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Author: Admin | 2025-04-28
Timothy C. Hain, MD • Page last modified: September 1, 2024 See also: bilat_cause• bilat_prevent• Bilat_recent• bilat_vn• gentamicin_toxicity• ototoxic_drops• ototoxins • progressive_bilateral • regeneration • sensory_substitution Chemotherapy Agents Antibiotics With Good Evidence for Ototoxicity (see also: gentamicin tobramycin vancomycin)Antibiotics for Which There is Some Suspicion of Ototoxicity Antibiotics Generally Considered Safe Ototoxic Diuretics Quinine Derivatives Aspirin and related medications Miscellaneous Ototoxic Drugs Other Toxins ProtectionThe purpose of this page is to list drugs well known to be toxic to the ear. It is not all-inclusive and it should not be relied upon for medical care.CHEMOTHERAPY AGENTS Drug Vestibulotoxicity Hearing Toxicity Toxic Level Carboplatin 1-10% Cisplatin Minor 69% total dose > 200 mg/sq meter. nitrogen mustard yes yes Vincristine yes yes Methotrexate Unlikely possibly as a late effect. Comment: While reportedly ototoxic, chemotherapeutic medications are rarely encountered as a source of vestibular dysfunction. Cisplatin is the most widely used anticancer drug currently and unfortunately, it is cochleotoxic, and may injure supporting cells (Ramirez-Camacho et al, 2004). The toxicity begins in the outer hair cells (Reavis et al, 2011) and for this reason DPOAE's have been suggested to be a reasonable method of detecting toxicity. The toxicity of cisplatin is synergistic with gentamicin, and high doses of cisplatin have been reported to cause total deafness. In animals, cisplatin ototoxicity is related to lipid peroxidation and the use of antioxidant agents such as vitamin E are protective (Rybak et al, 2000; Kalkanis et al, 2004). There are many chemotherapy agents which have no credible evidence for ototoxicity, and also many in whom there are single case reports of dubious significance. In general, drugs that are "broad" in their effects on the body would be expected to also have some ototoxicity. Drugs that are very narrow, perhaps aimed at cell markers, would not be reasonably expected to be ototoxic. Some chemotherapy drugs are used in treatment of inner ear disease -- i.e. cytoxin, methotrexate, and Enbrel. These would obviously not be expected to be ototoxic. Naples et al (2022) reviewed chemotherapy agents that are not "platinum-based". They stated "Ototoxicity from non-platinum-based chemo- and immunotherapies
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