest editions.
You can actually get this hardcover book on Amazon for as little as 1 cent to 10 cents (plus shipping which is typically about $4.00) so it is well worth it. There are newer editions too—you can get the latest edition in paperback form for as little as $11.48 (used).
Don’t let ototoxic drugs inadvertently damage your ears and cause hearing loss, tinnitus or balance problems. To learn which drugs are ototoxic, get the 3rd edition of Ototoxic Drugs Exposed. This book contains information on the ototoxicity of 877 drugs, 35 herbals and 148 chemicals.
Thanks goodness I found your website. I was beginning to think I was nuts or losing my mind. My Dr. recently (2 mon ago)added Carvedilol to try to lower my BP, which is avg 155/85. And I am hearing things that aren’t there and my tv sounds raspy and tinny and I went and bought a new one and it sounds terrible and am ready to take it back until I got on the internet tonight and decided I am not crazy, but that I gave tinnitus. Loud noise makes me crazy. I also take Altace for 2 yrs. I need help! Thanks so much. I’d love to hear from you.
Hi Bob:
Carvedilol can cause both hearing loss and tinnitus in some people. So can Altace (Ramipril). Who knows what happens when you take both together? (Obviously something as your ears are now having problems.)
As mentioned in the article there are three (two now as Labetalol has recently been reported as causing tinnitus) Beta-Blockers that do not cause tinnitus namely Nebivolol or Sotalol. Neither of these are reported to cause hearing loss either–so if you want to save your hearing and dump your tinnitus, these would seem to be the best choices.
Of the ACE inhibitors, Ramipril (Altace) is not the easiest on your ears. Less ototoxic choices include Benazepril, Captopril and Imidapril. Of these three, it appears that Captopril or Imidapril would be the least ototoxic.
Regards
Neil
I am a longtime user of Carvedilol 25 mg and Telmisartan 80 mg. I am now experiencing tinnitus, hearing loss at the higher frequency range and occasional vertigo. Since Carvedilol are known to cause tinnitus and hearing loss, can I stop taking Carvedilol or take an alternative medications?
Hi Ed:
Both Carvedilol and Telmisartan can cause hearing loss, tinnitus and vertigo (among other ototoxic side effects). If you want to stay with a beta blocker, you may find that Pindolol, or Carteolol or Betaxolol or Acebutolol have a lower risk that Carvedilol.
As far as the ARB class of drugs (sartan drugs), Losartan has quite a bit lower risk than Telmisartan. Candesartan may also have a lower risk as well.
You need to run this by your doctor and see what he says.
Cordially,
Neil
I have single sided deafness and was put on BP medicine Lotrel 5/20 – prescription was written 10/4/2012. In early November I starting noticing problems with the “good” ear. Saw my Ear Doctor, Dr. Brackman- and was told to switch right away to med that included a diuretic- switched to Losartan HCTZ 100-25mg tablet and a low sodium diet. Also underwent Prednisone treatment to restore the loss of high frequency sounds. It worked, but have been having sensations off and on..including buzzing in the good ear (low sound. Is this the new BP the right choice? I am considering stopping the BP meds in hopes to either stop or improve my situation.
I am sorry my paragraph seems to go on and on, but any response would be appreciated.
Regards,
Stephan Weiler
What about hyperacusis? I started getting extreme sensitivity to sound after taking nebivolol..is that possible?
Hi OC:
Anything’s possible I suppose, but I just checked and I have never seen hyperacusis listed as a side effect for any of the Beta Blockers.
Regards
Neil
Rusuvastatin and tinnitus does this med cause it
Hi Ron:
Rosuvastatin can, and does, cause loud tinnitus in a good number of people taking this drug. So you want to be careful.
A bit of good news is that one man reported that his tinnitus went away about a month after he quit taking this drug, so the tinnitus may not ultimately be permanent–at least for some people.
Cordially,
Neil
I was put on Rosuvastatin and got tinnitus in left ear. After a year and research, I asked to be taken off. My tinnitus has started to come and go after just a couple of weeks off Rosuvastatin. I am praying it will be gone completely. The heart doctor put me on Metopolol and every time I take this my tinnitus starts up so I probably need to change this medicine also? Your help is greatly appreciated!
I was also put on Losartan so what could I suggest to my doctor to replace this?
Hi Debra:
I’m glad your tinnitus from taking the Rosuvastatin is slowly going away.
Instead of taking Metoprolol, you might want to ask your doctor to switch you to Labetalol (if it will do the job) as it has a much lower risk of tinnitus as compared to Metoprolol.
Losartan has the lowest risk of tinnitus in this class of drugs, so, unless you know it is negatively affecting your tinnitus, you might want to stay with this drug.
Cordially,
Neil
I have been having hearing loss in my right ear and inner ear issues. I am on an ace inhibitor (ramporil) lowest dose whatever that is, a beta blocker(100mg Atenalol), and a calcium channel blocker (Cardizeim 240mg) had a heart attack 4 months ago and thats when they added in cardizem which said would help with my agina also. I’m only 50 and this hearing thing is totally driving me crazy. Went through Dr.’s thinking it was an inner ear infection so antibiotics etc no luck, then a negative pressure issue and was on Prednisone and flonase for a month, still nothing. Go in tomorrow again to see what is next. I am now off of short term disability after my heart issue and will be a road warrior again and my first flight is in a week from Detroit to Seattle. I normally fly 80-100K miles a year, which does not help. I am not sure what other blood pressure pills are out there, I know I cannot stop the beta block no matter what. The other two just bring down my numbers to a reasonable level, but a day without the beta blocker and my pulse rate is 135>
Thanks in advanced for any insite.
Hi Bob:
Ramipril can cause hearing loss and tinnitus in some people. All the drugs in this class can cause tinnitus, but there are a number that are not listed as causing hearing loss such as Benazepril, Captopril, Imidapril among others, but these are probably the least ototoxic of the bunch.
Atenolol can cause hearing loss and tinnitus also–and also mess up your ears. If you wanted to switch to beta-blockers that are not listed as causing tinnitus or hearing loss, you could consider Levobunolol, Nebivolol or Sotalol.
Diltiazem (Cardiazem) can cause tinnitus in some people. Calcium channel blockers that are not listed as causing tinnitus include Felodipine, Isradipine and Lacidipine.
So there are other drug choices that may work for you and at the same time, not damage your ears. See what you doctor says about the above.
Regards
Neil
3 days on citalopram gave me fierce screaming high tinnitus which persists after 6 months. Will it ever go away. I am maddened by it. What can I do to make it go away?
THANK YOU
Hi Patricia:
If you have had your tinnitus for 6 months now and it hasn’t reduced in volume, I fear it is permanent. So what you have to do now is learn how to control your tinnitus so it doesn’t drive you batty.
There are a number of techniques, but they all have the same underlying premise, and that is that you have to take control of your tinnitus. First, you have to free yourself from any negative emotions you feel towards your tinnitus. The more you focus on your tinnitus and have bad feelings toward your tinnitus, the louder and more intrusive it becomes.
Also, you have to choose to ignore your tinnitus by focusing on the loves of your life. When you are focused on other things, by default, you are not thinking/worrying about your tinnitus. When you do this, your tinnitus becomes less and less intrusive and tends to fade into the background. It may never go away, but at least it will not bother you anymore. This is called becoming habituated to your tinnitus.
If you need help doing all this, seek out a tinnitus clinic. You may enroll in Tinnitus Retraining Therapy or Neuromonics. Both of these have good success ratios IF you persist with them for the year to 3 years it takes to bring your tinnitus under your control.
My book on tinnitus, “When Your Ears Ring” gives much information on many different tinnitus treatments including the above two treatments. You can see it at http://www.hearinglosshelp.com/products/books.htm#tinnitus.
Regards
Neil
I am having tinnitus due to ear infection or levaquin that was prescribed. Dr wants to change BP med from Lotenson Hctz to anangiotension ii inhibitor Benicar. It seems to have scarry side effects of its own. I sthere a safer angiotension ii inhibitor for my ears?
Hello doctor, I have been taking indapamide and felodipine for quite some time now. I am getting very concern as I can hear heart beat in my ears, especially when I am lying in bed. Also in the past my ear drum have been covered over in wax and the last time I went to my gp to have my ears syringed was around 4 years ago. Doctor I also have sinus. Doctor I would be great if you could come up with a solution of what this problem could be. I am age 60.
Kind regards
Cecille.
Hi Cecille:
Why don’t you go to the doctor and have any ear wax removed? At the very least, you should hear better if your eardrums are covered over with wax.
How long has it been that you’ve been able to hear your heartbeat in your ears?
What was going on in your life back at that time that may have started it? Any ideas?
Cordially,
Neil
Greetings: I am taking Carvedilol and think it might be causing tinnitus. To see if Carvedilol is the cause, how long would I need to top taking it to see if the tinnitus goes away? Thank you
Hi Lynn:
Carvedilol can indeed cause tinnitus, so your tinnitus could be from taking this drug. If you stop the drug for a couple of weeks, that should be enough time to see if your tinnitus goes away–or drops in volume.
There are no guarantees that your tinnitus will go away if you stop taking Carvedilol. It may or may not. That’s the nasty thing about drugs and tinnitus. Sometimes the tinnitus goes away completely. Sometimes it drops in volume, and sometimes it never goes away.
And even the time it takes to go away varies, but I think you should notice a definite difference in about 2 weeks (if it is going to go away or reduce in volume).
Cordially,
Neil
Greetings, I am taking 75mg of Losartan and 50 mg of Metoprorol Succinate currently. I have been experiencing ringing in my ears for the past 3 weeks and it is annoying me. Doctor insists I need to be on beta blocker due to my heart valve condition and aortic aneurysm. I have been taking Losartan (Cozaar) for the past 3 years. Doctor insists to take a beta blocker in addition as the high BP was not in control. Please advise on how to stop/reduce the ringing in ears.
Hi Zaki:
I’d get your doctor to switch you from the Metoprolol which is likely causing your tinnitus and put you on a different beta blocker. The least ototoxic in my opinion would be Celiprolol followed by Oxprenolol, Nadolol and Pindolol in that order. Hopefully when you get off the Metoprolol, your tinnitus will go away. It has done that for other people so you can be hopeful.
Cordially,
Neil
Thank you doctor. I will discuss with my doctor the medicines you suggested. Do any of these cause insomnia?
Another question – is Bystolic a good option? (that doesn’t cause tinnitus)
Hi Zaki:
Bystolic (Nebivolol) is also a reasonable choice–about the same as Pindolol in terms of ototoxicity.
It can cause tinnitus in a few people.
Cordially,
Neil
Does lorsatan worsen tinnitus?
Hi Nnamdi:
Hundreds of people have reported getting tinnitus or their existing tinnitus worsening from taking Losartan. So it could for you too.
Cordially,
Neil
Are any of these lessor ototoxic meds ok for compromised kindneys ? I have an appt with nephrologist soon to discuss options . I currently take 25 atenolol and seem to get ototoxic tinnitis spikes frim it. im worried it may be permanent it was 6 mo ago and think onset of tinitus was from taking a z-pac antibiotic. its seems to very – i think i need a ledsor ototoxic bp med.
Hi Jim:
I don’t know. I don’t get into that since I’m not a medical doctor. I just focus on ears. But I do know this–that any drugs that damage your kidneys, can also damage your ears. That’s not surprising since Chinese medicine says that your ears and kidneys are linked.
Ask your doctor about the “lesser” ototoxic drugs and see what he says. Maybe one will work for you and not damage kidneys.
Cordially,
Neil
Thank you Dr – your comment about the connection between ears and kidneys is spot on I think. when I got the tinitus they noticed my kidney GFR level was 60 and had fallen from a previous reading – i was on asprin a statin drug and was quickly taken off but have been slightly compromised – non the less I am very hypervigilant about my kidneys and meds effecting both now. Thank you
Does metoprolol cause ringing in the ears.
Hi Ron:
For numbers of people, yes–they get tinnitus from taking Metoprolol. The good news is that it seems the tinnitus is typically temporary while you are on the drug and stops several days after you stop taking it.
Cordially,
Neil
Hi Neil
Very interesting reading!
I had a TIA a few months ago and currenty prescribed:
Warfarin
simvastatin
losartan
I have noticed that my hearing ability is slightly reduced recently. Would any of my medicines be potentially causing this?
Hi Sharon:
Warfarin is not ototoxic as far as I know.
Simvastatin can cause tinnitus and balance problems (dizziness, vertigo, etc.).
Losartan also causes tinnitus and balance problems.
So as far as I know, none of the above are reported as causing hearing loss, but you never can be certain. There is always a chance.
I think you should look elsewhere for your hearing loss.
Cordially,
Neil
Hi Neil, between Valsartan and Irbesartan, which is less ototoxic?
Hi Zaki:
There is not much difference between them as regards ototoxicity, but if you had to choose, I think the edge would go to Irbesartan. I rate them both as Class 2 drugs.
Cordially,
Neil
Thanks Neil
Hi Neil,
Got tinnitus from being on 25mg of HCTZ for blood pressure which isn’t even listed as an ototoxic drug. Went off drug after four days of tinnitus but still have a ringing. The level was close to a 9/10 now about a 3. Will this ringing ever go away?
Hi Dorlene:
Correction. Actually, hydrochlorothiazide is ototoxic. It does cause tinnitus in some people, but you are correct, it is not listed in the current drug books as being ototoxic.
Since your tinnitus drop from a nine out of 10, to a three, that is a good sign. Hopefully over time, your tinnitus will continue to fade away. However, in order for this to happen, you need to habituate to your tinnitus.
This means that you totally and completely ignore your tinnitus and focus on the loves of your life. You also need to realize that tinnitus is not a threatening sound to you in any way. Thus, remain completely emotionally neutral to it. Treat it as you do the sounds your fridge makes. And like the sounds your fridge makes, it will fade into the background and you won’t even be aware of it. Hopefully, over time, it will completely disappear. However, even if it doesn’t it won’t bother you, and you will go for hours without even realizing you have tinnitus.
Cordially,
Neil
Hi Neil,
Diagnosed with HBP and was prescribed Valsartan. Within a week I started experiencing tinnitus, but kept taking it another 3 weeks until I could get in to see my md. She switched me to Losartan, and after a week, the tinnitus is worse! It’s becoming difficult to sleep or concentrate while awake. Is there anything less ototoxic in that class of drugs, or a different class I could try? I’m now having difficulty convincing both my primary physician and an ENT that the tinnitus is drug-related, yet I find it more than coincidence that it all started concurrently with the prescription. Should I try discontinuing it and see if it goes away in hopes of proving my point? Or can I expect it to ever go away (has the damage already been done?) I appreciate any guidance.
Hi Rhonda:
Valsartan and Losartan both can cause tinnitus. In fact, Losartan is a bit worse than Valsartan as you have, unfortunately, found out.
The sartan drug that seems to be the lowest risk for tinnitus is Irbesartan, so that is the one you could ask your doctor to switch you to. Eprosartan and Telmisartan are next in line.
Another thing to try is to reduce the dose such that it doesn’t cause tinnitus. For example, if you cut the dose in half and your tinnitus went away, and yet the drug still did the job, you could get the best of both worlds. Switching to the least ototoxic sartan drug AND cutting the dose would be even better. Run this concept by your doctor.
However, it may be that you are sensitive to all the sartan drugs and need to switch to a different class of medications to get your tinnitus under control.
If I were you, I’d dump the drug and see whether the tinnitus goes away. I’d give it a couple of weeks at least. That should prove to your doctors whether it IS drug-related or not.
It’s always hard to predict whether your tinnitus will go away or not. Thus, the best thing is to try stopping the drugs and see. Unfortunately, tinnitus can take on a life of its own and keep on going even after you stop taking the drug. This is probably mostly due to the person’s emotional make-up. If you worry about your tinnitus and focus on it, this can happen. So you want to ignore your tinnitus as much as possible.
Cordially,
Neil
Hello Dr. Neil,
I was recently put on Losartan 25mg QD for HTN and now am suffering from unilateral pulsatile tennitis. Could this be a side effect of the Losartan? Or should I be looking for other causes? Any input on this would be greatly appreciated.
Hi Stacy:
Losartan does not cause pulsatile tinnitus as such. Rather, pulsatile tinnitus is related to turbulent blood flow in the arteries near your ears. This is likely a result of your high blood pressure. The blood has to flow faster through constricted arteries and blood, like water, when it flows fast, becomes turbulent. You hear this turbulence as pulsatile tinnitus.
You may have noticed the pulsatile tinnitus coincidentally with your taking the Losartan–thus thinking the two were related. This is one possibility. But they may indeed be related. Perhaps taking the Losartan relaxed your blood vessels enough that more blood could flow and this extra blood flow caused the turbulence you now hear.
You need to work with your vascular doctor to get your hypertension under control and your arteries “cleaned out” so blood can flow normally. When you do this, your pulsatile tinnitus will likely fade away on its own.
This is the most likely scenario. However, there are a number of other causes of pulsatile tinnitus. If you are interested, you can read about them in my new tinnitus book, “Take Control of Your Tinnitus“.
Cordially,
Neil
Hello, I have been experiencing pulsatile tinnitus for about two years however I didn’t know what it was until recently I am on clonidine .02mg 2x a day and it makes the pulsatile tinnitus less frequent but still happens and I’m really concerned what are your thoughts on that?
Hi Andraya:
I can see why Clonidine can make your pulsatile tinnitus be less frequent. This is because it lets your blood vessels relax so the blood flows slower and thus is less turbulent–and thus doesn’t make as much noise–so you don’t hear it as pulsatile as often.
I’d run it by a good vascular surgeon if you are worried about your pulsatile tinnitus. See if he can find the cause. Depending on the cause, sometimes surgery is the answer. But at least you’ll know what is causing it.
Cordially,
Neil
Hi Neil, concerning Losartan/pulsatile tinnitus: Feb 2017 I started .25mg Losartan and in a few weeks noticed the intermittent unilateral pulsatile on top of my very very very bad since 1986 tinnitus. The Dr said hardening of arteries is the cause of hearing my pulse. Feb of 2018 I have had enough and even took alprazolam to relax if possible. Now that I have researched a little and stopped the Losartan – 24 hrs 50% less pulsatile, 5 days later near minimal. Having extreme tinnitus on one side, lighter amount on the other side, having an extreme hobby of playing classical and other guitar music – I am concerned on which med to suggest next? Thanks in advance for your answers on this page!
Hi Terry:
Interesting how your pulsatile tinnitus went away when you discontinued the Losartan. Obviously it caused your blood to flow faster and become more turbulent which you then heard as pulsatile tinnitus.
You should get/read my special report, “The Relative Ototoxicity of Anti-Hypertensive Drugs”. You can get it through the link at the end of my article at http://hearinglosshelp.com/blog/which-are-the-least-ototoxic-beta-blockers/ . It gives you many of the answers you are looking for.
Cordially,
Neil
i’m using carvedilol,simvastatin,lisinopril and 81 mg aspirin. Also 2 or 3 times per year i use amoxicillin prior to dental appt. can these cause my tinnitus and if so why do you think i was not informed about this when i had my hearing tested and was told that i had tinnitus.
Hi Robert:
Carvedilol does cause tinnitus in some people. So does Lisinopril. So does Amoxicillin. Unless you are particularly sensitive to aspirin, one 81 mg of aspirin a day shouldn’t bother your tinnitus.
Typically, doctors don’t know much about tinnitus, and don’t believe the drugs they prescribe cause tinnitus, so they don’t mention that fact when giving you prescriptions.
But your tinnitus could be caused by many things apart from drugs. For example, the most common cause is exposing your ears to loud sounds. Tinnitus is also associated with any degree of hearing loss. Why do you think that one of those drugs is the culprit?
Cordially,
Neil
Very informative, I have acute tinnitus. Have an appointment next week with my nepthrologist next week, will discuss these drugs with him. Thank you!
Hi Neil! Great website.
I have had tinnitus for a number of years, ever since childhood due to many bouts of glue ear and the amount of scarring in my ears. But since being prescribed bisoprolol for irregular heart beat (and secondary for migraines) I sense that the tinnitus is getting worse and at a different and lower frequency. I am also on long term rivaroxiban which i do not think is tinnitus causing. Is there a non ototoxic beta blocker that can help with the heartbeat and migraines without potentially making my tinnitus worse?
Hi James:
I don’t know of any totally non-ototoxic beta blockers, but some of them are much less ototoxic than others. Bisoprolol happens to be one of the more ototoxic ones.
The least ototoxic beta-blockers beginning with the least otototxic in my opinion is Levobunolol, Dilevalol, Celiprolol, Nadolol, Oxprenolol, Labetalol, Nebivolol.
I don’t have a clue if any of these will work for you, but you can take this list to you doctor and see what he says. The first one on the list is the only one that doesn’t have tinnitus listed. All the others do, but it is typically not very common. If you have to take a beta blocker, these would be my choices based solely on their ototoxic properties. You have to consider ALL the side effects, not just the ototoxic side effects.
Cordially,
Neil
Dr Neil,
Unless i missed it, I could not see the juris on ototoxicity of Telmisartan ….
I am yet to begin, Bp drugs but having sever tinitus for many years. Now prescribed telmisartan …. ?
thanks
Hi Arun:
Telmisartan, like other drugs in this class, is somewhat ototoxic. It can cause tinnitus in some people as well as dizziness, vertigo, and ear pain. I rate it a class 2 out of 5, so that is still mildly ototoxic. You can try it–just keep and eye out for these side effects. You may not experience any of them, especially if the dose is lower.
Cordially,
Neil
Hello I have been on metoprolol 25 mg for 2 years now I have tinnitus don’t know what did it , I also had a sinus infection around that time and I would listen to music on my tablet which was loud but maybe listen to it not that often , my ent says some hearing lost on the high frequency side. Could it be the the metropolo but after 2 years is it to late
Hi Ron:
If your tinnitus was caused by the Metoprolol, I have sort of good news for you. Numbers of people have gotten tinnitus from taking Metoprolol–sometimes it starts right away and other times it is delayed by several months. When people stop taking this drug, for numbers of them, their tinnitus reduces in volume or goes away. That’s the good news part. Unfortunately, for some their tinnitus stays the same volume and never goes away.
Now, your tinnitus could have been caused by the Metoprolol, or it could have been caused by the loud noise exposure your ears have had, or it could have been the result of your high frequency hearing loss, or it could have been caused by the cold virus that gave you the sinus infection. There are several possibilities and one or more of them could have been the cause.
Cordially,
Neil
Hello Neil,
I have had a huge spike in my tinnitus one month ago which hasnt lessened after taking propranolol and mirtzapine for just one week. What in your opinion out of these two drugs caused the problem and will it decrease in time as I stopped both immediately after one week. Thank you very much.
Hi John:
My money is on the Mirtazepine for causing your tinnitus. Propranolol also causes tinnitus, but Mirtazepine is probably the more likely culprit. Or it could have been a synergistic effect of taking both drugs at the same time.
Cordially,
Neil
Just read that propranolol and Mirtazepine can cause tinnitus! these are the 2 drugs I am taking, the mirt is for sleeping because of the tinnitus, I give up with these doctors. My tinnitus has increased to unbearable levels since I had 3 teeth extracted at the front and now have a denture. I have been checked for TMJ and apparently have not got that. Any thoughts on my theory that the teeth extraction caused my Tinnitus to rise and what I can do about it Thanks Christine
Mirtazepine causes tinnitus in some people, but it seems to cause hearing loss in a lot more than what get tinnitus from it. It also causes a host of balance problems.
Propranolol also causes tinnitus in numbers of people, not to mention weird hearing problems.
I’ve had numbers of people tell me that dental work, especially on upper molars, has resulted in bad tinnitus. So I wouldn’t be surprised if you are a victim of this too.
Cordially,
Neil
Thank you Neil, I,m still suffering, I now have hypertension and am taking one of the drugs you recommend. I think maybe my high bp has caused my T to worsen.
Hi dr.Neil….I have taken benicar and recently Diovon …both gave tintinitis….occasional I use nitrostat ….they all on ur list…so please suggest any calcium blocker safe for me…thanks….Ghulam
Hi Ghulam:
I don’t know of any Calcium Channel Blocker that aren’t ototoxic in any way. So the best I can do is tell you the drugs in this class that have the lowest risk of getting tinnitus. In descending order from least ototoxic to more ototoxic, the top 5 are: Lacidipine, Lercanidipine, Isradipine, Nitrendipine and Nilvadipine.
Cordially,
Neil
I am so confused. You repeatedly list countless different drugs in different orders and then later half of them turn out to cause the g.d. tinnitus. It seems very hopeless.
Which do NOT cause tinnitus?
Levobunolol appears to only exist in ophthalmic drops for glaucoma. Not sure why you list it for blood pressure.
Hi Lisa:
You’re not the only one that is confused. Let me explain.
Almost all drugs doctors use in the treatment of high blood pressure can cause tinnitus. That doesn’t mean they will cause tinnitus in every person taking them–but some people do get tinnitus as a result. Thus, you want to lower your risk, by taking the drug that has the least chance of giving you tinnitus.
As I pointed out in this article, I only list the drugs that are known to cause tinnitus (or any other ototoxic side effect), not the ones that do not cause any side effects. And as time goes on, I sometimes find that drugs I thought were not ototoxic now are listed as being ototoxic. So even if I don’t list a drug as being ototoxic now, it still might be ototoxic. That is why I don’t say which drugs are not ototoxic. Sometimes I say, “This drug is not listed as causing tinnitus as far as I know, but there are no guarantees.”
That is why you need to get my book “Ototoxic Drugs Exposed” and see how high the risk is for any given drug in relationship to any given ototoxic side effect and then suggest to your doctor those that have a risk low enough that you want to try them.
The reason that Levobunolol (or any other drugs) that seem to appear in a “blood pressure” (or other list) is simply this. I do not list drugs by their usage, but by their chemical composition class. This is because drugs of similar chemical composition often have similar ototoxic side effects. Thus, all the drugs that end in “olol” are lumped together because they are beta-adrenergic blocking drugs. I name the class by the MAJOR use doctors commonly prescribe these drugs for–in this case high blood pressure.
Some drugs are prescribed for several different uses–but I list them in just one place. You see, doctors are free to prescribe any drug for any use they want. Thus a doctor, if he wanted to, could prescribe Levobunolol for ingrown toenails–but because it still ends in “olol”, it will always show up in my book in the Beta-blocker class.
Doctors prescribe other drugs for high blood pressure too. For example, ACE inhibitors (angiotensin-converting enzyme drugs) are often used for high-blood pressure. All the ACE inhibitors end in “april” or “ipril” and thus are lumped together in this class–even though they me also be used for other conditions.
Cordially,
Neil
I’m so relieved that I found this resource! I developed tinnitus after being on 3 different blood pressure meds that all were listed in your book as causing tinnitus. My doctor did not know which blood pressure meds do not cause tinnitus, and that is when I found your book. Now I have hope that I can find a blood pressure med that works without causing ear damage. Thank you!
Hi Kyley:
You probably won’t find one that is totally non-ototoxic, but you can certainly put the odds in your favor by choosing the least ototoxic drug in its class.
Cordially,
Neil
Hello Dr. Bauman.
I am doctor who has tinnitus since a month. I am on Cellcept (mycophenolate mofetil) for 5 years and quinapril due to kidney related problems. What is your feeling about these medications? I think that Cellcept is ototoxic while quinapril is less.
Hi Yannis:
I agree with you. I don’t have any listings for Quinapril showing it causes hearing loss (but it might–who knows), but Cellcept is listed as causing hearing loss in 3% of the people taking it–and that figure is probably low since not everyone reporting hearing loss links it to the CellCept they are taking.
At the same time, realize that if you have kidney problems you can also have hearing problems. These two organs are somehow related. It could be the drugs used to treat kidney problems are also ototoxic to the ears, or if the kidneys don’t filter out drugs in the bloodstream the way they used to, blood concentrations of such drugs could rise to ototoxic levels. So there are several possibilities.
Cordially,
Neil
Many Thanks Neil! These are exactly my concerns as well.
I have been on amlodipine 5mg for three years for mild HBP w no side effects until recently —I went on a plant-based diet. Lost weight but BP went down but woke up w Tinnitus high pitched both ears along w fullness. Went to ENT who saw Nothing structurally off at all. GP said get off the BP because of success re weight loss but ringing continues. Mostly when I wake up. Comes and goes. Could it be the Amlodipine even if off it?
Hi JB:
Yes, some people have permanent tinnitus even after they stop the Amlodipine for months. Others find their tinnitus drops in volume but still persists and still others finds their tinnitus goes away. So yours seems to have dropped in volume and is intermittent, but has not gone completely away. If it doesn’t really bother you, just ignore it and hopefully it will fade away in time.
Cordially,
Neil
Hi Dr Neil I got Bp almost 10 years back, that time Dr prescribed me Aten 50mg after 3 months I got the tinnitus, I didn’t know that time that these medicines can cause tinnitus, after change to many anti Bp medicine, at the moment I am taking losartan 50mg. I had consult many ENT Dr they said my ears are perfect and my dizziness also not related to ears. I feels
Tinnitus in the head. After so many years I am use to it, but due to this I got so many other problems, like anxiety, panic
Attacks because I lost my sleep after I got tinnitus. I will be highly thankfull if u
Have any advise for me.
Hi Baig:
Right, Atenolol can cause tinnitus. So can almost every other drug used for reducing blood pressure. Note, I said “can” and not “will”. It will cause tinnitus/make tinnitus worse for some people and not for others. You need to find a drug that won’t affect your tinnitus and yet will control your blood pressure.
I disagree with your doctor about your dizziness. It CAN be caused by the drugs you are taking–either by messing up your balance system, or by reducing your blood pressure so much you feel faint (orthostatic dizziness).
You need to learn how to successfully deal with your tinnitus. I devote several chapters in my tinnitus book to this topic. You would do well to read it. You can get a copy at http://hearinglosshelp.com/shop/take-control-of-your-tinnitus-heres-how/ .
Cordially,
Neil
Hello Dr Neil.
I have been taking Lisinopril for 1 year,and have developed a dry cough. My Dr changed me last week to Losartan, but I had a couple of reactions to it,so I can’t take it. It looks like it might be a good thing,as I see on here it can worsen tinnitus. I developed tinnitus after getting out of the hospital with knee relplacement. It was almost 10 months ago. My tinnitus went from a high screeching in both ears to a low hiss in one ear,and I can go days without even hearing anything,so hopefully it might go away. So,with that being said,i try not to take meds that are ototoxic. My Dr knows my story,and I thought he wouldn’t put me on meds that could worsen it ,but he did(with the Losartan) I have to go back to him next week to get a different Bp med,so my question is,what is the least ototoxic bp med for someone who has a high sensitivity to meds? I have had reactions to a lot of meds,so I am scared to try a lot of things. I don’t take any more meds,and I don’t have other medical conditions. Your help would be greatly appreciated Thank you.
Hi Cathy:
Some drugs do indeed cause a constant cough–so it was good you got off the Lisinopril.
Your tinnitus could have been the result of the antibiotics you were given for your knee surgery. It looks like your tinnitus is fading away and you are on the right track with it.
Your doctor doesn’t “put you on” drugs. He just prescribes them. It is YOU that CHOOSE to take them or not. When my doctor prescribes a drug I don’t like, I tell him I refuse to take that drug as it is dangerous to my health and to come up with another one, often in a different class of drugs. For example, he wanted me to take a fluoroquinolone drug, but I refused. He then suggested a cephalosporin class drug which is a much safer class of drugs–and it did the trick.
I can’t answer your question directly. First, I need to know what class of blood pressure drugs he is considering such as alpha blockers or beta blockers or ACE inhibitors or calcium channel blockers, etc. If I know which class of drugs you are talking about, I can then tell you which ones are the least ototoxic in that class.
Cordially,
Neil
Thank you for answering Neil. Since the Lisinopril made me cough I know it won’t be an ACE inhibitor. I was taking 5mg of Lisinopril a day,and it was working until the cough started. I just don’t want him to try me on so many different ones that might damage my hearing. I’m assuming he’ll try another ARB. I can’t take diuretics either , even HCTZ, makes mine worse. I just wanted to go in with a good idea of what not to take. Thank you
Hi Cathy:
All the Angiotensin-2-Receptor blockers (ARBs) can cause tinnitus in some people. So they is going to be a risk of tinnitus no matter which one you take. Furthermore, studies on some of these drugs (Olemsartan for example) have shown that people taking it get more heart attacks than people with high blood pressure that do not take it. So I don’t see any benefit of taking this class of drugs.
If you don’t want tinnitus, don’t take any drugs. More than 550 drugs are associated with tinnitus. Why not go to a naturopathic doctor (ND) and learn how to control your blood pressure naturally? Then you won’t have to take any drugs.
Cordially,
Neil
Thank you Dr Neil. I will definitely not take any drugs in the ARB category. I’ve tried to control it naturally,but it won’t work. I do not eat salt or sugar. I have gave up red meat and haven’t ate pork in years. I only drink water,and have lost 6 lbs in the past week. I’m trying to bring it down,but for now it’s running around 160/90. I’m going to keep on working on it,and maybe one day in the near future,it will go down. Thank you for your help.
Hello Dr. Neil. Have been experiencing Tinnitus in my head for past 2 months. All tests are normal. Switched to Diovan 160 for BP and Tulip 10 for cholesterol one year ago. Could these medications be the cause of the constanst hissing sound in the head.
Hi Vish:
Both Valsartan (Diovan) and Atorvastatin (Tulip) could have caused your tinnitus, but my guess that of the two, the more likely culprit would be the Atorvastatin.
Cordially,
Neil
Hi Dr. Bauman
I’ve been taking Renitec 5 mg for almost 20 years which was replaced with ENAP 5mg. Have tinnitus in the left ear for more than a year now. It developed some time after I started using ENAP although this is the generic for Renitec. Can it be the ENAP that caused the tinnitus?
Hi Karen:
I suppose it is always possible, but personally, I doubt it. Was there anything else that changed in your life a year ago that might be the cause of your tinnitus?
Cordially,
Neil
Hi Doc,
I was taking amlodipine and the high pitched tone in my left ear started and in the past one and a half month it grew with intensity. My GP changed to lisinopril only 4 days ago but the tone is still there, will it go away eventually or its still the meds issue?
Hi Jas:
Amlodipine is well known for causing tinnitus. Lisinopril can also cause tinnitus but not us often as with Amlodipine. It may take at least a couple of weeks before your tinnitus goes away if your tinnitus was caused by the Amlodipine. But there are no guarantees that it will ever go away.
Cordially,
Neil
Just curious – Are you aware of any lawsuits against the companies which manufacture these ototixic medications?
Hi Cathy:
No, I’m not. And I don’t expect any to be successful any time soon if such casses exist as the drug companies have very deep pockets so can hire the smartest lawyers. Furthermore, where are you going to find doctors to testify against the drug companies? If they do, they’ll more likely than not be blackballed. And they’ll be incriminating themselves in the process since it is doctors that prescribe these very drugs.
Cordially,
Neil
Hi – I started getting tinnitus about 3 months ago. I had no idea that my medications could be causing it. I have been taking lisnopril for about a year and propranolol & citalopram for about 8 years. Is it possible that the delayed tinnitus be caused by these medications?
Thank you so much!
Hi Katie:
All three of these drugs can cause tinnitus, but Citalopram is by far the worst as regarding tinnitus. Of all the reports I’ve had on Citalopram, tinnitus seems to start in the few days after beginning this drug. I don’t have reports of tinnitus starting eight years later. (There are a few drugs that can do this though.)
So, to answer your question, it may be possible that any one of these drugs, or a combination of them has caused this delayed tinnitus. However, it seems unlikely that this is the cause of your current tinnitus.
Cordially,
Neil
Hi Neil, Another comment from me, I have realised that my tinnitus may have started when I started on Statins, years ago. Any thoughts on Statins and tinnitus, I also have pulsatile tinnitus and my BP is a bit high ,
Regards Christine Wright
Hi Christine:
Some of the statins do indeed cause tinnitus in good numbers of people. Others are not reported to cause tinnitus. Two of the bad ones are Atorvastatin, Rosuvastatin and Simvastatin in that order.
Cordially,
Neil
I have been taking Amlodipine 5 mg and Metoprolol Succinate 50 mg for some years now and the tinnitus is getting almost unbearable– what suggestions would you make for me to ask my Dr? Thank you-Lillian
Hi Lillian:
I’d ask your doctor to change your prescriptions to drugs in these classes that are less ototoxic in relation to tinnitus. For example, maybe he could substitute Bepridil, or Nilvadipine, or Nimodipine or Nitrendipine in that order for the Amlodipine. All of these are easier on your ears than Amlodipine if they will do the job.
In like manner, perhaps he could substitute Levobunolol or Celiprolol or Dilevalol or Nadolol or Oxprenolol in that order for the Metoprolol. Again, all of these are easier on your ears than Metoprolol.
There is no guarantee that doing this will make your tinnitus go away, or even reducing volume, because your tinnitus from these drugs may prove to be permanent. However, if your tinnitus is not permanent, you should notice a change in the volume of your tinnitus. So if you have to be on beta-blockers and calcium channel blockers, it’s worth a try.
Cordially,
Neil
I just found these posts. Tinnitis is driving me nuts. I just fealised that the tinnitis started after i was put on APO Telmisartin 40mg. I had thought it could have been tonsilitis that caused it. Tonsilitis was what sent me to Dr in the first place. He took my blood pressure, it was high so he started me on the Telmisartin. I just didnt relate the two.
Hi Sue:
Telmisartan can indeed cause tinnitus in some people. The good news is that if you get off this drug, your tinnitus has a good chance of going away, so I’d ask your doctor to change your medication as soon as possible.
Cordially,
Neil
I totally agree about tinnitus starting very soon after beginning citolopram. I had not been on any drugs until a severe panic attack changed that..and I was 62 years old..I never had tinnitus before that..I was on 25mg for 5 1/2 years..now take metoprolol and diazide water pill and have started tinnitus in both ears..makes me depressed.
Hi…I have always had some ringing in my ears, but it is much worse now. I have loud ringing and I dry cough. I recently started taking Verapamil. Could that cause it? It is quite annoying.
I was also taking Crestor, and thought that was the culprit, but I stopped taking it (though I have beem prescribed a smaller dose to resume taking it).
Hi Carlene:
Numbers of people get tinnitus from taking Verapamil. Sounds like you are one of the “lucky” ones. Some drugs also cause a persistent cough. If you stop taking this drug and your dry cough goes away, then you’ll know this drug was the culprit.
Rosuvastatin (Crestor) also causes tinnitus in numbers of people. So it could also have been the cause of your tinnitus.
Cordially,
Neil
Thanks….never took anything until now. I have upped my activity (even more) and tightened my diet. My triglycerides are 39, and LDLs 111. But they want them lower due to family history. If/when that happens no more crestor!
But since my psvts were frequent with bpm over 200 and near fainting, its either some meds or ablation. We’ll see…
Thanks…
On Ramipril 5 mg for ten years. Had stent 1 1/2 yrs ago. Put on Metoprolol 25 mg. lowered to 12.5 five mo ago. ramipril lowered to 2.5 seven wks ago. Tinnitus for several months. Now small amount of virtigo especial when lying down. Been to ENT nothing but small amount of high pitched sound loss. All doctors say I take to low a dose to have effect. Any suggestions where to go now.
Forgot to mention that I am hypothyroid. Was on .125 mcg until two weeks ago and Levothyroxine was lowered to .112 mcg. Actual vertigo systems started around same time but already had the tinnitus.
Thanks
Hi Darlene:
Ramipril can result in hearing loss, tinnitus, ataxia, dizziness and vertigo. These side effects can be temporary in some people while you are on the drug.
Metoprolol is much more ototoxic than Ramipril and causes the above side effects plus even more.
I wouldn’t believe your doctors when they tell you that you are on too low a dose to have any ototoxic side effects. The point is that you ARE having ototoxic side effects.
The way I explain it is that each person has a “magic threshold”. Below that level you don’t have any obvious side effects. Above that level–bam–there they are.
I call it a “magic threshold” because neither you, nor your doctors, know exactly where it is. It can be different for everyone. For example, you may have a very low “magic threshold” so even though many people might not get the side effects at your dose (because they have a higher threshold), you get them because of your low threshold.
My suggestion would be to dump the Metoprolol (with your doctors permission of course) and see how your ears respond. The good news is that ototoxic side effects from taking Metoprolol may be temporary and go away in a few days after stopping taking this drug.
Cordially,
Neil
Hi, I’ve had tinnitus for 20 years now and am appaled by the lack knowledge by our general practitioners and pharmacists concerning drug side effects on Tinnitus. Why do I have to be the one that has to check such things and inform my doctor?
Anyways, sorry about the rant…
I suffer from deep depression and was prescribed Prozac last year, a couple of days later my tinnius shot up and I stopped taking it but my has been louder ever since.
Now my doctor has prescribed me Act Diltiazem 120mg (Cardizem I believe) for my blood pressure.
Kinda scared to take it. Any suggestions?
Thank you
Robert
Hi Robert:
So many hundreds of drugs can cause tinnitus. You would have been far better off if you had taken St. John’s Wort for your depression rather than taking Prozac. At least you wouldn’t have gotten tinnitus.
Diltiazem (Cardizem) can cause tinnitus in some people–but I think it is a relatively low risk, so it may be worth risking it and see. The good news seems to be that any resulting tinnitus is temporary. If it causes louder tinnitus, it may go away about 2 weeks after you stop taking it. Of course there are no guarantees–so you need to decide whether you are prepared to risk it or not.
Cordially,
Neil
Post aortic dissection I took Metoprolol, Clonidine and Nefedipine without a problem. All of a sudden out of nowhere I developed bad tinnitus. My doctor has been next to useless in solving the problem.
I’ve determined my tolerance for Metoprolol is 150mg per day. I determined. London to be a problem. I determined Nefedipine to be a problem.
Lisinopril caused a horrible cough. Hydrochlorothiazide, Omeprazol caused horrible tinnitus. 80mg of Valsartan was fine. 160mg has caused the worst tinnitus I’ve experienced.
I’ve tried all natural cures. They work short term. They stopped working. At one point I was taking Jarrows Pressure Optimizer and my original mess about every three to five days has needed when my BP exceeded 140/90. Then it stopped working altogether.
I’ve gone through twenty months of hell off an on. As each attempt at a solution fails there’s a point where stress and anxiety take over driving up my BP even more. Every few months I have to head for the ER with BP higher than 200/100.
Now my doctor wants me on anti depressant. Great! More chemicals to solve a problem caused by chemicals. I refused.
I’m desperately in search of medication to help my BP without causing tinnitus. My quality of life has decreased considerably due to tinnitus. Right now I haven’t slept more than two or three hours for nine straight nights. I’m at the point where I’m considering dumping all medicines and having one peaceful last year of my life.
I’ve gone through this board and made a list of every BP medication listed over the past five years to be less of a problem. What are the best choices for 2017?
Note: I’ve been checked every way possible by one of the best ear specialist hospitals in the country to determine I don’t have structural tinnitus.
Blasting loud music loud rock with guitar and high singing voices or loud classical with violins) or loud crashing waves noises into my ears tones down the tinnitus for an hour or two. But I’m guessing it’s bad for my ears structurally.
Hi Warren:
Blasting your ears is bad for your ears and I’m surprised that it tones down the tinnitus. I’d expect it to make your tinnitus worse.
If you want to take an antidepressant, why not try St. John’s Wort. It works as well as prescription antidepressants but it is not ototoxic. If you choose to take it, just make sure that it says “standardized” on the bottle so you know what you are getting. Then it should say what the active ingredient (hypericin) is standardized to–and that figure should be somewhere between 0.3 and 0.7%
St. John’s Wort works for numbers of people–including my wife.
What is the cause of your high blood pressure? I’m of the persuasion that you need to treat the cause, not the effect. Blood pressure medications only treat the effect and never get to the cause. You need to find a health care professional that actually roots out the cause and shows you how to get and keep your blood pressure under control.
Cordially,
Neil
Hi Neil, I recently developed some freqwency tones in my head wich started during exams. Fiew weeks back. 3-4 weeks back. Consulted my doc,he referred me to a ENT specialist. The specialist confirmed theres nothing wrong with my ears,and that its perfectly healthy.Said that the freqwency or Tinitus is cause by Stress,anxiety and Tension,and that I should not worry about it. I did some research on the drugs Im taking, and encountered that atenelol was ototoxic. Tried to stop taking it under doc supervision,the freqwency toned down,but on day 3-4 my bloodpresure shoots up again,causing me to take the atenelol.Right now Im on Co-Tareg80 (Valsartan/hydrochlorothiazide). Im trying to go without the Etenalol,but if im reading correct,Valsartan will give the same effect. Do you have any advice?
Hi Ben:
I think your tinnitus was the result of the drugs you are taking and the added stress of your exams.
Atenolol can certainly cause tinnitus and does so in numbers of people so it is probably a good drug for you to stay away from in the future.
Valsartan also causes tinnitus in numbers of people, Hydrochlorothiazide not so much.
if you want to continue taking a beta blocker that is in the same class as Atenolol, you might want to try taking Celiprolol or Levobunolol or Nadolol or Oxprenolol as these are not as likely to cause tinnitus as other beta-blockers do. see what your doctor says.
Cordially,
Neil
Hi Neil, Thank you very much for your response, I appreciate advice. I did make a turn at the doc and told him about drugs and Tinitus. The Valsartan made the Tinitus a bit loader to the point where I had to use betapam(diazepam) to get some sleep in, amazingly when I woke up,the Tinitus was toned down alot. I whent back to the doc and took some advice from one of the comments you answerd that Catopril is least ototoxic. So Im on Captopril now. The volume of the Tinitus is way lower then b4 on the Captopril. Its been a week since leaving Atenelol,the volume tuned down alot but the screetching sometimes get the better of me. Am I to hasty for it to fade away? Or isit the ototoxity of the Captopril thats keeping it a constent low toned screetching pitch?
Hello. I have sensory peripheral neuropathy and have recently discontinued Lyrica and Bystolic . My bilateral tinnitus improved dramatically after stopping these medications. I now take 20mg of Nortriptyline for neuropathy. I started Amlodipine 2.5 mg this morning and already have a significant increase in tinnitus. I see the cardiologist tomorrow. What do you think would be a good substitute for Amlodipine. ( A recent 24hr test is normal with the exception of increased total volume. GFR is low at 50.50 Serum Creatinine is normal). Thank you very much.
Hi Helen:
I’m sure the Pregabalin (Lyrica) was the main culprit. I wouldn’t have expected the Nebivolol (Bystolic) to make your tinnitus that bad, but it is also ototoxic to some degree. You may find that you can go back on the Bystolic without any problems.
Nortriptyline can cause tinnitus in some people, but it seems you are ok with this drug at this dose–at least so far.
Amlodipine is another likely culprit for your increasing tinnitus so you are wise to get off it. See if you doctor thinks that the Bystolic will do the job and substitute it and see whether your tinnitus reacts to it or not.
Cordially,
Neil
Dr. Bauman,
Thank you for the advice. My Cardiologist agreed, and I will give the Bystolic another try. If the Bystolic does exacerbate the tinnitus what would be a good substitute? Also, is there a substitute for Nortriptyline and Simvastatin that is less likely to cause tinnitus? The Cardiologist seems open to suggestions. Thank you.
Dr. Bauman,
I have been on Benazapril HCTZ for hypertension, but requested Benazapril w/o HTCZ because my blood sugar level was elevated to pre-diabetic levels with the HCTZ. The switch brought my blood sugar level back to normal. But, since i experienced a little bit of a dry cough, the doc switched me to Losartan some months back. Again, my blood sugar level is elevated and I am experiencing tinnitus constantly, though I can ignore it most of the time. I had tingling in one of my feet for awhile, but that seems to have gone away. I am also not beginning to experience a dry cough and some weight gain. I am beginning to think I should go back to the Benazapril and deal with the cough.
I should have added that I discovered that Losartan has HCTZ in it, thus, the elvated blood sugar level. Also, my first note should say i AM beginning to experience a dry cough on Losartan, too.
Thoughts?
Thank you.
Hi TL:
To answer your last question first. Losartan is a generic drug and is just Losartan. The brand drug Hyzaar is a combination of Losartan and Hydrochlorothiazide. The brand name Cozaar is just Losartan. Don’t confuse Cozaar and Hyzaar.
Some classes of drugs do indeed produce a dry cough as a side effect. In any case, Benazepril has a moderate risk of giving you tinnitus and hearing loss. If you want to stay on this class of drugs, the drugs with the lowest risk of causing tinnitus are in this order from least to worst are Imidapril, Cilazapril, Moexipril, Trandolapril and Perindopril. I rate all those as low risk.
If you want to stay with e ARB drugs in the same class as Losartan–which incidentally–has the second highest risk of ototoxicity of the drugs in this class, you might want to consider Eprosartan which has a very low risk, or Telmisartan which has a moderate risk.
Cordially,
Neil
Hello! I am 37 years old about 7 or so years ago I started having pulsatile tinnitus but only when I would lay my head down on a pillow. Went to an ENT about 3 years ago. Normal hearing test and CT. Fast forward to now. My pulsatile tinnitus has been much better but I started having high blood pressure. Went to cardiologist and had a normal stress test and echocardiogram and have been put on Bystolic. 2 weeks after starting my tinnitus is all the time. Every time my heart rate is up or randomly when I’m doing nothing. I have very bad medical anxiety and can’t figure out if this is something serious
Hi Mandi:
Nebivolol (Bystolic) can cause tinnitus in a few people, however, in your case, I don’t think it is the culprit. It is more likely, since you have pulsatile tinnitus, that your high blood pressure is the culprit. The proof of this is that when your heart rate is up you hear it. It wouldn’t work this way if it were the Bystolic.
I’d talk to a vascular surgeon about your pulsatile tinnitus. Then you’ll be able to set your mind at ease.
Cordially,
Neil
Thanks for your reply. I read some horror stories on the internet about tumors and all kinds of things that make me very anxious
Hi Mandi:
There are a number of things that can cause pulsatile tinnitus. One is a glomus tumor. That is just actually a mess of blood vessels that grow near your ear and you hear the blood flowing through it. This is not a cancerous tumor. So you don’t have to be afraid of it in that respect.
Cordially,
Neil
Hello,
I’m a 44 year old male who has had tinnitus for about 6 years. It’s constant, but the pitch and volume varies from hardly noticeable to constantly noticeable (I’ve found sound therapy helps in that case). I’ve found things like allergies and colds make it worse
Anyway the past 3 months it’s been in the barely noticeable stage. I had noticed my blood pressure recently was frequently high in the evenings (over 140/90), so my doctor prescribed 10 mg Lisinopril. He mentioned it could cause a cough. It didn’t, but less than an hour after taking the pill in the morning, my tinnitus went from “good” to “bad” and it’s been like that all day. That’s not to mention the dizziness it caused. I see you mention that Lisinopril is known to cause tinnitus, but is it really possible to make tinnitus worse that quickly?
This is very similar to my experience with Verapamil which another doctor put me on for PVCs last year, but I took myself off of after a week because it too made my tinnitus worse. It took a week or two to go back to “normal” after going off.
Because of the PVCs, my measured pulse can be quite low (37), so any medication which lowers the pulse is a bad thing for me to take.
Is there a category of drugs which would work for me, helping both blood pressure without lowering heart rate or making my tinnitus worse?
Hi Michael:
Lisinopril and Verapamil are two different classes of drugs and both can cause tinnitus in some people. Obviously you are on of those “lucky” people.
Some drugs can cause tinnitus within minutes of taking them. Others can take years. So the speed at which you begin to hear tinnitus can vary all over the place.
You can try to avoid tinnitus by putting the odds in your favor and try drugs that are the least ototoxic in any given class of anti-hypertensive drugs.
A good place to start is to get/read my special report, “The Relative Ototoxicity of Anti-Hypertensive Drugs”. You can get it through the link at the end of my article at http://hearinglosshelp.com/blog/which-are-the-least-ototoxic-beta-blockers/ . It gives you some of the answers you are looking for.
Cordially,
Neil
Hello. I am a 47 years old female, and three months ago I was diagnosed with high blood pressure, I am now taking concor cor 5, crestor 10, aspirin, and seroxat.
Few days after starting the treatment I started having pulsatile tinnitus in my left ear, which stops if I press on the back of my neck. It’s getting worse. My ENT did a hearing test and ear pressure and they were normal. Then an MRI which was also normal.
I know it’s possibly from the blood pressure but it is continuous 24/7 even if my blood pressure is normal or below normal (it sometimes drops to 90/60).
I pushed on my doctor to change the concor, so he changed it to seloken zoc and stopped all other meds except the seroxat. But there is no change.
Can you please let me know what to do as this is so annoying.
Hi Mona:
Did your doctor prescribe all four drugs–Bisoprolol (Concor), Rosuvastatin (Crestor), Acetylsalicylic Acid (Aspirin) and Paroxetine (Seroxat) all at exactly the same time? And then a few days later you get this pulsatile tinnitus?
If so, if you stop taking all four of these drugs for a week or so, will the pulsatile tinnitus go away? If it does, you know it is one or more of these drugs.
How high was your blood pressure? It seems strange that if it was just high blood pressure that caused your pulsatile tinnitus, it would go away when the drugs lowered your blood pressure–especially when it goes too low.
Since it doesn’t do that, and since it started soon after taking these drugs, I think one or more of these drugs is the culprit. Tell your doctor you are going off all the drugs for a week or two to see if it goes away.
If it goes away, then only start taking one drug at a time–say about a week apart–and see if it comes back after taking a given drug. Then you’ll know which drug you want to avoid in the future.
Another thing you might try is to stop the Paroxetine (Seroxat) since it isn’t a blood pressure medication anyway and you didn’t stop it, and see if it goes away. Of course, let your doctor know what you are doing.
See if you can find the drug that is causing it? Once you’ve ruled out the drugs, then it is time to search further afield for the cause.
Cordially,
Neil
Hi Neil
Thanks a lot for your feedback. Pulsatile tinnitus started when I was only taking Bisoprolol (Concor), Rosuvastatin (Crestor). It wasn’t happening before I took any medications although it seems my blood pressure was high for some time without noticing it. My blood pressure reached 160/100. With the medication the bp got better but the pulsatile tinnitus is continuous 24/7 even when my bp reached 90/60 sometimes.
The approach you suggested (to stop all meds) is what I am doing with my doctor, he replaced the concor with seloken zoc, he said I cannot go without one of those due to my condition. This has been going for a week now without any change.
Could it be that I replaced one ototoxic med (Bisoprolol) for another (Seloken zoc)? Can you advise on another medication with the same effect but doesn’t cause tinnitus?
Much appreciated
Mona
Hi Mona:
If I had to choose between the Bisoprolol and the Rosuvastatin, I’d probably choose the Rosuvastatin as the culprit–but the Bisoprolol could certainly also be the culprit.
I’d say you are right in that you’ve replaced the Bisoprolol with Metoprolol (Seloken) which has many more reports of ototoxicity. It has 7.8 TIMES as many reports of tinnitus than Bisoprolol.
If you want to stay on the beta-blocker class of drugs, there are a lot to choose from that are not as ototoxic as Metoprolol. In fact, Metoprolol is the most ototoxic of the whole beta-blocker family based on the number of reports of ototoxicity.
Good choices for low ototoxicity would be Levobetaxolol, Oxprenolol, Levobunolol, Celiprolol, Esmolol, Pindolol, Carteolol, Sotalol, Betaxolol, Acebutolol, Nadolol and Lebetalol in that order although all are very low in ototoxic reports.
Cordially,
Neil
I am on micardis 40mg and I am experiencing tinnitus – I have been in it for over 6 months- firstly what is a better HP media action I can suggest to that this and would it get betteif i stopped taking or or changed medications?
Hi Brett:
If you get off the Telmisartan (Micardis), I think you’ll have a good chance of your tinnitus going away.
If you want to stay on the same class of drugs, then the only drug that is less ototoxic is Eprosartan. You might want to ask your doctor if that drug will do the job, and if so you might want to try it.
Another possibility is reducing the dose. That might let your tinnitus go away, but I don’t know whether a reduced dose would do the job or not. See what your doctor thinks.
Other than that, you’d have to try a different class of drugs.
Cordially,
Neil
Thank you Neil – I’ve noticed in previous messages there are a few options for Telmisartan replacement – are there any other s – I would just like to find something that is not as ototoxic at all . I did have a very extreme bp reading at the time and was on i there drug for the heart starting with am which was optional and it’s drig review had lots of side effects. So glad I found your site and found I am not the only one. Why do doctors not advise of this side effect – it can me very debilitating
Just checking as I am located in Australia, and want to ensure an alternative is available. Thanks again.
Hi Dr. Niel, I have been taking ramipril 10 mg and amlodipine 10 mg for about 10 years now. I have always have a nerve deafness in my left ear since I was a teenager due to a freak accident where I was hit by a hand over my ear. Since about 18 months ago my left ear started to ring. Like everyone I visited my ENT who told me what I already I knew from I was a teenager. Nothing new, but he gave me prednisone which did’nt help. A few weeks,then months passed and I was getting frustrated and angry, but I did exactly as you said on your website. No cure, have to live with it, and I basically reprogrammed my brain where I basically tunned out the ringing in my ears, there are times I don’t even remember its there. Thanks for that. Now lately I have been noticing that the ringing sound is getting loader and its seem now its in both ears. From my research it seems I am taking the 2 worst pills for tinnitus. Considering that I have a Kidney issue (think I was born this way because doctors are puzzled as to whats the cause)stage 2, been stable ever since I was diagnosed, which was when I started taking ramipril 10 mg (doctor said for mainly my kidney) and the amlodipine for my hypertension. By the way I don’t drink or smoke, my last gout attack was 8 years ago and I do not take allopurinol which was prescribed. So doc, with my kidney issues in mind and the ringing ears which 2 meds would be my best bet with the lowest ototoxic. Thanks for your help and keep up the good work.
Hi Colin:
I wrote a special report one the relative ototoxicity of the various anti-hypertensive drugs. This report includes both the ACE inhibitors (including Ramipril) and the Calcium Channel blockers (including Amlodipine) and some other classes of drugs.
You can see how these two drugs compare to others in the same class and between classes. I think you’ll find it very useful and enlightening.
You can access it from the link at the bottom of the article at http://hearinglosshelp.com/blog/which-are-the-least-ototoxic-beta-blockers/
Cordially,
Neil
I have had Tinnitus for years. I have on Metaloprol, Benzoflurizide an Cetalopram plus Norpress at night, do any of these or all of these cause Tinnitus which drives me crazy?
Hi Sharon:
All of the above drugs can cause tinnitus, however Bendroflumethiazide (formerly Bendrofluazide) which is the drug I think you mean, and Nortriptyline (Norpress) only cause tinnitus in a few people–relatively speaking. I don’t think they are the culprits.
However, Citalopram and Metoprolol cause tinnitus in large numbers of people. So I’d suggest one or the other or both are the cause of your tinnitus. See if your doctor will take you off of them (and maybe substitute a drug that does not cause tinnitus in its place).
Cordially,
Neil
Hi,
Started taking Bystolic 5mg for PAT/IST symptoms. Went down to 2.5mg because the 5mg were making my PVCs worse. Now, I am getting this constant humming/ringing in my ears. I hear it especially at night when its quiet. I read that you didn’t think Bystolic was ototoxic in the past. Any update on Bystolic cause tinnitus?
Hi Jamie:
Recently I’ve come across a lot more information on the ototoxicity of drugs. More information on Nebivolol (Bystolic) shows that it is indeed ototoxic–but mildly so compared to a lot of other drugs. I rate it as a 1 out of 5, but there are a number of reports of it giving people tinnitus. So while the chances of getting tinnitus is quite low from taking this drug, some people do get it. You appear to be one of the “lucky” ones.
Cordially,
Neil
Thanks Neil! Is Valsartan ototoxic? My doctor wants to put me on that. Thanks for your help.
Kate
Hi Kate:
Actually, it is the most ototoxic of all the “sartan” drugs. That is why I suggested Eprosartan or Telmisartan and failing that Irbesartan, Candesartan or Olmesartan. These last three are only 1/3 as bad as Valsartan so are better choices from your ears perspective.
Cordially,
Neil
Hi.Dr.neil ,
Ca n you please help me i am taking candesartan 8mg blopress it was okay for me at first month then when i consumed the blopress i shifted to atacand and it started my tinnitus because of that i am worried that it might get worsen the tinnitus, then i go back to my Doctor reported that i am having a tinnitus in atacand bu t instead he prescribed me again to blopress after a week of using it I still have this tinnitus and i am afraid that i might loss my hearing because of tinnitus should i change to other group of hypertensive drugs that does not causing tinnitus?or i should stay with candesartan?please help me.
Best regards,
Rochie
Hi Rochie:
Blopress and Atacand are both brand names of the same generic drug Candesartan so they should have the same effect on your tinnitus. You could try either Eprosartan or Telmisartan as they have fewer reports of tinnitus. Candesartan also can cause hearing loss. In fact, there are half again as many reports of hearing loss as there is for tinnitus.
If you want to see all the anti-hypertensive drugs and how they stack up for tinnitus and hearing loss, you may be interested in my special report, “The Relative Ototoxicity of Anti-Hypertensive Drugs” which you can get at http://hearinglosshelp.com/shop/the-relative-ototoxicity-of-anti-hypertensive-drugs/
Cordially,
Neil
I have been taking Amlodipine, Carvedilol and Irbesartan for the past two months and currently suffering from two forms of tinnitus: pulsatile and hissing. I was first put on 300mg of Irbesatan, 180mg of Cardizem and triamterene hctz. My doctor stopped the Cardizem and triamterene ne hctz after I started experiencing ringing in the ears and added . Currently I’m on 300mg of Irbesartan, 10mg of Amlodipine and 12.50 of Carvedilol daily. which of these medications is the most ototoxic?
Hi Kate:
Amlodipine is the worst of the Calcium Channel Blockers. You’d greatly lower the tinnitus risk with Nicardipine or Nisoldipine or Nimodipine or Nitredipine.
Of the Beta-blockers, Carvedilol is the 3rd worst for tinnitus, but is still much less than Amlodipine. Better beta-blockers include Pindolol, Carteolol, Betaxolol, Acebutolol Nadolol, etc.
Of the Angiotensin-2 Blockers (ARBs), Irbesartan is the third highest for tinnitus. Two better choices in this regard are Eprosartan or Telmisartan.
Talk with your doctor and see if any of the alternative choices will do the job. Switching to them should greatly reduce your risk of tinnitus. However, there is no guarantee your tinnitus will go away if you stop taking these drugs–it may–or get less–or may not. But it is certainly worth trying.
Another alternative is to reduce the dose. For example, one lady I know was put on Irbesartan with no problems–then her doctor doubled the dose and right away her tinnitus flared up. I told her to get her doctor to lower the dose back to its original level and her tinnitus went back down to baseline again. So that may work for all three of your drugs, but they may not do the job at that level. But that is also worth a try.
Cordially,
Neil
I started taking 25 mg of Metoprolol Aug 2018 and it has caused my bp numbers to decrease about 20(D) and 10(S). About a month ago my tinnitus (ringing in left ear only) increased and I feel that its the Metoprolol. So what are your top 4 choices for non ototoxic beta blockers?
Hi Robert:
Metoprolol is the most ototoxic of the Beta Blocker drugs. There aren’t any non-ototoxic beta blockers. But some have very few ototoxic reports so they are the ones I try first–such as Pindolol, Carteolol, Betaxolol, Acebutolol, Nadolol, Labetalol and Nebivolol in that order.
Cordially,
Neil
I just received your “The Relative—-Drugs “and per your page 13, I would think that you would give the 1st 3 on the table 1st choice in that they all scored a Grand Total of 0. Also, I looked up Pindolol and it comes in a 5 or 10 mg tabled so how does a 5 mg tablet correlate to 25 mg tablet of Metoprolol which I am now taking per day?
Hi Robert:
The reason I didn’t is because I think those first few have very limited data, or they may be foreign and not available in the USA, so they may not really be 0, but it is the best data I have, but if they are available here and your doctor thinks they will do the job, by all means try them.
As for dosages, that is not something I deal with–talk to your doctor about that. Remember, I’m not a medical doctor so I don’t get involved with that.
Cordially,
Neil
Thanks Neil, you have been a big help. Thursday evening the Tinnitus Club of Seattle meets and I will inform them about your info. BTW, a member is very concerned about taking Metoprolol which his cardiologist prescribed.
I have switched from Metoprolol to Pindololto minimize the ototoxic effect. Barry Keate, a well known tinnitus expert , states that a way to help in overcoming the toxic effect is to take 1kmg to 2kmg per day of N-acetyl Cysteine(NAC). What is your take on his advice.
Hi Robert:
Taking between 1,000 mg and 2,000 mg of NAC a day is right in the ballpark for a therapeutic dose. I wouldn’t take the NAC “forever”–just a couple of weeks.
Cordially,
Neil
Big question, why only for a couple of weeks?
Hi Robert:
You take a therapeutic dose (a high dose) just as long as you need it. This is not a maintenance dose that you’d take for a long time.
After two weeks, the drug that is causing ear damage should be out of your body and the free radicals zapped–so you won’t need a high dose after that.
Cordially,
Neil
But I am taking Pindolol every day so the drug is put into my body daily, therefore don’t I need the NAC also daily in lieu of 2 weeks?
Hi Robert:
We were talking about two different things. I was thinking of the ototoxic side effects of the Metoprolol you were going off.
You are thinking of the new drug you are going to start taking. There is no indication yet that the Pindolol is causing any ototoxic side effects, therefore, I didn’t see any need to continue taking the NAC. However, if you choose to take it, drop the dose down to the amount shown on the bottle. You don’t want to take a high dose forever.
Cordially,
Neil
Hello Dr. Neil
Thanks to my finding and reading your excellent suggestions, I tapered off of Metoprolol completely, and luckily many of my symptoms disappeared completely, including hearing loss, although a bit of tinnitus remained, but it seemed to be diminishing. Of course, my doctor had to replace it with something, so he chose Amlodipine 10 + Irbesartan 75. I’ve had Amlodipine before without side effects, as well as Ramipril with no problems (although not effective), and I’ve deduced from your postings that the Irbesartan is probably not a culprit; but since resuming Amlodipine my tinnitus has returned with some severity. I dropped the dose by half since I also had ankle swelling for the first time, but the tinnitus hasn’t improved, and the small dose (5 mg) seems to do nothing to reduce my BP. I plan to try tapering off of the Amlodipine totally for a couple of weeks to see if the tinnitus improves. If there’s no change, I don’t know what’s left to try; my doc says he’s running out of options. I’m very health-conscious and have always followed a BP-friendly regime, with lots of water and veggie fibre in my diet, plus no salt, alcohol or smoking, regular exercise and age-appropriate weight. I’m at a loss.
Could it be that the Metoprolol experience has made me tinnitus-prone? I’m 65 and never had hearing issues of any sort (including no tinnitus whatsoever) before my awful time on Metoprolol, which lasted about 6 months. Thanks so much for your insight.
Hi Joe:
It’s good that getting off the Metoprolol got rid of most of your ototoxic symptoms. Shows that this drug was the culprit.
You know that the Metoprolol exacerbates your tinnitus like it has done for many, many other people. It is the worst of the beta-blockers as far as ototoxicity goes.
Amlodipine is the worst of the calcium channel blockers. I’m not at all surprised that it has also made your tinnitus worse.
I don’t think I’d say you are more susceptible to tinnitus now (but you may be), but you now know two drugs that you want to stay away from as they cause your tinnitus to get worse (among other things).
What is the problem with taking other drugs in the same class that are MUCH less ototoxic? For example, of the calcium channel blockers has you doctor considered Nivaldipine, Lacidipine , Nimodipine, Nitredipine, Nicardipine, Nisoldipine, Lercanidipine or Isradipine. The chances of getting worse tinnitus from them is VERY low.
And for the beta blockers has he considered Levobunolol, Celiprolol, Pindolol, Carteolol, Betaxolol, Acebutolol, Nadolol, Labetalol or Nebivolol. The chances of getting worse tinnitus from these is also VERY low.
Cordially,
Neil
I’m grateful for your response, Neil — thanks. Since my last message here is a recap, after a lifetime free of any hearing issues:
1. Hearing loss, distorted sounds and tinnitus from Metoprolol; stopped Metoprolol, symptoms improved, only a bit of tinnitus remained.
2. Began Amlodipine and Irbesartan and tinnitus came back; stopped Amlodipine, kept Irbesartan, tinnitus remained.
3. Stopped Irbesartan, tinnitus remained.
3. Stopped Crestor, tinnitus remained, and now seems worse.
I have no other symptoms and am otherwise well; but despite stopping all BP meds + Crestor — a week after stopping all, my new world of tinnitus remains.
I suppose it is now permanent, and I will have to adjust; but it is a terrible outcome, with insomnia and worry now the norm for me.
It all seemed to have begun with Metoprolol, and I thank you for raising awareness of this potential outcome for other patients. I do wish my doc hadn’t been so cavalier in prescribing it.
Best wishes,
Joe
Hi Joe:
If your tinnitus is now permanent, yes you will have to adjust to having it. But worrying about it is counterproductive and will make it worse.
What you want to do is learn to totally and completely ignore it, and have no negative thoughts towards your tinnitus. Instead, focus on the loves of your life–which by default, means you are ignoring your tinnitus. When you do this, over time you’ll notice that your tinnitus becomes less and less intrusive and tends to fade into the background so that hours will go by without your even being aware you have tinnitus. This is what you want to happen. It’s called becoming habituated to your tinnitus. Once you are habituated to your tinnitus, it won’t matter whether you hear it or not because it won’t bother you or affect your life, or your sleep. My book, “Take Control of Your Tinnitus” specifically chapter 16 in it shows you how to do this. You can get this book at http://hearinglosshelp.com/shop/take-control-of-your-tinnitus-heres-how/
Cordially,
Neil
Hello again, Dr. Neil
While every individual is unique and responds differently, I wanted to share a positive update on my situation to offer some hope to others: A full month after stopping all my BP meds, plus stopping Rosuvastatin, my tinnitus is mostly gone. The sense of relief is overwhelming — my good quality of life has returned and I look forward to living out my days in peace and quiet! I do plan to be much more selective about meds in the future.
Thank you, once again, for raising awareness of this issue and providing
crucial support to those experiencing adverse effects from ototoxic drugs.
Sincerely
Joe
Hi Joe:
That’s great news! Tinnitus from taking drugs does not have to be permanent as you have found out. I’m sure your words will encourage others to get off the drugs they are taking and get their lives and tinnitus back to normal again.
Cordially,
Neil
Joe how long were you on Amlodipine?
My husband began experiencing what I described as hearing loss… I noticed he was listening to tt=he TV louder and louder. I had his doctor check his ears- to make sure they weren’t impacted with wax.. however they were clean… I was surprised. So I got him some cheap hearing amplifiers to see if that would help… And he mentioned something that he has never mentioned before.. It make the ringing worse.. I asked “what ringing?” He went on to tell me.. his ears ring ALL the time. He is taking Losartan 100mg and Hydrochlorothiazide 50mg. I am at a crossroad because I am not sure which med might be causing it- if any… It could be all the ROCK concerts he went to as a youth.. However I feel i have to try and see – he has been on both for several years… however in the past year his health has greatly improved with some weight loss. He has lost over 70 lbs. Any suggestions would be greatly appreciated- Thank you
Hi Kimberly:
I’m sure your husband has a hearing loss. The fact he turns the TV up louder and louder is the proof. It’s interesting that the hearing amplifiers cause his tinnitus (ringing in the ears) to get worse, yet he doesn’t seem to mind having the TV turned up louder and louder so presumably the TV is not bothering his tinnitus.
Typically tinnitus accompanies hearing loss. If he attended a lot of concerts when he was younger, it probably caused some hearing loss and consequently he has had ringing in his ears ever since.
You need to ask him when this ringing started if it started way back and hasn’t changed since he’s been on the Losartan and Hydrochlorothiazide, then probably those drugs are not bothering his tinnitus. However, if his tinnitus began AFTER he began taking these drugs, then that is a good indication that the drugs are the culprits. Both of these drugs can cause tinnitus and hearing loss in some people, so I think it is important to determine whether he had tinnitus before he began these drugs or only since he started taking them. It’s also possible that he had a low level of tinnitus before he began the drugs and his tinnitus got worse once he started taking them.
Cordially,
Neil
Hi Neil,
This has been a new development as he has just recently in the past few months ( I noticed about 3-4 mo ago) that he was turning up the TV.. I asked why- he said it was to differentiate what they were saying over the ringing. Another interesting thing is yesterday and today without meds… his BP is averaging 113/79. I have asked him to pay attention to if his ears improve without the meds. I will be monitoring his BP closely. At first when i ordered the amplifiers.. I did it because he said he was deaf… after the amplifiers got here and he tried them- is when i found out about the ringing in his ears. He claims that is why he can’t hear. He isn’t a complainer -he is the type that will just suck it up and deal with it.
He can’t pinpoint when it started- but he has been on thesemeds since at least 2015. I do know the TV volume is a recent complaint of the whole household.
Hi Kimberly:
Your husband needs to go to an audiologist and have his hearing tested so you know whether he has poor hearing, or whether he perceives his tinnitus as affecting his understanding of speech. (Normally it doesn’t.) During the hearing tests, if he has trouble distinguishing between the pure tones and is tinnitus, have him tell his audiologist to switch the audiometer from the pure tones to double tones, or even better, warble tones so it is easy to tell whether he is hearing the tone or whether it is his tinnitus.
I don’t understand why your husband is taking blood pressure medications since his blood pressure is only 113/79. That could be perfectly normal for him especially if he is middle-aged or older.
Cordially,
Nail
I took amlodipine for three weeks. two days after I stopped it I developed tinnitus. It’s been six weeks. The doctors can’t explain why and I am having a hard time finding an explanation of why it causes it. Not enough blood flow or too much blood flow? blood thinners and how they play a role. aspirin versus fish oil I’m getting no help from my doctors. ENT said it’s to soon I was given prednisone and now Flonase. Only on Flonase for 2 weeks. She said I need to give it at least six weeks.
Hi Deanne:
Hundreds upon hundreds of people have reported to the FDA that taking Amlodipine caused their tinnitus. You don’t necessarily get tinnitus as soon as you start taking Amlodipine. It can take several weeks and longer for some people. Your tinnitus could have been caused by this drug’s side effects finally kicking in, rather than in response to stopping taking it. I do not know the underlying cause why this drug causes tinnitus as well as the other 26 ototoxic side effects it causes.
It is by far the most ototoxic of the Calcium Channel Blocking Drugs. Any of the other drugs in this class of drugs should be much less ototoxic.
Cordially,
Neil
Hi I inherited High BP from my Dads family everyone has died died from Heart Attacks. I’m 65 had carotid blockage in 2010 had a mini-stroke was put on Metropahol maybe spelling it wrong for 6 yrs it cleared the blockage. But was also put on Enapril 20 so now that’s 10 yrs. Just in the past 3 years I have Tinnitus its so bad now I have 50% hearing loss in both ears. I also hear chirping sounds like a 100 birds in my roof. If I go outside or to the store It’s not bad at all. I get that whooshing sounds when I turn my head especially at night. Now here’s another thing I’m on a CPAP I lived at 7200’ elevation from 1999 then in 2011 returned to 3600’ the pressure was reduced to 6 from 10 as It was too much on my lungs at the lower Elvation. Can the CPAP Contribute to the tinnitus?
After reading your suggestions I’m getting off the Enapril. I can’t sleep w/o CPAP and it gives me great energy. I recently was told I had blockage and went in to have a Stent put in but he turned the monitor towards me and said blockage was gone and would see me in a year!
Hi Sue:
I don’t see your CPAP machine as causing your tinnitus to get worse as long as it is set properly to give you the correct amount of oxygen you need in your blood. You could get tinnitus if your blood oxygen levels are too low as that would cause your inner ears to not work properly which can result in tinnitus. But I doubt your CPAP machine is the culprit.
Much more likely is the Metoprolol and/or the Enalapril. My money is on the Metoprolol. It has far more reports of ototoxic side effects such as hearing loss and tinnitus than any other drug in its class (Beta blockers).
As compared to Enalapril, Metoprolol has 3 TIMES as many reports of hearing loss and 10 TIMES as many reports of tinnitus. Thus, if I were you, I think I’d try to get off the Metoprolol, rather than the Enalapril.
Cordially,
Neil
Hi Neil and all,
I had pre-hypertension often peaking into high. Cardiologist here in Australia prescribed Candesartan Cilexeril which gave me bad anxiety and nightmares so I stopped. Was then prescribed Perindopril Erbumine – an ACE inhibitor – no nightmares but instantly gave me a dry cough and tintinitus that night. After 2 weeks I stopped taking it but the T has continued 8 days later after stopping taking it without reduction. Is driving me crazy and finding it hard to sleep at night. Do I need time for this to come out of my system or is it here for good? Many thanks, Dan
Hi Dan:
Perindopril (Erbumine) causes tinnitus in a few people–not all that many as near as I can tell–but you seem to be one of the “lucky” ones. Unfortunately, I don’t have any information to indicate whether the tinnitus tends to be temporary or permanent. We can hope it will be temporary. I’d give it a full month to see whether it begins to get less and less.
However, you should learn how to habituate to your tinnitus so it won’t bother you whether it fades away or not. Basically, you need to accept that tinnitus is NOT a threat to your well-being. This gives your limbic system permission to let it fade away. If you focus on your tinnitus and worry about it–this tells your limbic system it is a threat to your well-being (you wouldn’t worry about it if it wasn’t) and therefore it constantly brings it to your attention. So focus on the loves of your life and by so doing ignore your tinnitus (as much as is humanly possible) and let it begin to fade away.
My book, “Take Control of Your Tinnitus” chapters 16 and 17 in particular show you how to do this. You can see it at https://hearinglosshelp.com/shop/take-control-of-your-tinnitus-heres-how/ . Get the eBook and you can start reading it in 5 minutes.
Cordially,
Neil
Hello Dr Neil..
I’m a 51yr old male that was diagnosed with hypertension in June 2019 and prescribed 2.5mg Ramipril each day. No issues for the first few months but lately (about 5 weeks) I’ve noticed a steady increase in tinnitus which I’ve not experienced before. I’ve been stressed lately through work and family trauma and my BP is around 145\90 most days. Do you think the Ramipril is causing my tinnitus and should I stop taking it to see if there is any reduction in its volume ? Thanks for considering my questions.
Hi Kevin:
It’s hard to say whether the Ramipril is making your tinnitus worse (it does in numbers of people so it sure could be), or whether it is your stress (or a combination of both). You could experiment and stop the Ramipril for 3 or 4 weeks and see what happens to your tinnitus. If it drops or goes away, then you’ll know it was the Ramipril. If nothing changes it could be the stress, or the tinnitus from the Ramipril is permanent.
Cordially,
Neil
Thank you for that Dr Neil. I’ll give it a go and let you know how I get on. I’m a little worried my BP will rise too high through not taking the meds it I’m willing to give it a go and see if o can reduce the tinnitus as it really is unpleasant…
What was your outcome? I am having similar issues. Did you stop taking the medication and did it go away?
Sir i 38 years old and I am having tinnitus for last 3 months. I am on Tab nebivolol 2.5 mg. Should i stop or change the drug?
Hi Kaushik:
Did you tinnitus begin soon after you began taking the Nebivolol? If so, that is a good indication that this drug is the culprit.
Just so you know, Nebivolol is one of the lower-ototoxic beta-blockers. You might ask your doctor about switching you to Acebutolol or Betaxolol–they have even fewer reports of tinnitus than Nebivolol.
But if you don’t REALLY need to take the Nebivolol, you could just stop taking it–if it was the cause of your tinnitus in the first place. Run it by your doctor of course.
Cordially,
Neil
In early December I took Lisinopril for 4 days and got a case of tinnitus. I am upset that neither the doctor nor the pharmacy literature mentioned the side effect and I certainly did not assume the risk.
I was switched to Lostaran. And I have been taking the flavinoid supplement. The tinnitus has lessened some. On occasion, it is very light. Then after a movie , etc, it comes back.
When I stretch my body on the floor, my ears sometimes pop. Therefore I wonder if the etiology of the tinnitus may be some kind of eustachian tube dysfrunction?
Permanent hearing impairment seems like a steep price to pay for four days on a medication.
In a little over 6 weeks with lifestyle changes I have lowered my BP from 161 systolic to 121.
I wonder if sometime in the future with additional weight loss if I can stop the Losartan, and that would help with eliminating tinnitus?
Sincerely,
Joe
Hi Joe:
Tinnitus from taking Lisinopril has been reported hundreds upon hundreds of times to the FDA. In fact it is the most ototoxic of all the ACE inhibitor drugs. So any other drug in the same class would have about 1/4 or much less of the risk of getting tinnitus than Lisinopril. For example, Benazepril has 13.7 TIMES less risk of tinnitus.
Losartan has about half the risk of tinnitus as compared to Lisinopril. Benazepril would still be 7 TIMES less risk than Losartan.
If your doctor wants to stay with the ARB drugs, then Telmisartan would be the lowest risk for tinnitus followed by Irbesartan and Candesartan.
I doubt your tinnitus is related to your Eustachian tubes based on what you have said.
Unfortunately, you can choose what you do/take, but you can’t choose the consequences. So, in your case, you got tinnitus which may or may not prove to be permanent. That is why you need to evaluate the risks and do your own due diligence before you take any drug or undergo any treatment.
How about sharing how you got your blood pressure down so much. Many other people need to hear how you did it so they can try something similar for themselves, instead of taking drugs.
Getting off the Losartan may help with your tinnitus, but there are no guarantees. This is because what triggers tinnitus in the first place may have nothing to do with stopping the tinnitus. Doesn’t seem fair, but that is the way it often is. But getting off any drugs is always a good step in the right direction in my opinion. I go for natural ways if at all possible.
Cordially,
Neil
I am in 2nd stage heart failure, am on lisinopril, cervidilol and lorazapam. I have a huge amt of ringing, what can i do. I’m 69 female in good health. Usually exercise, and weigh only 120.
Hi Roxanne:
I sure don’t call having 2nd stage heart failure being in “good health”. I’d call that poor health–and a warning call to change you lifestyle, diet, etc. to get your heart healthy again. The drugs you are taking are not designed to make your heart strong and healthy. They just try to hide the symptoms.
Besides, they can and do cause tinnitus–hundreds upon hundreds of people have reported getting from taking Lisinopril and Lorazepam. Only about a quarter as many people report tinnitus from taking Carvedilol. Unfortunately, there are no guarantees that your tinnitus will go away if you get off these drugs, but there is a good chance your tinnitus would drop in volume.
If I were in your shoes I wouldn’t take drugs of dubious value (as far as I’m concerned). Rather I’d read what Dr. Bruce West has written on the subject.
Here are links to a couple of his articles on heart health.
http://www.healthalert.com/Article?ArticleID=24
http://www.healthalert.com/Article?ArticleID=17
Once you have studied these articles, then decide which direction you want to go.
Cordially,
Neil
Hi dr
I have high blood pressure have been on my 3 rd lots of drugs which is losartan 25 mg which is making my pulstate tinnitus worse , went to see a cardiologist and he told me to go on doxazosin 20 m is this worth taking
Hi Teresa:
From an ototoxic viewpoint, Doxazosin has only about 1/3 the ototoxic reports for tinnitus and hearing loss as does Losartan. So Doxazosin looks to be a reasonable choice.
Cordially,
Neil
My mother is 92 and is suffering from tinnitus. She is on 25mg of Losarton for around 1 1/2 years now. She has had surgery on her inner ear where she had a perforated ear drum over 20 years ago. Surgeon repaired the hole but not 100% closed. This was the best he could do for her. Has recurring ear infections 2-3 times a year. Has balance issues sometimes worse than other times and always has some kind of dizziness. The past 2 weeks has had bad hissing in her ear and disturbing her quality of life and I have made an appt. with specialist ENT for her. Wondering if Losarton is the cause or just a bad ear. She also has hearing loss but does not want hearing aids. Any suggestions or comments.
Hi Linda:
Losartan can certainly cause tinnitus. Hundreds and hundreds of people have reported to the FDA getting tinnitus from taking this drug. Ditto for hearing loss.
Not only that, thousands upon thousands of people have reported getting dizziness and various balance disorders from taking this drug.
So your mom’s ear problems could well be related to Losartan. But her tinnitus could also be associated with her hearing loss as tinnitus very often accompanies hearing loss. Ear infections can also result in hearing loss.
However, my money is on the Losartan as it can explain ALL her ear symptoms apart from the hole in her eardrum.
Cordially,
Neil
Hello and thank you so very much for the very informative article! I was just wondering if you would still consider Benazepril and Eprosartan to be two of the safest and least Ototoxic choices for blood pressure meds? Also, are there any water pills that seem to have low Ototoxicity? I’m on Hydrochlorothiazide 25mg daily at the moment and thinking I should switch to something that is hopefully less Ototoxic. I’ve had minor to moderate tinnitus in one ear for years (long before I started the water pill, so that had nothing to do with it). It took me a year to habituate to it back in 2017 and I really don’t want it to get any worse. However, my blood pressure does go quite high without meds so it seems I need to be on one. I would really appreciate any info you might be able to provide! Thank you again!
Hi Drew:
What I know at this time indicates they are pretty good choices. Of course, I could change my mind tomorrow if I find out other information. They are certainly not the worst!
If the Hydrochlorothiazide has worked for you and has not affected your tinnitus in all these years, why take the risk of changing?
Cordially,
Neil
Hello doctor I am 37 and on blood pressure drugs
Vasoprin
Novask
Valsatan
And I have been having tinnitus
Can these drugs cause these or I shld change it
Hi Omotola:
I assume you mean Norvasc, not Novask, and Valsartan, not Valsatan. If so, here is what I can tell you.
Vasoprin is a combination of Acetylsalicylic acid (aspirin) and Isosorbide. This drug can cause tinnitus in numbers of people.
Amlodipine (Norvasc) causes tinnitus in a good number of people. I get lots of reports about this drug.
Valsartan (Diovan) also causes tinnitus in a good number of people.
From what I know, the most likely culprit is the Amlodipine, followed by Valsartan and bringing up the read is the Vasoprin.
Unfortunately, all blood pressure medications can cause tinnitus, so you have to take the least ototoxic ones and hope for the best. Maybe just dumping the Amlodipine might do the job–see what you doctor says.
Cordially,
Neil
Hello Dr. Bauman,
what is your current recommendation for the safest and least Ototoxic choices for CCB, ARB or ACE for high blood pressure? If I have to pick one from each, which you recommend?
Thank you,
Grant
Hi Grant:
You need to choose one that works for you and hopefully at a low dose. So you and your doctor have to work together.
As far as I’m concerned, I’d just stay away from the below drugs if you can.
For the CCB drugs, I’d choose any of them EXCEPT Amlodipine and Diltiazem.
For the ARB drugs, I’d choose any of them EXCEPT Valsartan and Losartan.
For the ACE drugs, I’d choose any of them EXCEPT Lisinopril, Ramipril and Enalapril.
That should reduce your risk of getting ototoxic side effects, but there is still a risk as all these drugs can be ototoxic.
Cordially,
Neil
Thank you so much Dr. Bauman! Very helpful. I had Ramipril and Amlodipine for long time, and now I am having Diltiazem. Pretty unlucky.
Hello Dr Bauman
I have been taking Lisinopril for 15 years with no hearing issues/tinnitus until this year. I am 47 and in January this year i started a health kick to get healthier and to also lose allot of weight. I am 6″1 feet in height and in January i was 257lbs (obese on BMI) and today (August) i am now 218lbs (overweight) but still keeping fit/eating well/losing weight each week and my average bp has dropped to be around 138/80 now while still taking 20mg Lisinopril. But in June during high grass pollen season i got sinus issues and my nose/eustachian tubes got very sticky/clogged and had popping/crackling and started getting ringing in my ears. Doctor saw extreme amount of wax so after using some ear drops (Remo-Wax) I had both my ears syringed for the first time ever but the ringing continued a few days later, so saw ENT who gave me some Nasonex for 2 weeks which cleared the congestion, tubes crackling/popping but now i still have ringing in my ears (mostly 95% in the right ear) – ENT tests were all fine, no infection/no pressure issues/no hearing loss – just this variable higher pitched ringing noise (changes abit still). My question is could the Lisinopril be the issue here (even though i have taken it for 15 years with no previous tinnitus/ringing issues?) – could the fact i have lost around 40lbs this year mean Lisinopril now having a pronounced impact on my hearing (i never experienced in previous 15 years) – or maybe it’s just going to take time for tinnitus to clear following the sinus/ear clearing issues in June. If it could be the Lisinopril i will maybe speak to my doctor to change to one of the least ototoxic ACE drugs you mentioned (until maybe one day as i lose more weight i can maybe get off them all together)
Hi Robin:
I congratulate you on your “health kick”. You are doing well losing so much weight, getting fit and eating properly.
My question is why you are still taking the Lisinopril? You probably don’t need it anymore. You are down to what I’d consider a reasonable BP given your age. (I know doctors want a ridiculously low BP, but that isn’t necessarily good for you. For example, I didn’t feel good until my BP rose to around 140–so that is what is right for me.)
You might want to tell your doctor that you want to go off the Lisinopril and see what happens to your blood pressure. If it stays at 138 or continues dropping, I’d think your new lifestyle is all you need–and then you won’t have to worry about any ototoxic and other side effects from the Lisinopril.
That’s what I’d do if I were in your shoes. You need to make up your own mind. Remember, I’m not a medical doctor–I’m just telling you what I’d do for myself.
Then you can see whether your tinnitus goes away, or gets softer and fades into the background or not.
Cordially,
Neil
I was taking valsartan for about 4 months then I started getting tinnitus, I saw your article and wondering that if I stop valsartan, would the tinnitus stop… Iv already stop taking it for a week and I will see my ent tom. How long does it take to loose the tinnitus after I stopped using valsartan, I’m also taking jardiance,, should I stop jardiance too, does jardiance caus
Hi Joe:
Hundreds upon hundreds of people report getting tinnitus from taking Valsartan so it is certainly possible that this drug is the cause of your tinnitus. I don’t have any specific information on whether tinnitus from taking this drug is temporary or permanent. But if you stop taking it you should know within a month whether it is temporary or not. Hopefully, it will begin to fade away as the Valsartan leaves your body, but there are no guarantees.
Unfortunately, Empagliflozin (Jardiance) is still too new a drug so I don’t have any information on its ototoxicity.
Cordially,
Neil
I have been on blood pressure meds since my mid 40’s. I am now 64. I was recently taken off atenolol as it had started to cause my heart to beat too slowly.It was replaced with Bisoprolol . I have also been on amlodipine for a long time. I noticed around 2010 that I developed tinnitus and had never considered that the meds could be causing this ringing. I also take an aspirin every day which I now understand is also ototoxic. I am on 5 mgms of Bisoprolol now and 5 mgms of amlodipine. I have learned to live with the tinnitus but honestly if there is something you can suggest to try I am all ears! I am speaking with my cardiologist in a week and while I probably need to be on some type of meds to control my irregular heart beats and afib and moderately high bp, is there anything you might suggest as a viable alternative so I can at least rule out my meds as the cause of my ear ringing…Thank you!
Hi Howard:
I have heard from many people that are taking Atenolol and have hearing loss and tinnitus as a result. So I think it’s a step in the right direction switching to Bisoprolol as it doesn’t have near as many ototoxic side effects reported.
Amlodipine also causes a lot of hearing loss and tinnitus. Thus your tinnitus could be from the Amlodipine you been taking or from the Atenolol or a combination of both.
Unfortunately, getting off either or both of these drugs is no guarantee that your tinnitus will go away. It can be permanent so you may not notice any change by switching to the Bisoprolol.
Taking one aspirin a day is highly unlikely to cause tinnitus unless you are particularly sensitive to aspirin. Typically, you’d have to take five or six aspirin a day to get tinnitus from aspirin.
I’m not a medical Dr. so I can help you with what drugs might work for your condition, but if you ask your cardiologist for a list of drugs that he thinks would work, I could tell you which ones are the least ototoxic in my opinion.
Cordially,
Neil
Thanks for your reply…..I think the amlodipine is the culprit as I have been on it for more than 10 years and the tinnitus started shortly after I started taking it.. Unfortunately I need to stay on it as it works for me along with the bisoprolol…I spoke with my cardiologist about the ototoxicity of the drugs I am on..He wasn’t much help sadly.
I also started taking Valsartan and started hearing my pulse in my right ear. I have Tinnitus to begin with. Dr. Switched me to Edarbi and The pulsating is still there. I stopped the Valsartan 3 weeks ago . And a few days ago I stopped Edarbi just to see if that causes it also. I am 48 years old. Also been on Levothyroxine for 8-10 years. Your opinion on Edarbi would be greatly appreciated! Dr. wants me to see cardiologist if it does not go away. Thanks so much Jenny
Hi Jenney:
I have almost no information on Azilsartan (Edarbi) but since it is an Angiotensin-2 Receptor Blocker drug, it probably has similar side effects to the other drugs in this class including Valsartan. There are going to be some differences of course, but don’t expect it to be greatly different from Valsartan.
Although Levothyroxine can cause tinnitus, my gut feeling is that it is not the culprit.
Cordially,
Neil
Hi Dr. I read through your page comments here i think its amazing that you offer so much advice and response!
I had been taking Edarbi Mexomil 40 mg for 2 year Before it “over night ” made my Tinnitus extremely high pitch. (not noice induced)(all ready had it faintly before).
Because my providers consistently debunct my indication that it was from the drug i continued taking it. I continued for another year with some homoeopathic herbs seems to decrease it slightly.
Alcohol the day before seems to be the only thing that drastically improves it (go figure).
Do you have any recommendations or considerations for my case? Thats has been the biggest challenege of my 28 year old life.
Hi Dana:
I don’t have much information on Azilsartan (Edarbi) and nothing that says it causes tinnitus, but I sure wouldn’t be surprised if it did as the other drugs in this class all cause tinnitus–some more than others. How do you know it was the Azilsartan that caused your tinnitus overnight and not something else since you had been taking it for 2 years without problems?
Tinnitus is caused by hyperactivity in your auditory neurons. For some people alcohol calms them down, so it can also calm down tinnitus. However, for others alcohol revs them up and thus makes tinnitus worse. Sounds like you are in the “calm down” class. Is this true for you.
If the Azilsartan did indeed cause your tinnitus, you might want to try another drug in the ARB class of drugs. Maybe one of them won’t cause tinnitus in your case. I’d stay away from Losartan and Valsartan as they have the most reports of tinnitus. You might want to suggest to your doctor you want to try Eprosartan.
Have you tried getting your blood pressure down by natural means?
Cordially,
Neil
Thank you for the response! I cant be 100 % certain that the azilasartan hightened the tinnitus. However it is the only thing that i consistantly take. I did have some sort of milk cake that night and woke up with extra mucus . However thats the only remarkable event.
That is good information concerning the hyperactive nuerons. I never expected a couple grams of alcohol to make it DRASTICALLY better for days. How may i use this information to get me out out of this terror!
As pertaining to the natural measures. My blood pressure has always been steady. I am and was an athlete, one day suddenly i began to get neck tigheness and my blood pressure was so high none of us exosted concervitive measures. We went directly to drugs (norvasc, then lisinopril, then an alpha blocker then losartan then edarbi) And edarbi was the first to consistently control my pressure.
Hi Dana:
If your neck went tight, its possible that it also constricted some blood vessels in your neck causing the high blood pressure. If it were me, I’d go to a chiropractor and see if any cervical vertebrae are out of proper alignment. A treatment or two could do wonders. Some people see a sudden flush in their face as the blood starts to flow properly again. It is possible that’s all it takes.
Cordially,
Neil
That would be fantastic! As it happens i am a chiropractor and have had plenty of treatment myself!
Hi Neil,
I have been taking atorvastatin and losartan for roughly 3-4 years, and in the last year had the ringing in my ears, and just recently noticed after taking my medication the ringing gets louder or more noticeable.
Originally was prescribed losinopril but due to the cough side effect was taken off that fairly quickly.
Any recommendations as to better medications that dont cause the ringing in the ears?
Hi Melissa:
Atorvastatin certainly causes tinnitus in numbers of people. Losartan, not as many, but it can still cause tinnitus.
I can’t help you there because I don’t know what you are taking the drugs for, etc. That is your doctor’s job. I can tell you how ototoxic they are in my opinion if you send me the ones you are considering replacing them with.
Cordially,
Neil
I looked through the website and see you comment a lot about Losartan and only mention one time about Olmesartan. I have been on a 20mg dose for more than a decade and not had any known side effects. In the past year I have had increasing intensity of high pitched Tinnitus at around 12.5kHz and a broad loss of hearing above that frequency. At age 55, I didn’t expect this significant hearing loss at this point. Are there any studies on long term impacts of Olmesartan use in this context?
Hi Bill:
When I divide the number of prescriptions written/year against the total number of tinnitus reports, it works out that Losartan is only 1/8 as ototoxic as is Olmesartan regarding tinnitus. There are 22.5 TIMES as many prescriptions written for Losartan as there is for Olmesartan so that is where the action is–thus people write about it more than they do about Olmesartan.
Having said that, there are still hundreds of reports of Olmesartan causing hearing loss, so you could be one of them. For you information, there are almost no post-release studies of the results of drugs (with a few exceptions) on hearing loss.
By the time you are 55, you could expect an average of 40 dB hearing loss at 12.5 kHz. But if you have been around noisy venues (either at work or for recreation), your hearing loss could be significantly worse.
Note that tinnitus is often at a frequency just below your greatest hearing loss.
Cordially,
Neil
Thanks for your thorough response. Could you direct me to where these many reports of hearing loss correlate to Olmesartan can be reviewed? I am certainly interested in this specific topic.
Hi Bill:
They are buried in the FDA’s data base. I don’t think there is public to the individual reports. All I know is the number of reports (not the contents of the reports) that I compiled from a website that has since then disappeared.
Cordially,
Neil
I actually have access to FDA formally filed reports, not only the publicized reports. I was not seeing reports related to this specific set of constraints in my searches, hence my query to you. I have no method to confirm your statement “there are still hundreds of reports of Olmesartan causing hearing loss”. I would very much like to investigate this further, so any resources you are using to support your statements I very much want to review. Thanks!
Hi Bill:
Have you searched through the more than 20 million individual reports in the FDA’s data base searching for all instances of Olmesartan and tinnitus and “ringing in the ears”? Then you have to compile all this data.
Sorry, you can’t review my source because alas, it disappeared from the Internet–much to my dismay. Fortunately, I had captured about 50,000 lines of semi-compiled ototoxic data before it disappeared. I have been slowly compiling all this date for the next edition of my drug book so everyone can have access to it.
Cordially,
Neil
Can you tell me what the ototoxic ingredent is in all these drugs and why it cannot be left out of the recipe? Also shameful that the danger of getting tunnitus is kept firmly under cover and patients don’t even know of the risks.
Hi Eliza:
Typically, the active ingredient is the ototoxic factor. That is why it cannot be left out. In some drugs, one or more of the “inactive ingredients” may be ototoxic substance and could be eliminated–but I don’t think this is too common. And sometimes an “inactive” ingredient isn’t inactive at all, but is an ototoxic drug in its own right–but is labeled as “inactive” because it is “inactive” for the main purpose of the drug. So in that case, why indeed is it included in that medication?
Cordially,
Neil
Hi Neil I have been taking Amlodipine for 6 months woke up with tinnitus. Asked Dr to switch meds she recommended Olmesartan. I would like to know which one is least to increase tinnitus. Olmesartan or Losartan?
Thanks Dee
Hi Dee:
Losartan has about 8 times LESS risk for tinnitus than Olmesartan based on number of reports compared to number of prescriptions written annually.
And to compare, Amlodipine is about 35% higher risk than Losartan.
Cordially,
Neil
Thanks for your reply! I am trying to gather info for Dr. which appears to be best choice for high blood pressure Calcium Channel Blocker, ACE, and ARB? My tinnitus is not going away been a year already.You appear to be very knowledgeable! The Dr insist meds are not cause of Tinnitus. Unfortunately, I was fine before I started amlodipine.
Thank you
Hi Dee:
I’ve just compiled a list of the various classes of anti-hypertensive drugs in relation to the number of prescriptions written per year divided by the number of reports of tinnitus side effects I have to come up with the top 11 blood pressure drugs with the lowest incidence of tinnitus.
Here is the list from the lowest risk of getting tinnitus to the highest risk.
The percentages are based on Lisinopril as the base (0) so the percentages are the increased risk in percent above the risk of tinnitus from taking Lisinopril.
1 Lisinopril 0 ACE
2 Labetalol 2% BB
3 Benazepril 7% ACE
4 Losartan 10% ARB
5 Carvedilol 30% BB
6 Nebivolol 46% BB
7 Amlodipine 48% CCB
8 Tamsulosin 50% AB
9 Propranolol 78% BB
10 Metoprolol 128% BB
11 Alfuzosin 166% AB
The class abbreviations are
AB Alpha-Adrenergic Blocking Drugs
ACE Angiotensin-Converting Enzyme Inhibitors
ARB Angiotensin-2-Receptor Blocking Drugs
BB Beta-Adrenergic Blocking Drugs
CCB Calcium Channel Blocking Drugs
Note: the data from which this list is compiled is not necessarily accurate, but it is the best I have available to me, so use this list as a rough guideline only.
Note 2: This list only includes drugs for which I have annual prescription data. This just includes the top 300 prescription drugs, so drugs not on this list are not included in my above list, but some of them may be even less risk than those included, but I have no way of calculating their rank at this time.
Cordially,
Neil
Hi Neil,
i’ve been taking Famotidine for about 18 months with no problems. My doctor prescribed Olemasartan for me and after about 4 months I got tinnitus. I had a hearing test done and doctor said my hearing is still in the normal range, but my ears ring all the time. Do you think the Olemasartan or the Famotidine is causing the tinnitus?
Hi Carol:
You have several possibilities. First, both Famotidine and Olmesartan can and do cause tinnitus. Actually, there are more reports of Famotidine than for Olmesartan. So either of them could be the culprit.
Second, the combination of both together could have a synergistic effect and caused the tinnitus.
Third, you have some high frequency hearing loss even though yu are STILL in the normal range. Tinnitus accompanies hearing loss almost all the time. “Normal” hearing can still give you a fair hearing loss of 25 dB which is the bottom range of “normal”. So that could be the cause.
Fourth, you could have hidden hearing loss causing the tinnitus. Hidden hearing loss would be hearing loss in those frequencies above 8,000 Hz where they don’t test so you could have a massive hearing loss up there and no one would be the wiser–except your brain and the neurons that are supposed to process those high frequencies.
Furthermore, the drugs you are taking can also cause hearing loss–and typically hearing loss from drugs begins in the highest frequencies and works it way down the frequency spectrum. So either or both drugs could be doing some dastardly deeds up there and when no one tests your hearing up there, any hearing loss stays hidden.
Another kind of hearing loss is hearing synaptopathy that they don’t test for.
So you have several possibilities just for hearing loss and consequent accompanying tinnitus.
And then there are all the other causes of tinnitus apart from drugs such as anxiety, depression, noise damage, aging, etc., etc.
Since 4 months went by before your tinnitus showed up after beginning on the Olmesartan, it is somewhat unlikely that it is the culprit.
What was going on in your life back then–stress, anxiety, depression, etc, etc. that might have caused your tinnitus? Any ideas?
Cordially,
Neil
I can’t think of anything else that caused the tinnitus besides olemasartan and the famotidine. i’m going to get off these drugs and see what happens. i’ll talk to my doctor about weaning off of these drugs. Thanks for your reply
I have great problems with tinnitus for 1½ years and suspect it could be related to the medicine I take. When it started I was on a combination of amlodipine and losartan. I feel it is getting worse and worse. Currently, I use amlodipine along with avamys and esomeprazol. Do these have an effect on tinnitus? Felt the tinnitus was terrible two nights ago when I took them all an hour before going to bed.
Hi Carsten:
Amlodipine and Losartan can both cause tinnitus. Amlodipine is a bit more ototoxic than Losartan. Who knows how taking them together affects tinnitus–but as you know, they did cause your tinnitus.
The Esomeprazole is much higher risk of tinnitus than the Amlodipine–at least 7 TIMES higher risk. The Fluticasone is about 2 times the risk of Amlodipine.
Taking all 3 of these drugs together just compounds the risk.
As you can see, the most likely culprit is the Esomeprazole. I’d dump it (with your doctor’s permission of course) and see if your tinnitus drops. If not, then I’d dump also dump the Fluticasone and see if you tinnitus drops even more.
If not, you might want to also dump the Amlodipine and go back on the Losartan as it has the lowest risk for causing tinnitus of all these drugs.
Cordially,
Neil
Hi The Dr prescribed Diltiazem. Is that a good choice to not increase or cause tinnitus?
Hi Dee:
Diltiazem is a fairly good choice since all the drugs used for controlling blood pressure can cause tinnitus. Of the Calcium channel blocker drugs, they least ototoxic in regards to tinnitus is Amlodipine, then both Diltiazem and Nifedipine are tied in second place–but they have about 2.5 TIMES the risk of getting tinnitus as for Amlodipine.
Cordially,
Neil
Hi Neil
I’m in my early 40s a chance just been diagnosed with genetic hypertension. The cardiologist has put me on telmisartan and about a week in I have constant high pitched tinnitus. Is this something that comes from using the drug? I couldn’t find much about telmisartan but plenty of information on ace inhibitors.
Thank
Paul
Hi Paul:
Telmisartan does indeed cause tinnitus in numbers of people. Your experience is consistent with what others have experienced from taking this drug.
The good news is that the tinnitus may go away if you stop taking this drug–at least it does for some people.
Cordially,
Neil
Thanks Neil. This came out of nowhere and was told by the doctor that there basically no side effects when I asked prior to starting the medication.
Hi Paul:
Well, now you know how little your doctor knows about the side effects of the drugs he prescribes. It’s always better to do your own due diligence than to rely on the people who prescribe the drugs as they are biased, not independent or neutral.
Cordially,
Neil
Hi Neil,
Thank you for keeping this blog to let the people know about the problems with these blood pressure medicines. I doubt you’ll find on any of these medicine prescription information mentioning Tinnitus which just shows how wicked the FDA and pharmaceutical industry are (my comments). I take rosuvastatin 10 mg for a few years and Losartan Potassium 50 mg. Recently (3/15/2021) my Doctor increased my Losartan to 50 mg from 25 mg. I took the Covid19 vaccine (moderna) 5/3/2021, 6/7/2021. I took the 2nd does of Shingrix vaccine on 6/22 and 5 hours later I have Tinnitus. I’m hoping I can lose the Tinnitus. I’m been looking at the Losartan and read your comments above in this blog. Realizing Losartan can cause Tinnitus I got my Doctor to change my blood pressure medicine (7/15) to Telmisartan starting at a low dose of 20 mg.
Thank you again for this blog. You are a beacon of light in a dark world only interested in pharmaceutical profits.
Bless You,
Glenn
Hi Glenn:
Why are you suspecting the Losartan as causing your tinnitus? Your tinnitus appeared just 5 hours after taking the Shingrix vaccine. I’d suspect it was the vaccine that cause it.
Certainly the Rosuvastatin or the Losartan could have caused it, but I suspect the Shingrix vaccine was the culprit in your case.
Cordially,
Neil
Neil,
Follow-up. Agreed you must do your due diligence in researching these medicines and vaccines, which I wish now I would have done more of.
Glenn
Dr. Bauman,
I need clarification on the type of tinnitus caused by blood pressure medications. I’m under the impression it is pulsatile tinnitus – because the BP meds affect blood flow. If I have continuous high-pitched bilateral tinnitus, am I right to conclude it is not from a BP medication?
And what are the most likely causes of this continuous tinnitus?
Can high-blood pressure itself cause it? For example, a friend told me her mother’s tinnitus was eliminated by lowering her BP with Losartan.
Also, stress is often mentioned as a cause of tinnitus. Does anyone know how this actually happens?. What does the body do when under stress that affects the ear or brain so that tinnitus is the result? What is happening precisely on a cellular, molecular level?
Thanks
Hi Al:
Blood pressure medications typically cause the common neurophysiologic tinnitus. Typically BP meds do not cause pulsatile tinnitus, but may reduce it. Pulsatile tinnitus, which incidentally, is not true tinnitus at all but a somatosound, is caused by high blood pressure among other things.
Continuous high-pitched tinnitus could very well be a result of blood pressure medications. It is commonly caused by three things–hearing loss, exposing your ears to loud noise and taking ototoxic drugs of all kinds.
Yes, it is possible that high blood pressure can cause tinnitus, but I don’t know how likely it is compared to other factors. Lowering blood pressure, if the cause of tinnitus, could eliminate the tinnitus, or at least reduce it. Just be aware that Losartan can also cause tinnitus in some people.
Stress supposedly can cause tinnitus, but I think that it most cases it just exacerbates existing tinnitus. I don’t know exactly how stress affects tinnitus. I haven’t seen any studies on the exact mechanism. However, one likely possibility is that since stress causes tension which constricts blood vessels, less blood gets to the inner ears (which have some of the smallest arteries in your body). This lack of oxygen causes the inner ear to not function optimally and that could cause tinnitus.
Cordially,
Neil
Don’t some BP medicines relax and widen blood vessels to lower blood pressure – so that if stress is constricting the vessels and causing tinnitus, then BP medicines should help counteract the effects of stress in that respect. But on the other hand are these BP meds so ototoxic that their usefulness in relaxing vessels is negated by their toxicity to the ear. Or are there some BP meds which aren’t ototoxic yet relax the vessels and possibly reduce tinnitus.
Also, you describe tinnitus resulting from exposure to loud noise. Does exposure to loud noise cause tinnitus immediately or can the tinnitus come later? Is there a cumulative effect of exposure to noise that manifests itself later in the onset of tinnitus – not at the time of exposure? Specifically in my case, I have played a pipe organ all my life, over fifty years. I’m wondering if the long term exposure to that level of sound is just now manifesting itself in my tinnitus which has become debilitating in the past couple of weeks and is continually increasing.
Thanks for your insights.
Al
Hi Al:
IF your tinnitus is a result of not enough oxygen reaching your inner ears, then a medication that relaxes your blood vessels so more blood reaches your ears could indeed help in that respect. If your tinnitus is from another cause, then those medications won’t help.
And as you know, these medications all have ototoxic side effects, so you have to weigh the supposed benefit against the many ototoxic and other side effects of these drugs and then make up your mind.
Instead of taking a drug (with all it’s side effects) to relax your blood vessels so more oxygen reaches your inner ears, why not take more benign things such as Vitamin B3 (the Nicotinic acid form) that causes a flush on your face, proving it is indeed getting more blood to your head (and ears), or something like Ginkgo biloba that also improves circulation and thus increases blood flow to your inner ears.
Exposing your ears to loud sounds can give you instant tinnitus, or it can come later as hair cells and underlying structures die as a result of broken synapses. This can take up to 2 months or so.
If the loud noise exposure causes some hair cells to die, obviously, the more often you expose your ears to loud sounds, the more hair cells that die–so it is cumulative. And since tinnitus almost always accompanies hearing loss, you get tinnitus as a result.
The other thing is that as you get older, you typically lose more and more high frequency hearing and again, tinnitus accompanies that hearing loss too.
Damage to your ears can occur slowly over time. Remember, that ear damage is the product of the volume and the length of time you expose your ears to that volume. So playing the pipe organ for half an hour at a time at a higher volume can cause less damage than playing the pipe organ for say 4 hours at a lower volume. The way it works, is for every 3 dB increase in average volume, to stay in the safe range, you need to halve the time. So taking the EPA’s standard of 70 dB for 24 hours, then you could expose your ears for 12 hours at 73 dB and for 6 hours at 76 dB and for 3 hours at 79 dB and so on. This is a conservative rate that assumes no ear damage over a lifetime of exposure at these levels.
The OSHA standard is more liberal and assumes you won’t exposure your ears to loud sounds for longer than 8 hours a day, but will over your working life, still result in some hearing loss. Their standard starts at 8o dB for 8 hours a day. Thus for 83 dB it would be 4 hrs, at 86 dB it wold be 2 hrs, at 89 dB it would be 1 hr and so on.
There are a good number of causes of tinnitus. so your tinnitus may be getting worse from one or several causes at the same time. So noise exposure, tension/anxiety and drug use could all be contributing to your tinnitus for example.
Cordially,
Neil
Hello, I got tinnitus from ace inhibitors, stopped the meds but after 1 year I still had tinnitus.
I started taking sodium thiosulfate, 2g in the morning and I had great results! In the past month I’d say my tinnitus is at only 20% when it used to be at 60-80%. Most of the time I can forget it’s even there.
Hi Tony:
That’s great that the sodium thiosulfate works well for you. I just started on an ACE inhibitor today. Which ACE inhibitor did you take and at what dose? I’m hoping I won’t have any problems and can fly under the ototoxic radar so to speak.
Where did you learn about the sodium thiosulfate? I’d like to put that information in my latest tinnitus book that I am just finishing editing–but it’s not too late to add something that is pertinent.
Cordially,
Neil
Hi, sorry I don’t remember which ACE inhibitors I took. But I’m 100% sure I didn’t have tinnitus before because I’ve used Active Noise Canceling headphones, and would always test them by listening to the scilence. I stumbeled upon sodium thiosulfate by looking for the reverse word of ototoxic which turnes out to be otoprotective. And then STS (SodiumThioSulfate. There’s actually some research on it being used with chemotherapy to prevent hearing loss. And I found a few people claiming it helped them with tinnitus. I just started taking 2g because 5g is being used for detoxing and I did not want that. But It’d be interesting if some people would try different dosages, once, multiple times daily… You could also put a few grams in to a water bottle and drink it through the the day. Taste is very bad so I ussualy use a spoon and put it on the back of my tongue and rinse with water.
Hi Neil – I have been dealing with tinnitus for eight months now. My gut tells me that it may have been caused by a loud concert, but who knows. I have had my hearing tested twice and was told that I do not have any hearing loss. Now I am seeing that beta blockers may cause tinnitus.
I have used propranolol occasionally over the last ten years for performance related anxiety. On average, I only take it once per month max – many times it’s probably only once every two months. (Typically one 40mg dose).
In your opinion, what are the chances that the propranolol caused the tinnitus after such limited use? (And after using it for ten years with no perceived negative effects). It has really been a lifesaver for my anxiety, so I am hesitant to discontinue its use.
I appreciate any insight you can provide.
Hi Sarah:
How soon after the concert did your tinnitus appear? If it was within a week or so, I’d say it was likely the loud concert. If it was 6 months later, probably not.
Traditional hearing tests give a good idea of your hearing, but they have two shortcomings. First, they do not test your high frequency hearing (above 8 kHz) and if you have hearing loss up there, you can get tinnitus as a result, even though you apparently have a “perfect” audiogram. Second, they do not test for hidden hearing loss due to damage to the “loud” nerves in the traditional frequencies tested. What they test is the softest sound you can hear by frequency–and these specific nerve fibers are not damaged by loud noise like the “loud” nerve fibers are. So you can have a lot of hearing loss that does not show up on your audiogram–but the neurons that process these sounds know, and the result is tinnitus that doesn’t seem to have anything to do with hearing loss.
Propranolol can cause tinnitus as numbers of people have reported to the FDA’s database, but I don’t have any information on whether it was caused by just taking one pill or having to take it for some time before tinnitus shows up.
I tend to think it is not the Propranolol since you have taken it for a number of years and only take one at a time and very occasionally at that.
Incidentally, I’ve received several reports from musicians that find taking Propranolol alters their pitch perception (temporarily) so everything sounds out of tune.
Cordially,
Neil
Hi Neil – Thank you for your response.
Yes, the tinnitus did appear within a week after the concert so it does seem likely that was the cause. I was awakened the evening of the concert by a ringing in my right ear. That subsided within a couple of days, but then within a week I noticed a lingering ringing in my left ear.
However, what throws me off is that a couple of months after the ringing in my left ear started, it seemed to progress to ringing in my right ear, which is more bothersome than the ringing in my left. (Now when I have a spike, it is typically one ear or the other). I wasn’t sure if it was “normal” for the tinnitus to evolve like that, or if I should be looking for a separate cause of the ringing in my right ear. Do you have any thoughts on that?
Thanks,
Sarah
Hi Sarah:
Since both ears were exposed to the concert, even though one ear initially developed tinnitus, there is no reason that the other ear couldn’t also develop tinnitus. Its not unusual for tinnitus to switch from ear to ear in some people. Mine does. Sometimes its louder in my left ear, other times my right ear, other times it is the same in both ears, and sometimes I just hear it in my head without reference to either ear. That’s just the way tinnitus can be.
It’s possible there could be another cause, but I think most likely it is due to the results of the concert.
Cordially,
Neil
Hi Neil,
I’ve been on 5mg Lisinopril for many years. Over the past two years, I’ve developed high pitched tinnitus primarily in my right ear. I’m wanting to get off Lisinopril. What are your top three high blood pressure medication recommendations that have the least likelihood of causing tinnitus or making it worse? I’m trying to find a good replacement. Thanks in advance!
Hi Tom:
Are you saying you think the Lisinopril is the cause of your tinnitus? 5 mg is a very small dose. I’ve been taking 20 mg for a number of months without any changes in my tinnitus.
To be sure, Lisinopril can cause both tinnitus and hearing loss, but it is still one of the least ototoxic BP meds in my opinion.
My top five BP meds for least risk of tinnitus for which I have much data are in this order best first: Lisinopril, Labetalol, Benazepril, Losartan, and Carvedilol.
Remember, everyone is different so a drug that causes tinnitus in you may not cause tinnitus in me (and vice versa).
Cordially,
Neil
Hi Neil,
I had thought my tinnitus was from the long term use of Lisinopril. I’m glad to know you think it’s one of the least ototoxic BP meds. Knowing that, I’ll hold off on making a change. Thanks for the info and for your top five list. Much appreciated!
Tom
Hello Neil
I was just wondering if your top 5 safest blood pressure meds for having the lowest risk of tinnitus is still the same? Is Lisinopril still your #1 recommendation?
Hi Drew:
No changes since I wrote that post. I still take Lisinopril myself so that should tell you something. Remember, I am working with very incomplete data, so I can’t be positive which are actually the 5 safest drugs, but I believe the five I list are a good step in the right direction.
Cordially,
Neil
Hello Neil,
Thank you for the wonderful and helpful advice on these comments. In the UK, NICE has three licensed Beta blockers for Heart Failure, these are: BISOPROLOL, Which is causing me bad tinnitus, the others are CARVEDIOL and NEBIVOLOL. Are these last two less ototoxic than Bisoprolol? Some reports I have read said there are benefits from Betas that cross the blood/ brain barrier, other say these are the ototoxic ones. Its confusing! Any thoughts? Thank you so much.
Hi Michael:
Of these three beta-blockers, Nebivolol is the least ototoxic in my opinion and has the fewest reports of causing tinnitus. So hopefully it will do the job and not affect your tinnitus. If it still affects your tinnitus, then it is probably time to consider a different class of drugs such as the ACE inhibitors for example.
Cordially,
Neil