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The Olive Branch

What is the Best Medication for Tinnitus?

An ear to represent tinnitus

Tinnitus describes the sensation of hearing either an intermittent or continuous noise that has no outside source. This can come in the form of ringing, buzzing, hissing, whining, clicking, chirping, or whistling. It is associated with damage to the inner ear and noise-induced hearing loss.


As tinnitus, unless it goes away on its own, is incurable (or rather, there are no medications proven to reverse the neural hyperactivity at the root of tinnitus), there is a great demand for medication from sufferers wanting psychological relief from this life-changing condition.


Although tinnitus is relatively common (affecting an estimated 15% of the U.S. population in some form), it is a condition that has been baffling medical professionals for years, mainly due to its unknown pathophysiology.  


This article will discuss some of the treatment options and medications for tinnitus.


Can you get over the counter medication for tinnitus?


Currently, there are no FDA-approved drugs specifically for tinnitus. Despite this, there are a number of over-the-counter substances that are misleadingly marketed as remedies for tinnitus. These products display claims on their packaging as to their efficacy, however, regardless of any anecdotal success (which may be due to a short-term placebo effect), there is no reliable clinical evidence that these substances can relieve tinnitus symptoms. 


Unfortunately, these products play on people’s desperation and willingness to ‘try anything’. To avoid potential disappointment, it’s best to stay away from these products. There are, however, pharmacological options that may help ease the stress, anxiety, and depression that are caused by tinnitus or are making it worse.


What Medication Can I Take?


There are a few different medications recommended for tinnitus, however, they’re not all guaranteed to be effective. As we’re still learning about tinnitus, the efficacy of various drugs is still being evaluated in clinical studies, often producing findings with mixed results.


Not all drugs are appropriate for all patients, so it’s important you consult your healthcare practitioner to ensure you’re choosing the right treatment for your case.


Tricyclic Antidepressants


To manage the anxiety, stress, and depression associated with tinnitus, many people decide to take psychoactive drugs. For many, this eases the psychological strain of the condition and facilitates a sort of mental relief from its sometimes overbearing symptoms.


Some common tricyclic antidepressants (TCAs) used in cases of tinnitus include:

  • Clomipramine (Anafranil)
  • Desipramine (Norpramin)
  • Imipramine (Tofranil) 
  • Nortriptyline (Pamelor)
  • Protriptyline (Vivactil)

Some people might be put off taking antidepressants as they don’t treat the tinnitus itself. This frustration is completely understandable, but it’s worth considering with there being a strong connection between negative emotions and the worsening of tinnitus. 


When the anxiety and stress that comes with tinnitus is under control, some sufferers even report a perceived reduction in their actual symptoms. Still, it should be noted that research confirms that antidepressants have extremely limited efficacy in reducing tinnitus in patients without anxiety or depression.


Limitations of Tricyclic Antidepressants


If you’re thinking about taking antidepressants you should be aware that they can have some nasty side effects. In the case of TCAs, side effects can include nausea, dry mouth, weight loss, constipation, increased pressure in the eye, and insomnia amongst others. Because of the severity of these side effects, such medications are generally only used for severe cases of tinnitus related symptoms.


Furthermore, some research suggests that antidepressants and antianxiety medications can make it hard for patients to naturally habituate (learn to ignore) the sound of tinnitus over time as they might lead to a reduction in neural plasticity.


Some people even claim that taking TCAs caused their tinnitus in the first place. 


Above all, these medications can have a powerful effect and should only be used after the consultation and under the supervision of a trained healthcare practitioner. 


Alprazolam


Alprazolam, a benzodiazepine, is thought to work by enhancing the activity of specific neurotransmitters in the brain. It is used as a treatment for anxiety disorders, panic disorders, and symptoms of depression.


In some instances, you should not take Alprazolam, such as when you’re pregnant, if you’re taking itraconazole or ketoconazole, or if you have a history of having allergic reactions to any benzodiazepine. 


You should not take it with alcohol, some drugs that slow your breathing or cause drowsiness, or opioid medicine.


Limitations of Alprazolam


Alprazolam is sometimes used to treat tinnitus, however, there is limited evidence as to whether it actually has any beneficial effects.


Jalali MM et al. sought to measure the efficacy of alprazolam for the relief of tinnitus in this cross-over randomized clinical trial. The study’s primary outcome variables were tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS) - a psychometric response scale often used in questionnaires - and tinnitus loudness.


 It found that although alprazolam did not improve the THI score or sensation level of loudness significantly, it has a desirable effect on VAS. 


The drug may have some positive effect on tinnitus, but further work still needs to be conducted on the extent of alprazolam’s benefit for distressed or depressed patients. It should also be noted that alprazolam can be habit-forming and misuse can form an addiction.


Aspirin


Some informational sources list Aspirin as a medicine to relieve tinnitus, but Aspirin is NOT a medication for tinnitus. Large doses of aspirin (along with some other drugs) have even been recognized as a potential cause of tinnitus. Salicylate, the active component in aspirin, is sometimes even used to induce tinnitus in animals.


Small doses are unlikely to cause any tinnitus symptoms and large doses that may cause issues are prescribed much more sparingly. Nevertheless, even when people do experience tinnitus after taking aspirin, they often find it to be reversible as it quickly goes away once they stop taking the medication. A small number of people are unusually sensitive to aspirin and develop reversible tinnitus at very low doses. In these cases, aspirin should be avoided and they should talk to a doctor about their situation.


Other Options for Tinnitus Relief


As of today, there is no drug, herb, or supplement that has been found to be a medication for tinnitus that is more effective than a placebo. No single approach has the same effect on everyone and you might need to try a few different techniques or a combination of approaches before you find the one that helps your symptoms. 


Many people find it disheartening that there is no FDA approved drug for tinnitus, but there are other effective strategies. People have found success with behavioral approaches such as Cognitive Behavioral Therapy (CBT) which works on changing the way the patient thinks about their tinnitus, making it less bothersome. Tinnitus Retraining Therapy (TRT), masking, and biofeedback and stress management have also had some success.


If you have age-related hearing loss, a hearing aid that amplifies outside sounds can make tinnitus less noticeable.


If you have tinnitus and would like to find out more about your treatment options, contact a specialist. Take a look at the American Tinnitus Association (ATA) website where they offer lots of useful information and don’t forget to consult your doctor before taking any new medications. 


The information in this guide has been written using the following reliable sources:


https://pubmed.ncbi.nlm.nih.gov/19865063/


https://www.ata.org/managing-your-tinnitus/treatment-options/drug-therapies


https://www.drugs.com/condition/tinnitus.html


https://www.sps.nhs.uk/wp-content/uploads/2017/05/UKMi_QA-TCAs-Tinnitus_May-2017.doc


https://www.rxlist.com/antidepressants/drug-class.htm


https://www.tinnitus.org.uk/



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