Medicines that can cause tinnitus: what the evidence says and what to do

First: never stop a prescribed medicine on your own

If you suspect that a medicine is causing or worsening your tinnitus, talk to the prescriber or a pharmacist before changing anything. Many of the medicines involved treat serious conditions, and stopping them abruptly can do more harm than the tinnitus. The rest of this guide explains what is known, so that the conversation is a well-informed one.

Which medicines are involved

The US National Institute on Deafness and Other Communication Disorders (NIDCD) lists tinnitus as a possible side effect of certain medications, especially at high doses, and names non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and aspirin, certain antibiotics, anti-cancer drugs, anti-malaria medications and antidepressants. The NHS gives a similar list: some chemotherapy medicines, antibiotics, NSAIDs and aspirin. Being on these lists does not mean a medicine will cause tinnitus in you. It means the association is known and worth mentioning to the person who prescribes it.

Dose and frequency matter

Most of these effects depend on how much and how often. Aspirin is the best-studied example. A 2000 review by Cazals describes tinnitus, a slight to moderate loss of hearing sensitivity and altered perception of sounds after large doses of salicylate, developing over the first days of treatment and reversible within a few days of stopping. It also notes that people vary notably in their susceptibility. An occasional tablet for a headache is a different situation from high daily doses.

What a large study found for everyday painkillers

The Nurses’ Health Study II followed 69,455 women aged 31 to 48, who had no tinnitus at the start, from 1995 to 2017. Curhan and colleagues found that frequent low-dose aspirin use was not associated with a higher risk of persistent tinnitus. Frequent moderate-dose aspirin was linked to a higher risk among women under 60, and frequent use of other NSAIDs or of paracetamol (acetaminophen) was linked to a modestly higher risk among all the women, with risk tending to rise with frequency of use. Use and symptoms were self-reported, the reasons for taking painkillers were unknown, and the authors call for studies in men and in non-White women. These are associations, not proof that the medicines caused the tinnitus.

Which effects fade, and which may not

A 2017 review of drug-induced ototoxicity by Lanvers-Kaminsky and colleagues notes that the ear toxicity of many drugs resolves after treatment is stopped, but that platinum-based cancer drugs and aminoglycoside antibiotics are associated with permanent hearing loss. The review also discusses methods for detecting effects on hearing early. For those treatments, the decision belongs to the medical team, which weighs the risk to hearing against the condition being treated. If you are starting one, ask whether your hearing will be checked during treatment.

Signs that need a doctor quickly

Whatever medicines you take, some situations are urgent. The NHS advises going to A&E, or calling 999 in the UK, if tinnitus follows a head injury, or comes with sudden hearing loss, weakness in the muscles of the face or a spinning sensation (vertigo), and to bring any medicines you take with you. It also advises asking for an urgent GP appointment if the tinnitus beats in time with your pulse. Outside the UK, use your local emergency and doctor services in the same situations.

Build a timeline before the appointment

The most useful thing you can bring is a timeline: when the tinnitus started or changed, which medicines you started, stopped or changed around that time, and any over-the-counter painkillers or supplements you take regularly, with how often you take them, since frequency matters. Bring the boxes or a list with the exact names and doses. This lets the prescriber see whether the timing fits and whether an alternative exists.

Questions to ask the prescriber or pharmacist

Is tinnitus a known side effect of this medicine? Could the dose or the timing be changed? Is there an alternative with a lower risk for my ears? If this medicine is the cause, is the effect likely to fade after stopping? Should my hearing be checked during treatment? A pharmacist can often answer the first questions on the spot, especially for products sold without a prescription.

Over-the-counter painkillers deserve attention

Painkillers bought without a prescription are easy to forget when you list your medicines. If you take them several days a week, say so, and ask whether that frequency is right for you. Do not simply swap one for another on your own: the cohort findings above involved several types of painkiller, and each has its own risks beyond the ears.

What to expect if a medicine is changed

For many medicines, as described above, the effect on the ear fades after stopping; for others it may persist. Either way, change is rarely instant. Keep noting how the tinnitus behaves over the following weeks rather than day to day, so that the next conversation with the prescriber rests on a pattern rather than on one bad day.

If the tinnitus stays

If the tinnitus persists after a medicine has been changed, or if no medicine turns out to be involved, the general approach to tinnitus applies. The US clinical practice guideline by Tunkel and colleagues recommends a targeted history and examination, a prompt hearing assessment when tinnitus is one-sided, persistent or comes with hearing difficulties, and cognitive behavioural therapy for persistent, bothersome tinnitus. It recommends against dietary supplements such as ginkgo biloba, melatonin or zinc for treating it.

No medicine treats tinnitus itself

The NIDCD states that there are no medications specifically for treating tinnitus, although a doctor may prescribe antidepressants or anti-anxiety medications to improve mood or help with sleep. The US guideline recommends against antidepressants, anticonvulsants, anxiolytics or intratympanic medications for the routine treatment of persistent, bothersome tinnitus. Be wary of any product sold as a cure.

Where Tacet fits

Tacet does not assess medicines and cannot tell you whether a medicine is the cause. What it can do is support the conversation. Its daily journal records how much the tinnitus bothered you on a scale from 0 to 10, with optional tags and a free note where you can write the date you started or changed a medicine, and it exports as a PDF to bring to an appointment. Meanwhile, its sounds and its night timer, which fades out instead of stopping abruptly, can make quiet moments easier to live with.

Further reading

• NIDCD · Tinnitus
• NHS · Tinnitus
• Cazals (2000), Auditory sensori-neural alterations induced by salicylate, Progress in Neurobiology
• Curhan, Glicksman, Wang, Eavey & Curhan (2022), Longitudinal study of analgesic use and risk of incident persistent tinnitus, Journal of General Internal Medicine
• Lanvers-Kaminsky, Zehnhoff-Dinnesen, Parfitt & Ciarimboli (2017), Drug-induced ototoxicity: Mechanisms, pharmacogenetics, and protective strategies, Clinical Pharmacology & Therapeutics
• Tunkel et al. (2014), Clinical Practice Guideline: Tinnitus, Otolaryngology–Head and Neck Surgery