Ototoxic Medications from a Pharmacist's Viewpoint
by Ellen Luse, RP,H
Ototoxic medications are frequently dose and administration problems. Also, ototoxic medications seem to affect some people more than others. Most of the time, one can either avoid the medication altogether or give it in a manner such that the risk is very low.
Streptomycin is frequently used as an example of an ototoxic drug and it is, but it is so rarely used as to be almost extinct. It is only used in situations where no other medication has worked.
Aspirin, ibuprofen, and even furosemide (Lasix) are used in thousands of patients every day with no ill effects! Aspirin and ibuprofen have a history of causing tinnitus. If you are not on any other medications and you are taking either ibuprofen or aspirin, the tinnitus should stop when you stop taking either of those drugs.
Ototoxic levels of Lasix are unavoidable when needed to treat a great need for relief of water retention. This does not mean that ototoxicity MUST occur, just that it the conditions are right for ototoxicity to occur.
Oftentimes, it is the combination of more than one ototoxic medication that causes actual damage. There is one class of antibiotics used only in a hospital that can be ototoxic if administered incorrectly.
My point here is to say that ototoxicity is not something that should be ignored, but it is also something that might have to be tolerated. Be sure to inform your physician immediately if you experience increased tinnitus or any loss of hearing when given a new medication. It could be that he/she can change you to a different medication that is just as effective but not as ototoxic.
Inform your physician and your pharmacist of your desire to avoid ototoxic medications if at all possible. By all means, when you are to be admitted to the hospital for surgery, contact the pharmacy and let them know. Also, inform the anesthesiologist who will be in charge of all the medications given to you during surgery.
Between the two of them, they can monitor your medications during your hospital stay and help keep the risk as low as possible.
Being very upfront with all of your medical personnel is vital to your health. Always be sure they are aware of all medications you take, be they prescribed or over the counter. This includes vitamins and herbs!
One disease state that is often omitted is alcoholism, whether in recovery or not. There are medications that can make that disease worse or cause a relapse, especially in the surgical area. Everything that can affect your health is important to those of us who are trying to monitor and restrict harm to your body, which includes your ears.