Ototoxic Drugs — Are There Safe Amounts You Can Take?

[MichaelP]

Hi Dr Nagler,

I just wondered whether there are safe amounts you can take of certain drugs that are listed as ototoxic?

In particular, I'm referring to Ibuprofen, as I would often take this drug if I have inflammation from an injury or a bad headache (as it works much better than, for example, paracetamol for me).

Likewise other common drugs like Aspirin.

I believe I most likely have noise induced tinnitus, if it is relevant to the question.

Thank you for your help.
Michael

 

[Dr. Nagler]

Hello @MichaelP -

Thank you for your excellent question, a question that really gets to the core of the kinds of decisions tinnitus sufferers frequently face in an effort to responsibly and safely sail through murky waters.

As I read and re-read your question, the issue that immediately came to mind is ... what does MichaelP mean by "ototoxic?" Is he using the term in the sense of "drugs that can actually cause permanent auditory damage," or is he concerned about "drugs that might possibly cause a temporary increase in tinnitus loudness without actually causing damage?" I ask because there are about a gazillion drugs that might possibly cause a temporary increase in tinnitus loudness without causing any damage, and for each of these gazillion drugs there is so much variation among individuals with respect to dose that just trying to figure it all out is enough to make your head spin (or make your ears ring!)

Which is why I myself prefer to stay away from the term ototoxic altogether.

The way I have come to look at it, no dose is safe for drugs that can cause permanent auditory damage at normal recommended doses; they should all be avoided at all doses unless there are truly compelling indications and no safe alternative can be found.

But as far as the countless drugs that might possibly cause a temporary increase in tinnitus loudness at or below maximum allowable daily doses without causing auditory damage go, drugs like aspirin and ibuprofen, to my way of thinking it's simply a question of trial and error. I mean, living your life with an eye to avoiding anything and everything that might possibly temporarily aggravate your tinnitus is no way to live your life at all. For goodness' sakes, even the stress of making certain you avoid anything and everything that might possibly temporarily aggravate your tinnitus will temporarily aggravate your tinnitus! So I don't worry about it. If aspirin or ibuprofen taken for headache relief seem to aggravate your tinnitus, (1) take less next time, (2) try a different drug next time, or (3) put up with the temporarily increased tinnitus. That's my personal approach, anyway.

With respect to which "Drugs To Avoid" because they can actually cause auditory damage at recommended doses, please see the attached pdf file.

Hope this helps.

Stephen M. Nagler, M.D.