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Drugs and hearing loss Drugs and hearing loss This factsheet is part of our Ears and ear problems range. It is written for people who would like to find out more about ototoxic drugs – these are drugs that can occasionally cause hearing loss. Read this factsheet to find out: What are ototoxic drugs? How might ototoxic drugs cause hearing loss, balance problems and tinnitus? Should I change my medication? What is being done to make ototoxic drugs safer? What about aspirin? What about antibiotics? What about drugs used for treating cancer? What about diuretics? What about antimalarial drugs? Where can I get further information? If you would like this factsheet on audio tape, in Braille or in large print, please contact our helpline – see front page for contact details. Medical disclaimer You should not change the dose of any medication you are taking, or stop taking it, as a result of reading this factsheet, unless the doctor who prescribed the medication agrees it is safe to do so. If you have any questions about any medication you are taking, or are about to take, speak to your GP or pharmacist. What are ototoxic drugs? The word ‘ototoxic’ derives from the Greek terms for ear and poisonous. Ototoxic drugs may cause damage to the inner ear, resulting in hearing loss, balance problems and tinnitus. Tinnitus is the medical term to describe noises that people can hear in one ear, both ears or in the head, such as ringing, buzzing or whistling. The sounds can vary from person to person, but the common link is that they do not have an external source. See our tinnitus factsheets and leaflets for more information. Drugs and hearing loss, Action on Hearing Loss Information, May 2012 2 Over 100 classes of drug have been associated with ototoxicity. However, they are not usually given as a medicine that you need to take regularly. Many of the drugs described here are only ototoxic if taken in a large or excess dose. However, some are used in situations to try to save life. How might ototoxic drugs cause hearing loss, balance problems and tinnitus? Hearing loss Ototoxic drugs damage the following areas: The structures of the inner ear, like the hair cells, and/ or The auditory nerve, which carries sound information to the brain. Hearing loss caused by problems with the sensory cells or the hearing nerve in the inner ear is known as sensorineural hearing loss. Sensorineural hearing loss is usually permanent. Other drugs can cause temporary hearing loss. For an explanation of how the ear works, see our leaflet about how to take care of your ears. Balance problems Sometimes, ototoxic drugs can damage the balance system in the inner ear, leading to dizziness and/or balance problems. For more information, see our factsheet Dizziness and balance problems. Tinnitus Tinnitus can be a side effect of ototoxic drugs. It is often the first sign that your hearing may be damaged. Should I change my medication? If you think that a drug you are taking is causing hearing loss or making your existing hearing loss worse, you should discuss this with your doctor before you decide to reduce the dose or stop taking the medication altogether. If you are convinced that a particular drug is causing your hearing loss, your doctor may be able to prescribe another drug that does not affect your hearing in the same way. There is usually more than one drug available to treat most conditions. If this is not possible in your case, you will have to decide whether the benefits of taking the drug outweigh the possibility of permanently damaging your hearing. Drugs and hearing loss, Action on Hearing Loss Information, May 2012 3 You should only come off a drug if you have talked about it with your doctor first. You should go back to your doctor if you have withdrawal symptoms. You may be able to take the drug at a lower dose for a while, and then reduce the dose gradually. What is being done to make ototoxic drugs safer? We are funding research into how ototoxic drugs can cause hearing loss and how to prevent them doing so. For more information about progress in this area, see the biomedical research section of our website. What about aspirin? Aspirin is a drug taken to: treat colds, period pain, headaches and joint or muscular aches reduce fever help the symptoms of arthritis help prevent blood clots from forming. What are the side effects of aspirin? When taken in its correct dose, aspirin is very unlikely to cause side effects. If taken in a large dose or an overdose, aspirin sometimes causes the following side effects: tinnitus nausea digestive problems dizziness sweating. These side effects are usually temporary and should disappear if you stop taking aspirin. For more information about tinnitus and aspirin, read our factsheet Drugs, stress and tinnitus. Can aspirin cause hearing loss? There is little evidence that aspirin causes permanent hearing loss. If your doctor has prescribed aspirin for you, you can always discuss changing the dose before you go ahead. What about antibiotics? Antibiotics are a group of drugs that treat bacterial infections, ranging from quite mild infections to serious, life-threatening diseases. Drugs and hearing loss, Action on Hearing Loss Information, May 2012 4 Which antibiotics cause hearing loss? The group of antibiotics that are most likely to cause hearing loss are aminoglycosides. These include: gentamycin streptomycin neomycin. These antibiotics are often used to treat serious or life-threatening bacterial infections such as tuberculosis (TB). They are sometimes prescribed when a bacterial infection does not improve after treatment with antibiotics that are not in the aminoglycosides group. What are the risks of using drugs from the aminoglycosides group? The risk of hearing loss from aminoglycosides can increase, depending on: how high your dose is how long you take it for whether you are given it by injection. If you are prescribed aminoglycosides, you should be aware of the risk of permanent damage to your hearing. The effects are usually monitored when you are in hospital by regular blood tests to estimate how much of the drug is in your bloodstream. Aminoglycosides are generally prescribed to treat serious, life-threatening diseases, where saving your life is judged more important than the possible risk of damaging your hearing. What about drugs used to treat cancer (cytotoxic drugs)? Cytotoxic drugs are a group of drugs that destroy cells or prevent their regrowth. These drugs are mainly used to treat cancer, through chemotherapy. Cytotoxic drugs attack healthy cells as well as cancerous ones, so they can cause a variety of side effects. Can cytotoxic drugs cause hearing loss? A group of cytotoxic drugs can cause hearing loss. These include: Carboplatin – mainly used to treat ovarian cancer and lung cancer. Cisplatin – mainly used to treat ovarian, testicular, lung or bladder cancer. Oxaliplatin – mainly used to treat bowel cancer. It is thought that carboplatin is less ototoxic than cisplatin, although all these drugs can cause permanent damage to hearing. Drugs and hearing loss, Action on Hearing Loss Information, May 2012 5 Cytotoxic drugs are often used in combination with other drugs, which can affect the severity of hearing loss, depending on which drugs are used together. If you are prescribed cytotoxic drugs, the effects will be carefully monitored. Tell your doctor immediately if you are taking these drugs and you: Develop tinnitus. Start to feel unsteady. Have difficulty hearing. These signs can be the first indication of hearing loss as a result of taking ototoxic drugs. What about diuretics? Diuretics are a large class of drugs that increase the amount of urine produced by the kidneys. Diuretics are used to treat conditions in which fluid builds up in the tissues. These include heart and kidney failure and some liver diseases. Diuretics may also be used to treat high blood pressure. Which diuretics can cause hearing loss? Of the commonly used diuretics, only loop diuretics are known to cause hearing loss. They are called loop diuretics because they work in the region of the kidney known as the loop of Henle. Loop diuretics are commonly used to treat a build-up of fluid – for example, if you have a heart attack. Examples of loop diuretics are furosemide (also known as frusemide), torasemide and bumetanide. Loop diuretics are usually taken by mouth, but you may be given them by injection. Loop diuretics are usually only ototoxic when they are given in large doses by injection in lifethreatening situations. If you already have hearing loss and balance problems, you should tell your doctor, as it would be better for you to receive treatment with diuretics that do not have ototoxic side effects. What about antimalarial drugs? Malaria is a parasitic disease spread by the bites of infected mosquitoes. Antimalarial drugs should be taken before, during and after a visit to an area where malaria is common. They can also be taken as treatment for malaria. There are many types of antimalarial drugs available, which have different side effects. Some common side effects of antimalarial drugs include tinnitus, headaches, nausea, dizziness, sleep disorders, anxiety and depression. Drugs and hearing loss, Action on Hearing Loss Information, May 2012 6 For more about the relation between antimalarial drugs and tinnitus, read our factsheet Drugs, stress and tinnitus. Can antimalarial drugs cause hearing loss? In rare cases antimalarial drugs such as chloroquine and quinine, can cause hearing loss, although there isn’t currently enough evidence around this. Chloroquine is one of the oldest antimalarial medicines and many strains of malaria are now resistant to it. The risks of any side effect from antimalarial drugs may be greater if you actually get malaria and are given high doses to treat the disease. Patient information leaflets warn against hearing loss if you take an overdose of the medication. Risks of side effects are lower when you take lower doses to stop you from getting malaria in the first place. If you are about to travel to an area where malaria is common and are concerned about the possible side effects of antimalarial drugs, you should discuss this with your doctor. You should balance the risks of the side effects against the chance of getting malaria. Where can I get further information? Our helpline offers a wide range of information on many aspects of hearing loss. You can contact us for further copies of this factsheet and our full range of factsheets and leaflets – see the cover page for contact details. Action on Hearing Loss Information, May 2012 The Royal National Institute for Deaf People. Registered Office: 19-23 Featherstone Street, London EC1Y 8SL. A company limited by guarantee registered in England and Wales No. 454169, Registered Charity Numbers 207720 (England and Wales) and SC038926 (Scotland). Drugs and hearing loss, Action on Hearing Loss Information, May 2012 7