Naltrexone as a Tinnitus Treatment

[Tasty]

Nope, 2 mg 1st thing w/glass of water. Long half life. Splitting dose barely matters.

I wouldn't say it got worse as much as I got sick of dealing with it unmedicated and then having kids pushed me completely over the edge of "drugs are fine, probably".

Hey, I tried Clonazepam today, 0.25 mg, it did nothing lol.

 

[Hottopic29]

Did you ever get around to trialing high dose Curcumin?

What's a high dose? More than the recommended one?

 

[DebInAustralia]

What's a high dose? More than the recommended one?

I'd say up to 2000 mg or more.

 

[Nick47]

Hey, I tried Clonazepam today, 0.25 mg, it did nothing lol.

Wait 12-24 hours.

 

[Tasty]

Wait 12-24 hours.

Nothing happened lol, I dunno.

 

[EDDTEKK]

I stopped Naltrexone after 8 weeks because it had no effect on my tinnitus.

 

[DebInAustralia]

Nothing happened lol, I dunno.

Then perhaps your issue isn't GABA.

Have you considered the possibility that it might be neuro/cochlear inflammation and/or potassium channel involvement?

 

[DebInAustralia]

I stopped Naltrexone after 8 weeks because it had no effect on my tinnitus.

I'm sorry to see this didn't help you.

Are you going to try higher doses?

 

[linearb]

Hey, I tried Clonazepam today, 0.25 mg, it did nothing lol.

I take almost ten times that dose, and it bioaccumulates substantially (30 hour half life) such that taking 2 mg a day ends up equaling a blood level similar to a ~10 mg single dose.

I'm not encouraging anyone to use benzos, but 0.25 mg of Clonazepam would do very, very little for me even before I had a significant tolerance it took 2-3x that to feel any relief. And, again, I do think the Gabapentin seems to be an important part of this for me.

 

[EDDTEKK]

Are you going to try higher doses?

No. I don't see any hope that a higher dosage would have any effect.

 

[DebInAustralia]

No. I don't see any hope that a higher dosage would have any effect.

I'm thinking of trying MSM.

Maybe consider it?

 

[Tasty]

Then perhaps your issue isn't GABA.

Have you considered the possibility that it might be neuro/cochlear inflammation and/or potassium channel involvement?

I honestly do not know, maybe inflammatory, since I had this issue from age 3 or even earlier on.

VSS included. I'm quite skeptical since VSS seems to be majorly a GABA issue:

Visual Snow: Updates on Pathology

 

[Tasty]

I take almost ten times that dose, and it bioaccumulates substantially (30 hour half life) such that taking 2 mg a day ends up equaling a blood level similar to a ~10 mg single dose.

I'm not encouraging anyone to use benzos, but 0.25 mg of Clonazepam would do very, very little for me even before I had a significant tolerance it took 2-3x that to feel any relief. And, again, I do think the Gabapentin seems to be an important part of this for me.

I'll try 0.5 mg over the next days. Maybe it will do something but who knows. If not, I'll try the Gabapentin.

 

[Nick47]

I'll try 0.5 mg over the next days. Maybe it will do something but who knows. If not, I'll try the Gabapentin.

Did the higher dose help this time?

 

[Travis Henry]

I take almost ten times that dose, and it bioaccumulates substantially (30 hour half life) such that taking 2 mg a day ends up equaling a blood level similar to a ~10 mg single dose.

I'm not encouraging anyone to use benzos, but 0.25 mg of Clonazepam would do very, very little for me even before I had a significant tolerance it took 2-3x that to feel any relief. And, again, I do think the Gabapentin seems to be an important part of this for me.

How bad is your tinnitus without the current dosage you are on?

What time do you take the meds? And what is your dosage of Clonazepam and Gabapentin?

I am at the end of my rope with how loud and reactive my tinnitus is and I am trying to stay on this planet.

 

[Nick47]

What time do you take the meds? And what is your dosage of Clonazepam and Gabapentin?

@linearb takes 2 mg Clonazepam and 600 mg Gabapentin. First thing in the morning with a glass of water.

Hope I saved @linearb some time as I see he gets asked this a lot.

 

[KP26]

@linearb takes 2 mg Clonazepam and 600 mg Gabapentin. First thing in the morning with a glass of water.

Hope I saved @linearb some time as I see he gets asked this a lot.

Do you know how long he's been taking it?

 

[Nick47]

Do you know how long he's been taking it?

5 years.

 

[Ela Stefan]

600 mg Gabapentin

How does Gabapentin help tinnitus? Is it not for pain problems?

 

[2noist]

How does Gabapentin help tinnitus? Is it not for pain problems?

Look for Abraham Shulman tinnitus protocol. He used Clonazepam + Gabapentin combo successfully on tinnitus patients.

 

[Nick47]

Look for Abraham Shulman tinnitus protocol. He used Clonazepam + Gabapentin combo successfully on tinnitus patients.

@2noist, have you ever tried this protocol?

 

[linearb]

5 years.

Thanks

Yes this comes up so much and I feel bad because I genuinely believe this drug combination is pretty dangerous and also statistically unlikely to help ~any given tinnitus sufferer~ as much as it helps me because of all the specific stuff about my backstory that feeds into that.

I will probably attempt to taper the Gabapentin soon and see what happens.

 

[linearb]

Look for Abraham Shulman tinnitus protocol. He used Clonazepam + Gabapentin combo successfully on tinnitus patients.

This is also what led me to this, combination, but, again it also has a lot to do with my personal medical history and history with benzos. That said, I would hardly say there's strong evidence.

We had this preliminary report in 2002 that put this on people's radar:

GABAA-benzodiazepine-chloride receptor-targeted therapy for tinnitus control: preliminary report

Interesting, but hardly equivocal. 30 patients, with a 30% dropout rate (inherently casting doubt on claimed efficiency by at least that amount). The duration of effectiveness varied wildly, with some people seeing the effect wear off within a couple months. No control group, no RCT.

Also Shulman, 2002:

Benzodiazepine receptor deficiency and tinnitus

It provides some evidence people with tinnitus may have less benzo receptors in critical places. Again, interesting, but if this is correct then the effect of treating such people long term with drugs that manipulate the BDZ receptor "needs much study", since chronic BDZ use triggers downregulation.

So, then in 2006 we got this:

Benzodiazepines and GABAergics in treating severe disabling tinnitus of predominantly cochlear origin
(PDF - Full Text)

Still only 30 patients, but somewhat better design, 10 control (group 1), 10 benzo (group 2), 10 benzo + gabaergic (group 3). This references the earlier Shulman work, it's literally an attempt to reproduce the results with a more sound methodology, and this is where it concluded:

intensity and annoyance were significantly decreased in groups 1 and 3 as compared to group 1, but no statistically significant difference was detected between groups 2 and 3 (Tables 4–12). Two patients in group 1 experienced an increase in tinnitus intensity (see Table 4). Four patients in group 2 experienced drowsiness and nausea, and two patients had sexual dysfunction (clonazepam). Five patients in group 3 reported drowsiness and nausea, and two noticed interference with cognition (clonazepam and gabapentin).

Do these numbers look compelling enough for you to want to try a generally dangerous combination of controlled substances?

From "discussion":

Shulman et al. selected patients with SDT and brain perfusion changes detected by SPECT. They did not mention any otological disease affecting their patients. Our patients had SDT associated with otological diseases that are known to produce tinnitus. Therefore, it is reasonable to say that their symptom was of a predominantly cochlear origin. Another major difference between our patients and those of Shulman et al. is the fact that almost all their patients had psychiatric problems (e.g., depression, anxiety, and fear severe enough to require specialized medical care). None of our patients needed psychiatric treatment. Shulman et al. selected patients with SDT "predominantly central in origin" and showed the positive effect of treatment with benzodiazepines (clonazepam) and GABAergic (gabapentin) drugs, as seen both in the reduction of SDT and on the SPECT results: The brain perfusion was enhanced after treatment. We selected SDT patients with tinnitus of a predominantly cochlear origin; we compared the effect of placebo, benzodiaepines alone, and benzodiazepines combined with a GABAergic drug; and we found that the addition of GABAergic drugs does not enhance the results obtained with benzodiazepine drugs alone. The discrepancy between Shulman's results and ours may be due to the different patient populations but, to be sure about that, it is necessary to study patients with SDT of a predominantly central origin, comparing the results of placebo, benzodiazepines alone, and benzodiazepines combined with GABAergic drugs

So, sounds like a big wet fart to me. Also I am firmly in the camp of "preexisting anxiety disorders" which would make me look somewhat like Shulman's sample group, and not at all like someone with severe idiopathic tinnitus and no prior psychological discomfort.

All in all -- I'd say the evidence that this works in any general or broad way simply doesn't exist, and the existing data strongly implies to me that most people with tinnitus will NOT benefit from this combination.

It's also somewhat hard to get put on benzos long term, and if you do and then decide you want to get off that's even harder...

 

[Brian Newman]

Thank you Uklawyer.

I can still hear the whisper depending on how noisy the environment is. It's what is referred to as "head noise" commonly in the forums. My church is one open room with about 100 people all talking. I was speaking to another tinnitus sufferer telling them about the Naltrexone and I noticed that I had to "search" for the noise and even when I did I wasn't sure that I actually was hearing it in that environment.

Prior to Naltrexone even when I had the bath water running full blast in the tub with my head over the side next to the gushing water it was still easily heard. Un-maskable at any safe level. I heard it over my zero turn mower (granted with both earplugs and earmuffs on.)

I still have 24/7 tinnitus. I still wear earmuffs in Church while we are singing. I will continue to take all the same old precautions. The volume is just lowered and I went from electrical train brakes, electrical frying pan, cicadas, and multi low and mid pure drone type tones to a small electrical whisper. Like a pure high tone now. It is very "small". I can imagine for some it would be horrible but for me, starting out with horrendous tinnitus caused by SSHL from drugs that sounded and felt like an electrical wet saw cutting through the back of my head, this is nothing. I went from bad days of tinnitus being so loud I could not hear my own voice when I spoke quietly to having to listen for it in a crowded room of talking people. It still fluctuates a little especially when I wake at night it seems to be louder, but when I wake up and get ready for work it's back down to the 2/10.

If you try it, don't let fluctuations scare you from continuing. I had 2 terrible spikes, louder than I have ever heard hit me at the beginning of all this. They only lasted about an hour a piece. Even after suffering panic attacks, the relief was so great I decided it was worth it to continue on. That is a testament to how much of a difference it has made so far for me. I do not hear silence but I do not suffer like I did. I could compare my experience like this: If tinnitus was a sharp object, then prior to Naltrexone I was being stabbed by a kitchen knife in the lower back, as to were now I am getting a shot in the arm with a butterfly needle.

That's interesting because I stopped taking Naltrexone the first time because I had a nasty spike, then hours later it was gone. It seems to keep doing that. I'm only on 0.5 mg, going to work my way up. Before I tried 1.5 mg. I get random spikes, then it goes away randomly. Trying it for noxacusis so let's see if I get pain relief.

 

[David Vance]

Yes. It has definitely lowered my tinnitus. I had tones "in both ears" prior. The right side is silent now and it lowered the volume of my overall tinnitus. 50 mg was too much and i suffered from panic attacks again while on that dosage. 25 mg is working good. I will most likely go to low dose in a month or so and ride that dosage until I run out. This has not cured me, but it is definitely a therapeutic in my case. I will fight to stay on this for life if my tinnitus returns to full strength after running out of meds.

What caused your tinnitus? I am trying to ask my doctor about Naltrexone for tinnitus.

Thanks!

 

[Johnny Karate]

What caused your tinnitus?

Ototoxic drugs and noise exposure.

 

[Fightthearmy]

Look for Abraham Shulman tinnitus protocol. He used Clonazepam + Gabapentin combo successfully on tinnitus patients.

So why aren't ENTs talking about it, why aren't we on it?

 

[Lane]

why aren't we on it? [Clonazepam + Gabapentin]

Because of the potential "side effects", some of which can be fairly catastrophic.

 

[Nick47]

So why aren't ENTs talking about it, why aren't we on it?

Lots of reasons:

• Dependence
• Tolerance
• Withdrawal
• Sustainability
• Side effects

They were not followed up for more than a year... tough choices.

 

[Fightthearmy]

Because of the potential "side effects", some of which can be fairly catastrophic.

Alcohol has some catastrophic side effects, and none of it potential. Should you drink a lot instead to help you cope? I'm not sure, I haven't had a drink for ages.