by Neil Bauman, Ph.D.
A man explained:
I have had tinnitus now for 6 years. It was brought on by an inner ear infection. However I have suffered very little or no noticeable hearing loss. My tinnitus has been chronic and constant, never stopping. It is a hissing, whistling sort of pitch. Usually it is low, always noticeable to me but lately seems louder.
I was recently diagnosed with diverticulosis and my Dr. has prescribed Metronidazole and Levaquin. My question to you is, am I at risk for hearing damage or permanently making my tinnitus worse? I explained the situation to my Dr. but she affirmed that these are safe for my treatment. I am depressed because the tinnitus has been very hard for me to deal with over the past 6 years. I just want to make sure I am doing the right thing.
You are wise to check out the side effects of drugs before you take them. Metronidazole is mildly ototoxic and may cause tinnitus although I don’t think it very likely as only one source has reported tinnitus. It is not listed as causing hearing loss. I don’t think I’d worry about this drug.
However, Levofloxacin (Levaquin) is another matter. It is moderately ototoxic. In addition to my usual published sources indicating it can cause tinnitus, I’ve had a number of people tell me their stories, and for most of them it resulted in bad tinnitus. One person also reported hearing loss. So this isn’t a drug you’d really want to take since you already have enough tinnitus as it is—but of course, the choice is up to you in consultation with your doctor.
This man also asked, “If tinnitus is listed as a possible side effect to these medications, does one necessarily get tinnitus from taking them? Can I perhaps take them and not make my tinnitus worse and yet solve my other problem?”
Yes, you may take these drugs and not get tinnitus. Not everyone that takes these drugs gets tinnitus. In fact, it may be a reasonably small percentage that do get tinnitus from taking them. The real problem is knowing which group you are going to fit into—the small unfortunate tinnitus group, or the large non-tinnitus group. Since there is no way of knowing ahead of time, I warn people so they can decide for themselves whether they want to take this risk or not—especially as in your case, you already have bad tinnitus, and you don’t want to do anything to make it worse.
It looks like all the Quinolone family of which Levaquin is a member can cause tinnitus, but perhaps some of them are not as likely to cause tinnitus as are Levofloxacin and Ciprofloxacin (another common Quinolone)—I really can’t say.
Finally, this man asked:
Is there a safer medication or treatment to this?
Again, I can’t really say—remember I’m not a medical doctor—so I can’t prescribe or treat medical conditions. I just provide information to help people make more informed decisions.
However, I was looking in one of my books and it says that Cefadroxil (Duricef) is also used in treating diverticulosis—and this drug is not listed as causing tinnitus, nor have I heard any reports of people getting tinnitus from it. If your doctor agrees that this drug will do the job, it would almost certainly be much easier on your ears than any of the Quinolones. Its worth asking your doctor about it.
If you want to check out the ototoxic side effects of the Quinolones (or any other ototoxic drugs for that matter) look them up in “Ototoxic Drugs Exposed“. This book contains information on the ototoxicity of 877 drugs known to damage ears (and a number of chemicals too).
david t fuller says
Dr. Nell,
Although you are not a medical doctor you are far more informed regarding the quinolone class than the majority of the medical community. Indeed the quinolones are associated with tinnitus and hearing loss, with levaquin being by far the worse.
The side effects of the quinolone class are horrendous and may result in life long disabilities in some patients. Including spontaneous tendon and muscle ruptures as well as irreversible peripheral nueropathy, ocurring long after therapy has been discontinued.
Within the NDA for levaquin we find an adr rate (one or more reactions) of 42% within the submitted studies and a number of deaths. Whether or not these deaths were the result of the therapy is questionable.
I would invite you to log unto http://www.fqresearch.org and review the 4000 plus medical journal entries, clincal studies, case reports, post marketing, etc., that detail the safety profile of this class.
I thank you for providing reasonable warnings to this patient. The medical community has failed miserably in this regard.
Additionally Public Citizen has filed suit in Federal Court to compel the FDA to review their petition seeking “Black Box Warnings” and “Dear Doctor Letters”, regardin this class (This lawsuit was filed in January of 2008, the petition in 2006).
A similar petition filed by the Attorney General of the State of Illinois back in 2005 has also been ignored for almost three years now by the FDA and I would suspect that they are planning on filing suit as well in the near future.
Regards,
Mr. David T. Fuller
Director
Fluoroquinolone Toxicity Research Foundation
http://www.fqresearch.org
Joel says
My tinnitus problem aggravated after taking Livofloxacin for my Prostatitis condition.
Dan says
Hi there! Is it possible that Levofloxacin can cause tinnitus not only immediately, but a few weeks or months after the treatment? I took this antibiotic a few years ago, had some immediate reactions (tendinitis, paresthesia…), and 3 months later I started noticing this ringing in my ears that I still have nowadays. I didn’t link it to the antibiotic first, but after reading it’s ototoxic I wonder if it could have been the cause.
Neil Bauman, Ph.D. says
Hi Dan:
It may be possible, but I don’t have any evidence to show it does that. The tinnitus can start at the time of taking the drug, or soon after and persist for many months, but I haven’t seen any reports that indicate it starts several months later.
Cordially,
Neil
Vicki says
No one told me! I would never have taken this antibiotic if I had been informed! I first had tinnitus after Covid—it had not completely resolved. Now, it’s much worse!
Neil Bauman, Ph.D. says
Hi Vicki:
I rate Levofloxacin as a risk class of 4 (out of 5). Thus it has a high risk of ototoxicity. There are other antibiotics that are less of a risk of developing tinnitus. In the future, I’d suggest you stay away from all the fluoroquinolone class of drugs unless it is the only drug that will do the job.
Cordially,
Neil
A says
Hello, I am asking a question from another country
I’m sorry I got tinnitus after taking levoflexin tablets (since yesterday)
Will the tinnitus problem go away after I stop taking it, or what can I do to fix it sooner?
Neil Bauman, Ph.D. says
Hi A:
Tinnitus from taking Levofloxacin can be permanent–even after taking just 1 or 2 pills. So I can’t tell whether if you stop taking the Levofloxacin now will let your tinnitus fade away or not. In any case, I don’t recommend taking any of the fluoroquinolone antibiotics such as Levofloxacin unless it is a matter of life and death because of its ototoxic and other side effects. Isn’t there any other class of drugs that will do the job–perhaps the Cephalosporins?
If it were me, I’d immediately stop taking this drug, report it to my doctor, and take high doses (around 1,800 mg) of NAC (n-acetyl-cysteine) so my body could make more glutathione, it’s powerful antibiotic to kill the excess free radicals in your inner ears that are causing damage due to taking this drug. But even so, there’s no guarantee that it will stop the tinnitus–but that’s what I’d do if it happened to me.
Cordially,
Neil
A says
Hello Doctor, I am A.
After talking to your doctor, I started taking acetylcysteine tablets and took 1200 doses daily.
After 10 days of taking tinnitus, it got a little better and then I started taking Cinnarizine after consulting my doctor again.(50mg a day).
In general, from the last 20 days that I sent you the message until now, I can say that I have improved a little, but the sound is still annoying.
The first question I had was what do you suggest now?
Of course, my infection problem is almost solved and I no longer need antibiotics and I only have the problem of tinnitus.
And do you think taking cinarizine pills is effective in reducing tinnitus?
Or do you think I should take the same acetylcysteine pill?
And please tell me how it is possible to solve this problem? That is, in your patients, most cases of this sound have been eliminated or not?
Or maybe this is how many months or how long this problem will last?
This problem has become annoying because I am in a sensitive situation and I am studying.
And the doctor told me not to worry, the side effects of this pill will disappear after a few weeks, is that really the case?
And he told me that after about 10 days of taking cinnarizine pills, the problem should be solved, but there is still a problem.
Does this pill really work?
Thank you for answering my questions in full. I am really very worried and I am waiting for your answer.
Neil Bauman, Ph.D. says
Hi A:
As I said before, there is no guaranteed way to get rid of tinnitus. If may get fainter as time goes by, but it my never go completely away.
Cinnarizine is a type of antihistamine and I don’t see why it would take away tinnitus since NO drug is approved by the FDA (here) for treating tinnitus.
At this point, I think that medically, you have done what you can to try to eliminate your tinnitus. It has only been mildly successful.
Now you need to concentrate on habituating to your tinnitus. The first step in habituation is habituating to the annoyance of your tinnitus. When you do this, your tinnitus will no longer annoy you–even though it is still there. The second step is to habituate to the volume of your tinnitus so it reduces in volume and seems to fade away into the background much of the time.
In order to habituate, you must NOT think of your tinnitus as a threat to your well-being, but just as a useless background sound that it is safe to ignore–and then ignore it by focusing on the loves of your life.
When you focus on your tinnitus, you are just telling your brain that it is important (and thus a threat to your well-being in some way) and your brain cannot ignore or habituate to threats to your well-being.
Furthermore, when you think about your tinnitus it becomes louder–mine is screaming away at me right now as I write this because I am focusing on tinnitus, whereas just a few minutes ago I wasn’t aware I even had tinnitus. That’s how it works for me. Now for the good news. In less than 5 minutes, after I finish this post (and assuming that I do not have to answer another post on tinnitus, my tinnitus will again fade away into the background. That is how well habituated I am to my tinnitus. Even so, my “screaming” tinnitus does not annoy me at all. It is just there. I don’t get upset over it, so whether I hear it loud, or soft or am not even aware of it makes no difference. It is just not an issue for me. You want to learn to do the same, and you can.
Cordially,
Neil
Dan says
I think this answer is very accurate. I feel more or less the same with my tinnitus: it’s annoying when I pay attention to it, and it feels as if there’s something wrong within my ears, but I stop noticing it as soon as I focus on other things.
Andy says
My wife already has tinnitus. She just started taking Levofloxacin a couple days ago. Tonight she suddenly lost hearing in one ear. We can’t think of any other cause for this sudden change.
Neil Bauman, Ph.D. says
Hi Andy:
It’s possible the Levofloxacin caused the sudden hearing loss. I’ve had reports of hearing loss over 3 weeks, but not overnight so to speak. However, I just checked about Ciprofloxacin (a close relative of Levofloxacin) to see whether it causes hearing loss more quickly and found that a number of people have reported hearing loss and tinnitus about 3 days later–so that fits right in with your wife’s time frame. One lady reported, “After taking Cipro, I suddenly and completely lost hearing in one of my ears such that I could not even hear my own voice.” This seems very similar to your wife’s experience.
Therefore, I wouldn’t be at all surprised that Levofloxacin can have the same sudden hearing loss in three days as does Ciprofloxacin since drugs in the same class often have similar side effects.
Cordially,
Neil