Tinnitus Control by Dopamine Agonist Pramipexole in Presbycusis Patients

Tinnitus control by dopamine agonist pramipexole in presbycusis patients: A randomized, placebo-controlled, double-blind study

Objectives/Hypothesis:
Since the concept of tinnitus dopaminergic pathway emerged, studies have been proposed to investigate if dopaminergic agents influence tinnitus. We hypothesized that pramipexole, an agonist on D2/D3 receptors, may antagonize tinnitus in the presbycusis patients (in the frequency range of 250 to 8,000 Hz) in a dose schedule accepted for the treatment of Parkinson's disease in elderly people.

Study Design:
We designed a randomized, prospective, placebo-controlled and double-blind trial.

Methods:
Forty presbycusis patients aged 50 years or older with subjective tinnitus were randomized to two groups (20 patients in both). Patients in the drug group took pramipexole over a period of 4 weeks according to a treatment schedule as follows: week 1, 0.088 mg t.i.d.; week 2, 0.18 mg t.i.d.; week 3, 0.7 mg t.i.d.; week 4, 0.18 mg t.i.d. over 3 days and 0.088 mg t.i.d. the rest of the week. Patients in the second group received placebo. Determination of subjective grading of tinnitus perception, the tinnitus handicap inventory (THI) questionnaire and electrocochleography (ECOG) examinations served as the end points. Subjective audiometry was used to produce secondary data. A significant improvement in tinnitus annoyance is found in the group treated with pramipexole versus placebo with respect to inhibition of tinnitus and a decrease of tinnitus loudness greater than 30 dB. However, neither ECOG nor subjective pure-tone threshold audiometry revealed any change in hearing threshold in response to either pramipexole or placebo.

Conclusions:
Pramipexole is an effective agent against subjective tinnitus associated with presbycusis at a dose schedule used for the treatment of Parkinson's disease. The drug did not change hearing threshold.

 

Pramipexole is also used by bodybuilders and for treating erectile dysfunction. Maybe I could kill two birds with one stone.

 

My doctor has really tried to help me with my tinnitus. I showed him the article in the Tinnitus magazine and the research to back it up and he said I cannot see that it would hurt to try pramipexole 0.125 mg at the dosage used for someone with Parkinson disease. That was about a month ago. I do believe it has helped reduce my tinnitus. I will continue to take it for a month or two to see what kind of results I may get.

 

Gene, thanks for the report. I'm interested to see how this goes for you in the longer term. Is your doc an ENT? Please keep us updated with your outcome.

 

This study looked at tinnitus from hearing loss associated with aging. It might not work for other types of hearing loss, such as noise-related--but it would not hurt to try the drug.

If anyone tries this drug, please tell us and note what caused your tinnitus (noise, aging, barotrauma, a combination of factors, etc.)

 

I did some research on this recently. The theory I read, dating back to 2009, is that as we get older, a change occurs to our ability to deal with oxidative stress affecting the DCN. The study specifically stated that the change makes the voltage-gated potassium channels subject more susceptible to dysfunction. It suggested that there might be a way to fix the sensitivity chemically. It wasn't a tinnitus study, just something about presbycusis, but it suggests to me that aging-, stress-, and noise-induced tinnitus are all really just STRESS-induced.

Doesn't really suggest that pramipexole will be effective, but in my mind, the cause of tinnitus may not be as important a factor.

 

I wholeheartedly agree. The common theme is overexcited neurons.

Quell the neurons that need quelling and the tinnitus will be lowered.

 

I know a person who took Pramipexole and it diminished/lowered their tinnitus effectively.

The summary of the case is:

• The dosage the man used was 0.25 mg pill 3x / day
• He also used Amitriptyline as a med next to Pramipexole (this combination of meds could also be important for his experience)
• The effect seemed to wear off after some time but let him experience real silence (ohhh that would be great...) a couple of times in the beginning (he had lived for 12 years with tinnitus till then)

Hope this helps some of you.

 

Just for anyone reading this thread that wants to try a more natural approach - Mucuna Pruriens. It's a natural herb, helped with Parkinson's in some studies (which means it may have some similarities to Pramipexole).

Also found study where it showed efficacy for epilepsy:

Anticataleptic and antiepileptic activity of ethanolic extract of leaves of Mucuna pruriens: A study on role of dopaminergic system in epilepsy in albino rats

 

I found this.

NOW DOPA Mucuna, 90 Veg Capsules:

https://www.amazon.com/dp/B001QG5F0W/ref=cm_sw_r_cp_api_gapDzbXWTN4JX

 

Did you try it?

 

NOW Dopa Mucuna spikes tinnitus... I tried it and had to stop it.

It's here in the causes section, “levodopa”:
http://www.advocaremainlinepeds.com/Tinnitus

 

So the Parkinson's drug that acts on dopamine is no good either?

 

I tried both Mirapex (Pramipexole) and Levodopa. They didn't do anything at all for my tinnitus one way or the other.

 

Pramipexole works for me.

 

@GBB, what exactly was the effect of Pramipexole for you?

 

Curious as well. How did Pramipexole help you? How long did it take to see effects?

 

It made the noise smoother and a little quieter. It probably took 1-2 weeks for me to notice changes. I personally would look and am still trying other drugs (though still on Pramipexole). Although it has a modest effect, it's not a silver bullet.

I should clarify, I think my tinnitus is nerve related (I have never had hearing loss either on a chart or anecdotally).

 

I hear ya! I have no hearing loss either (on an extended audiogram I can hear up to my related age) and think mine is nerve related possibly. I am scheduled to get a stellate ganglion block on the 27th.

Stellate Ganglion Block for the Relief of Tinnitus in Vibration Disease

 

Can you tell me how the Stellate Ganglion Block went? Did it help the tinnitus?

 

I spiked the first day or two. Have not noticed much improvement and had 2 done, one on each side.

 

When you say your tinnitus is nerve related, do you refer to nerves other than the auditory one, and if yes, which one/ones?

I take Rivotril (Clonazepam) for sleep and I know this is also an epilepsy medication? I know you were trying out Keppra. Did it help? Do you have to take it all the time and do you have to raise the dosage as well? I was thinking of trying it out but if you are an old tinnitus sufferer, I don't know how much it could help.

 

Keppra helped my reactivity but didn’t eliminate it. I think reactivity might be nerve related but I could be wrong. A lot of my tinnitus used to be accompanied by tangible nerve sensations so that’s why I thought that.

 

Can you please elaborate more on what is tangible nerve sensations? I started with 250 mg of Keppra but I have the sensation it is making my tinnitus more intrusive, more intense. Don't know if I should continue taking it or to stop.

Is your tinnitus much better than in the beginning and would you give Keppra and Pramipexole credit for that?

 

Sure, regarding tangible nerve sensations, certain sounds would literally make the inside of my ear feel like deep inside there was a wriggling/tickling sensation which almost drove me insane after months on end of nonstop stimulus. Similarly, certain high frequency noise would make me get throat tightness or tingling in my jaw. It’s not imaginary - I could reliably induce this with certain kids of noise.

Neither Keppra nor Pramipexole made me worse at all when I started them (Pramipexole gave me terrible nausea for the first 24 hours but this is well known as a side effect). If either are making you worse it may not be effective for you.

I am moderately better but not sure how much credit the meds get - all I can say is if I miss a dose or try to taper down my symptoms go back to their old hell levels, so my inference is they help. Also my reactivity still shows up, for example I used to get crazy ringing from riding my Peloton with a fan for 30 minutes or showering, and that could last a week - now I can ride longer and shower more frequently with more brief spikes, but it’s still there, just with more “generous” allowances.

 

Please let me know how that goes!

 

Did you do the Stellate Ganglion Block for tinnitus or hyperacusis?

 

Tinnitus. No improvement from the two SGB's.

 

Are you still taking the Keppra? Did it help at all with the tinnitus? My neuro at the Mayo Clinic wants me to try Keppra for my visual snow syndrome, but all I really care about is lowering the tinnitus. The static, floaters, halos etc have nothing on the intrusive high frequency scream in my head all the time. Curious if Keppra could be helpful for that. I’m also considering trying Pramipexole.

 

No, it didn't help me!