Does Nortriptyline Cause Tinnitus Or Hearing Loss?

Answer

Thanks so much for reaching out!

It certainly is true that nortriptyline, a drug in a class known as 'tricyclic antidepressants, has been linked to causing tinnitus, but, it has also been evaluated for being able to treat tinnitus in certain individuals.

Technically, you could call nortriptyline 'ototoxic' (i.e., toxic to the ear and related components) based on the possibility that it could cause tinnitus. However, it's not traditionally lumped into medications that are far more associated with ototoxicity and can cause permanent hearing loss. These drugs include:

• Aminoglycosides, such as gentamicin, tobramycin, amikacin, and neomycin
• Chemotherapeutic agents, such as cisplatin, fluorouracil, bleomycin, and nitrogen mustard
• High-dose aspirin (6 to 8 g/day)
• Loop diuretics, such as furosemide (hearing loss or tinnitus is generally reversible with this class)
• Antimalarial medications, such as quinine (hearing loss or tinnitus is generally reversible with this class)

There are more drugs that have been linked to hearing loss and ototoxicity, but the above are good examples.

Going back to nortriptyline, the prescribing information for the drug does list 'tinnitus' as a possible side effect (as shown in the image below), but it appears to occur only rarely. 

Most studies also report tinnitus caused by tricyclic antidepressants tends to be reversible (if it occurs).

How Could Nortriptyline Cause Tinnitus?

Tinnitus is a condition characterized by the perception of sound in the absence of an external stimulus. It's a poorly understood condition and it's exact causes, and effective treatments, aren't well known. In fact, there is no FDA-approved drug treatment for tinnitus.

In regard to how a drug like nortriptyline could cause tinnitus, there are some theories.

One theory is that tricyclic antidepressants could damage cochlear hair cells. Some drugs, like PDE5 inhibitors (e.g., Viagra, Cialis), have been linked to this theory.

Another theory suggests that neurotransmitter abnormalities may play a role in some patients with tinnitus. Many patients with tinnitus exhibit signs of anxiety and/or depression and elevated serotonin levels and abnormalities at GABA receptors have been found in some tinnitus patients.

Serotonin and gamma-aminobutyric acid (GABA) receptors are found throughout the auditory system, and these neurotransmitter abnormalities may lead to abnormal neural firing and tinnitus perception.

As mentioned, although tinnitus is generally associated as a possible side effect of all tricyclic antidepressant medications (e.g., nortriptyline, amitriptyline, etc...), it appears to be uncommon. Calling tricyclic drugs ototoxic suggests a much strong association than there really is.

Nortriptyline As A Treatment For Tinnitus?

I mentioned that nortriptyline has been evaluated as a treatment for tinnitus.

One study included 92 participants who were randomly assigned to receive either nortriptyline or a placebo for 6 weeks. The study was divided into two groups, one group included patients with major depression, while the other group did not. The primary outcome variables were two global satisfaction questions regarding improvement in tinnitus and the overall benefit of the medication.

The results showed that 67% of patients treated with nortriptyline reported improvement compared to only 40% of patients who received the placebo.

However, the improvements noted were generally only mild. Other studies have shown mixed results.

Further Discussion

I completely understand how worried you must be about the possibility of experiencing further hearing loss while taking nortriptyline, especially since you have already had some prior to starting the medication.

However, it is, unfortunately, difficult to predict if you will experience hearing loss on the drug and there is no evidence to suggest that any one individual is more susceptible than another.

All we can really say is that it is a rare side effect and if tinnitus or hearing loss does occur on the drug, most studies indicate that it appears to be reversible (although this isn't absolutely certain).

it is important to speak with your healthcare provider to discuss your options and determine the best course of action for your specific situation.

I believe you alluded to the fact you are taking nortriptyline for migraine prophylaxis, and there may be other options out there for you that aren't associated with hearing loss or tinnitus.

Final Words

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