Medicine Informations

 

Tuesday
Dec042012

Ototoxic drugs

Miss M once asked me a good question about ototoxic drugs. Ototoxic drug is a drug or medicine that may cause problems to the inner ear structures such as the cochlea, vestibule and semicircular canals and this can result in hearing loss, tinnitus (ringing in ears) or dizziness. Over 100 classes of drugs have been found to be linked to ototoxicity. They include some antibiotics, platinum-based antineoplastic agents (chemotherapy drugs used to treat cancer), salicylates (drugs used to treat pain and inflammtion), quinine (drug used for malaria prevention and treatment) and loop diuretics (for treating fluid retention). Hearing loss can be temporary but can be irreversible with some drugs. There are no treatment available for ototoxicity-induced damage.

I'm going to focus on the drugs asked by Miss M about their ototoxic effects:

1) Doxepin (brand names: Deptran, Sinequan): used to treat depression in people over 18 years old. Its available as tablets or capsules but can make you drowsy, dizzy or feeling faint especially if you drink alcohol. And it can affect your alertness so care needed when driving or using machinery. And getting up slowly can help you reduce dizzines or lightheaded symptoms. In the first 2 weeks you may experience dry mouth and this can be made better by frequent sips of water, sucking sugarless lollies or chewing sugarless gum. However, continuing dryness of the mouth may increase the chance of dental disease, including tooth decay and gum disease. So see your doctor if dry mouth still continues for more than 2 weeks. Other mild side effects that can occur include drowsiness, blurry vision, constipation or diarrhoea, having trouble urinating, altered sense of taste, trouble sleeping, nightmares, change in appetite, nausea, vomiting, indigestion, changes in sex drive. They may or may not happen to you. The first 5 side effects I mentioned are temporary but if they persist or worsen then see your doctor. But see your doctor straightaway if you experience any of the following serious side effects - fast heart beat, signs of frequent infections such as fever, chills, sore throat or mouth ulcers, unusual bruising or bleeding, yellowing of the eyes or skin (jaundice), ongoing difficulty in passing urine, symptoms of tiredness, headache, dizziness and being short of breath when exercising, hallucinations, agitation, confusion, sudden switch of mood to one of excitement, overactivity, talkativeness and uninhibited behaviour, aggressive behaviour, nervousness, tingling or numbness of the hands or feet, uncontrolled movements, including trembling and shaking of the hands and fingers, twisting movements of the body, shuffling walk and stiffness of the arms and legs.

But if you experience any of the following rare and serious side effects go to the hospital or your doctor straightaway- skin rash or itching, swelling of the face, severe sunburn, blistering or swelling of the skin, symptoms of high fever, fast heart beat and muscle stiffness, seizures or fits.

There are no reports of hearing loss side effect with this drug.

2) Lercanidipine (brand name: Zanidip, Zircol, Lercadip, Lercanidipine Sandoz to name a few): used to lower blood pressure (BP) for those who have high BP. The mild possible side effects include flushing (feeling red and hot), swelling in ankles, feet or lower legs, headache, dizziness (so need to get up slowly), gastric poblems such as heartburn, nausea, abdominal pain or diarrhoea, tiredness or sleepiness (so care needed when driving car or using machinery). You may or may not experience them. But see your doctor straightaway if you experience angina (chest pain/tightness), increased heartbeat or allergy reaction which can be a rash, itching or hives on skin. They are rare but serious side effects. You also need to avoid drinking grapefruit juice or eating large amounts of grapefruit as it can increase the effects of lercanidipine. There are no hearing loss side effect reported with this drug.

3) Clopidogrel (brand name: Plavix, Clopidogrel Winthrop, Iscover, Piax to name a few): an antiplatelet agent used to prevent blood clots and to reduce risk of heart attack, stroke or death if you experience a cardiovascular event such as a previous heart attack, stoke or peripheral arterial disease (leg pain when walking/resting). The mild side effects include diarrhoea, pain or stiffness in joints. But if you experience the following serious side effects see your doctor - itching, inflamed, cracking or red skin, rash or hives, bloody or black bowel stools, red or purple spots visible through your skin, stomach pain, bleeding or bruising more easily than normal, unusually heavy or unexpected menstrual bleeding, nausea or vomiting, faintness or dizziness, fever, chills or other signs of infection, muscle pain, weight loss, anaemia (being tired and looking pale). 

However see your doctor or go to hospital straightaway if you experience any of the following very serious side effects - vomiting of blood or vomit that looks like coffee grounds, coughing up blood, blood in the urine or eyes, unusually heavy bleeding or oozing from cuts or wounds, numbness (paralysis) or problems with co-ordination, light-headedness or blurred vision, slurred speech or other difficulty in speaking, severe and continuing headache, confusion or hallucination, tightness of the chest, wheezing, coughing or difficulty breathing, yellowing of the skin or the whites of the eyes, pale stools and dark urine with vomiting and stomach pain, swelling of the face, lips, mouth, tongue or throat which may cause difficulty in swallowing or breathing.

No hearing loss side effect has been reported with this drug.

4) Trandolapril (brand name: Gopten, Dolapril, Tranalpha, Trandolapril-DP): used to treat high BP. Common side effects include light-headedness or dizziness, nausea, vomiting, diarrhoea or stomach pains, indigestion, persistent dry cough, headache, unusual tiredness or weakness, aching, tender or weak muscles not caused by exercise and taste disturbance. But see your doctor if you experience any of the following serious but rare side effects -palpitations (fast/irregular heart beat), signs of worrying/frequent infections such as fever, severe chills, sore throat or mouth ulcers, itchy skin rash or other skin problems, symptoms of sunburn (such as redness, itching, swelling, blistering) which may occur more quickly than normal. However if you experience any of the following very serious side effects go to the hospital straightaway and stop taking Trandolapril-fainting within a couple of hours of taking trandolapril, swelling of the face, lips, mouth, tongue or throat which may cause difficulty in swallowing or breathing (allergy reaction), severe dizziness and confusion with visual disturbances and speech problems, chest pain, rapid, shallow breathing, cold clammy skin, a rapid, weak pulse, dizziness, weakness and fainting.

No hearing loss side effect reported.

5) Zamvir- never heard of it. Do you mean Famvir?

6) Buprenorphine (Norspan patches): a patch applied on skin for 7 days and removed and a new patch can be applied on different site. Its used to relieve moderate to severe pain by releasing the drug through the skin and passing it into the blood. But it can result in physial dependence as its a strong painkiller and you may experience withdrawl symptoms if you stop using it suddenly so you need to follow doctor's advice on how to taper it down if you want to stop. The following common side effects include: mild abdominal problems such as feeling sick, loss of appetite, constipation or diarrhoea, dry mouth or changes in taste, sweating, feeling anxious or nervous or having trouble sleeping, trouble with your balance, new problems with your eyesight, itching at the patch site or other areas of your body, redness or rash at the patch site, swelling, including but not only, of the legs or ankles. The following serious but rare side effects that require medical attention include-stomach discomfort or pain, vomiting or indigestion, feeling deep sadness, drowsiness, fainting or dizziness especially when standing up, noticeable heartbeats, headache or confusion, unusual weakness or loss of strength or unusual sensations in your limbs. The following very serious side effects needs urgent medical attention by your doctor or hospital-your breathing slows or weakens, you have an allergic reaction: shortness of breath, wheezing, shallow or difficult breathing; swelling of the tongue, throat, face, lips or other parts of the body; rash, itching or hives on the skin, fast or irregular heartbeats and chest pain. No hearing loss side effect has been reported.

Hope you find it very helpful.

 

 

 

 

 

 

 

 

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