Drug‐Induced Ototoxicity: A Comprehensive Review and Reference Guide

Abstract

OBJECTIVE In an era of increasing polypharmacy, adverse drug effects such as ototoxicity have significant public health implications. Despite the availability of evidence, many health care professionals may not know the risk of ototoxicity in common medications. Therefore, the aim of this review is to provide a comprehensive, easy to use, ototoxic profile of medications with an assessment of supporting evidence. METHODS Medications of interest were identified through adverse drug reaction reports derived from Micromedex (IBM), Lexicomp (Wolters Kluwer), and the textbook, Drug Induced Diseases: Prevention, Detection, and Management. Additional evidence was identified though a query of PubMed and the Cochrane database. Evidence of causality was graded according to the following: A (randomized, controlled clinical trials), B (nonrandomized clinical trials, prospective observational studies, cohort studies, retrospective studies, case-controlled studies, and/or postmarketing surveillance studies), and C (case reports/case series). RESULTS A total of 194 systemically administered medications associated with ototoxicity were identified, most commonly antimicrobials (53), psychotropics (21), antihypertensive/antiarrhythmics (19), nonsteroidal antiinflammatory drugs (18), and antineoplastics (16). There was evidence of cochleotoxicity in 165 medications (evidence grading A [22], B [77], C [69]), vestibulotoxicity in 100 medications (evidence grading A [23], B [47], and C [30]), and dizziness in 142 medications (evidence grading A [50], B [76], and C [16]). In addition, a review of the evidence of ototoxicity in ototopical medications is also reviewed. CONCLUSION The effect and severity of ototoxicity can vary immensely depending on pharmacological and individual patient risk factors. The intent of this comprehensive review was to help health care providers of all sectors obtain a deeper knowledge of drug-induced ototoxicity to make more informed management decisions for their patients.

Adverse Audio-Vestibular Effects of Drugs and Vaccines Used in the Treatment and Prevention of COVID-19: A Review

“…Tinnitus may manifest as sensorineural hearing loss (SNHL) or may be a consequence of central alterations caused by drugs. Vestibular side-effects may manifest as loss of balance and dizziness, instability, unsteadiness, and difficulties in maintaining an upright posture [ 18 , 19 ]. Audio-vestibular disorders should be considered when, during treatment, COVID-19 patients require more than one treatment option or are being treated for additional comorbidities [ 19 ].…”

Apigenin alleviates neomycin-induced oxidative damage via the Nrf2 signaling pathway in cochlear hair cells

“…Thus far, few effective medications have been approved for the treatment of AIHL [32]. Several pathways, including oxidative stress and chronic inflammation, seem to play important roles in the pathogenesis of AIHL, and they represent possible targets for AIHL treatment [33]. In the present study, the hair cells exposed to neomycin suffered from severe injury with excessive ROS accumulation and activation of apoptotic cell death.…”

Editorial: Emerging Ototoxic Medications and Their Role in Cochlear and Vestibular Disorders

“…However, little is known about the newly emerging and very dynamic class of medicationsbiologics. A recent review of pharmacological databases (9) has identified ototoxic properties of 194 medications-among them, five biologics: dasatinib (a protein tyrosine kinase inhibitor), erlotinib (an epidermal growth factor receptor inhibitor), recombinant interferon, muromonab (a monoclonal antibody targeted at the CD3 receptor), and pembrolizumab (a humanized antibody that blocks PD-1 located on lymphocytes). Dasatinib, interferon, muromonab, and pembrolizumab were reported to affect the cochlea and peripheral vestibular organs, whereas erlotinib was reported to cause cochlear toxicity.…”