obat ototoksik
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Drug-Induced Ototoxicity
A wide variety of drugs can be ototoxic (see Table 1: Inner Ear Disorders: Some
Drugs that Cause Ototoxicity ).
Factors affecting ototoxicity include dose, duration of therapy, concurrent renalfailure, infusion rate, lifetime dose, co-administration with other drugs having
ototoxic potential, and genetic susceptibility. Ototoxic drugs should not be usedfor otic topical application when the tympanic membrane is perforated because
the drugs might diffuse into the inner ear.
Streptomycin Some Trade NamesNo US trade name
Click for Drug Monograph
tends to cause more damage to the vestibular portion than to the auditory portion
of the inner ear. Although vertigo and difficulty maintaining balance tend to be
temporary, severe loss of vestibular sensitivity may persist, sometimes
permanently. Loss of vestibular sensitivity causes difficulty walking, especially in
the dark, and oscillopsia (a sensation of bouncing of the environment with each
step). About 4 to 15% of patients who receive 1 g/day for > 1 wk develop
measurable hearing loss, which usually occurs after a short latent period (7 to 10
days) and slowly worsens if treatment is continued. Complete, permanent
deafness may follow.
Neomycin Some Trade Names
NEO-FRADIN
NEO-RXClick for Drug Monographhas the greatest cochleotoxic effect of all antibiotics. When large doses are given
orally or by colonic irrigation for intestinal sterilization, enough may be absorbedto affect hearing, particularly if mucosal lesions are present. Neomycin Some
Trade NamesNEO-FRADIN
NEO-RX
Click for Drug Monograph
should not be used for wound irrigation or for intrapleural or intraperitoneal
irrigation, because massive amounts of the drug may be retained and absorbed,causing deafness. Kanamycin Some Trade Names
KANTREXClick for Drug Monograph
and amikacin Some Trade NamesAMIKIN
Click for Drug Monographare close to neomycin Some Trade Names
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NEO-FRADIN
NEO-RX
Click for Drug Monograph
in cochleotoxic potential and are both capable of causing profound, permanenthearing loss while sparing balance. Viomycin has both cochlear and vestibulartoxicity. Gentamicin Some Trade Names
GARAMYCINClick for Drug Monograph
and tobramycin Some Trade NamesNEBCIN
TOBITOBREX
Click for Drug Monograph
have vestibular and cochlear toxicity, causing impairment in balance and hearing.
Vancomycin Some Trade NamesVANCOCIN
Click for Drug Monograph
can cause hearing loss, especially in the presence of renal insufficiency.
Chemotherapeutic (antineoplastic) drugs, particularly those containing platinum (
cisplatin Some Trade Names
PLATINOL
Click for Drug Monograph
and carboplatin Some Trade Names
PARAPLATIN
Click for Drug Monograph), can cause tinnitus and hearing loss. Hearing loss can be profound and
permanent, occurring immediately after the first dose, or can be delayed until
several months after completion of treatment. Sensorineural hearing loss strikes
bilaterally, progresses decrementally, and is permanent.
Ethacrynic acid Some Trade Names
EDECRIN
Click for Drug Monograph
and furosemide Some Trade Names
LASIX
Click for Drug Monograph
given IV have caused profound, permanent hearing loss in patients with renalfailure who had been receiving aminoglycoside antibiotics.
Salicylates in high doses (> 12 325-mg tablets of aspirin Some Trade NamesBUFFERIN
ECOTRIN
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GENACOTE
Click for Drug Monograph
per day) cause temporary hearing loss and tinnitus. Quinine Some Trade Names
QUALAQUINClick for Drug Monographand its synthetic substitutes can also cause temporary hearing loss.
Table 1
Some Drugs that Cause Ototoxicity
Type Examples
Antibiotics Aminoglycosides
Vancomycin Some
Trade Names
VANCOCIN
Click for DrugMonograph
Chemotherapeuticdrugs
Platinum-containing drugs
(eg, cisplatin SomeTrade Names
PLATINOLClick for Drug
Monograph
)
Diuretics Ethacrynic acid
Some Trade NamesEDECRIN
Click for Drug
Monograph
Furosemide Some
Trade Names
LASIXClick for Drug
Monograph
Other Quinine Some
Trade NamesQUALAQUINClick for Drug
Monograph
Salicylates
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Prevention
Ototoxic antibiotics should be avoided in pregnancy. The elderly and people with
preexisting hearing loss should not be treated with ototoxic drugs if othereffective drugs are available. The lowest effective dosage of ototoxic drugs should
be used and levels should be closely monitored. If possible before treatment with
an ototoxic drug, hearing should be measured and then monitored duringtreatment; symptoms are not reliable warning signs.
Last full review/revision July 2007 by John S. Oghalai, MD
Content last modified July 2007
http://www.merck.com/mmpe/sec08/ch086/ch086d.html