Drugs and Tinnitus

Drugs and Tinnitus

• According to British Tinnitus Association, number of people who report tinnitus while taking drug is tiny, usually less than 1 people in 1000 people for most drugs for cholesterol lowering drugs, high blood pressure drugs, and most antidepressant.
• Despite that, there are small number of drugs that do cause tinnitus. In general, the dose would correlate to the worsening of symptoms.  

• Aspirin – taken in high doses
• Quinine & some other anti-malarial drugs
• Aminoglycoside antibiotics – eg Gentamicin, Amikacin
• Cytotoxic drugs – eg Cisplatin, Vincristine
• Diuretics – eg Frusemide
• Antibiotics – eg Polymixin B , Erythromycin, Vancomycin

Statin and Tinnitus

• Statin is a drug class used extensively for hyperlipidaemia.
• While some patients cite tinnitus as a statin adverse effect, but trends to tinnitus benefit have also been reported.

Can Statin Cause Tinnitus?

• In an article by (Cianfrone, 2011), out of all statins, only Atorvastatin has been linked to both tinnitus while other statins has been linked to vertigo.
• A case report by (Liu et al, 2012) reported a case of tinnitus in a 32-year old. In the case report, the man which develops tinnitus after six months of taking atorvastatin which resolves spontaneously. By 18 months however, tinnitus becomes continuous.
• By self reporting, number of reports of tinnitus following use of simvastatin is as in figure below.

*Despite many reports of drugs causing tinnitus, only few scientifically confirmed cases as tinnitus might coincide while patient is taking the medicine.  
Can Statin Cure Tinnitus?

• There are currently no FDA approved drugs to treat tinnitus. Based on article by (Salvi et al, 2009) Atorvastatin is amongst drug that is studied for treatment of tinnitus.
• Based on study by (Olzowy et al, 2007), Atorvastatin resulted in a trend toward a beneficial effect of relieving tinnitus although it was not statistically significant when compared with placebo.

 Pharmacological Justification

• Based on study by (Golomb & Meskimen, 2012), statins have both antioxidant and prooxidant effects, tinnitus effects might depend on which predominate.
• Bidirectional effects of statins on oxidative stress/energetics may contribute to variable and perhaps bidirectional effects on tinnitus.

References: 

1. Olzowy, B., Canis, M., Hempel, J.-M., Mazurek, B., & Suckfüll, M. (2007). Effect of atorvastatin on progression of sensorineural hearing loss and tinnitus in the elderly: results of a prospective, randomized, double-blind clinical trial. Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 28(4), 455–8. http://doi.org/10.1097/01.mao.0000271673.33683.7b
2. Liu, M., Alafris, A., Longo, A. J., & Cohen, H. (2012). Irreversible atorvastatin-associated hearing loss. Pharmacotherapy, 32(2), e27–34. http://doi.org/10.1002/PHAR.104)
3. Salvi, R., Lobarinas, E., & Sun, W. (2009). Pharmacological Treatments for Tinnitus: New and Old . Drugs of the Future, 34(5), 381–400. http://doi.org/10.1358/dof.2009.034.05.1362442
4. Cianfrone, G., Pentangelo, D., Cianfrone, F., Mazzei, F., Turchetta, R., Orlando, M. P., … Cianfrone, G. (2011). Pharmacological drugs inducing ototoxicity, vestibular symptoms and tinnitus: a reasoned and updated guide.
5. http://vestibular.org/tinnitus
6. http://vestibular.org/sites/default/files/page_files/Tinnitus%20Ringing%20in%20the%20Ears.pdf
7. http://www.tinnitus.org.uk/drugs-food-and-drink