Can Alprazolam (Xanax) Cause Tinnitus & Hearing Loss?

Alprazolam (Xanax) is a benzodiazepine commonly prescribed for the acute treatment of anxiety disorders such as panic disorder and generalized anxiety disorder.

From each year between 2004-2019, the number of annual prescriptions for alprazolam in the U.S. ranged between 17-29 million.

While alprazolam is regarded as being very effective for the management of anxiety, some individuals are curious as to whether it could cause tinnitus and/or hearing loss.

Because I’m an alprazolam user (“as needed”) – I took some time to investigate whether alprazolam is associated with increased risk of tinnitus, hearing loss, and ototoxicity.

Does alprazolam (Xanax) cause hearing loss?

Not usually. In most cases alprazolam does NOT cause hearing loss.

In theory there may be rare cases wherein a specific user is allergic or hypersensitive to alprazolam – and this causes inflammation with hearing loss, but this would be extremely rare.

It’s also possible that a small percentage of individuals have a preexisting medical condition that might respond adversely to alprazolam such that hearing changes are noticed.

Additionally, the ingestion of other substances with alprazolam (e.g. other drugs) might cause some sort of an interaction effect to trigger hearing loss.

Is alprazolam ototoxic?

Not usually. There’s zero evidence to support the idea that alprazolam is an ototoxic agent.

Ototoxic means directly toxic or injurious to the ear – and thus damage audio-vestibular function.

According to Dr. Stephen Nagler (2014): “Alprazolam is NOT ototoxic.”

It is theoretically possible that some individuals might experience ototoxicity from: (1) an allergic or hypersensitivity reaction to alprazolam; (2) alprazolam overdose (directly or indirectly from secondary effects); and/or (3) alprazolam interactions or contraindications.

Most people who aren’t allergic to alprazolam and that are administering appropriate (medically-recommended) doses will not experience ototoxicity directly from the drug.

Does alprazolam cause tinnitus (ringing in the ears)?

Not usually. In fact, alprazolam is often prescribed off-label for the treatment of tinnitus because it often reduces perceived tinnitus loudness and decreases adverse psychological effects resulting from tinnitus (e.g. anxiety, insomnia, etc.).

Read: Using Alprazolam to Treat Tinnitus.

According to Dr. Stephen Nagler (2014): “The incidence of alprazolam-induced tinnitus is even lower than the incidence of placebo-induced tinnitus.”

Vernon & Meikle (2003): Alprazolam may increase preexisting tinnitus in a small number of patients. (R)

It is possible to develop tinnitus from alprazolam withdrawal but this is not the same thing as alprazolam causing tinnitus – it’s essentially the removal of alprazolam following physiological adaptation that causes tinnitus or increases preexisting tinnitus.

Tinnitus from alprazolam withdrawal?

Can occur. However, research suggests that withdrawal from short/medium-acting benzodiazepines like alprazolam and lorazepam may be less likely to cause tinnitus than withdrawal from longer-acting benzodiazepines like diazepam.

Schweizer et al. (1990): Examined rates of adverse events during benzodiazepine tapering (25% dose reduction per week).

Tinnitus occurred in 9/63 patients as a discontinuation reaction.

• Long half-life benzos (e.g. diazepam): Caused tinnitus in 7/25 patients.
• Short half-life benzos (e.g. alprazolam): Caused tinnitus in 2/38 patients.

Though it is unclear as to whether the data from the Schweizer et al. report are an accurate representation of tinnitus: (1) rates in benzo withdrawal and (2) prevalence disparities based on half-life (short vs. long).

Moreover, it is unlikely that tinnitus associated with alprazolam withdrawal is from an ototoxic reaction.

Instead, tinnitus in withdrawal is likely due to neurochemical changes that will generally dissipate over time (such that the tinnitus eventually fades into nonexistence).

Why does tinnitus occur during alprazolam withdrawal? (My hypotheses)

Reasons for tinnitus occurrence during alprazolam withdrawal are likely individualized.

Below are the different reasons I suspect tinnitus might: (1) emerge (never present until withdrawal); (2) worsen (had tinnitus before but gets worse in withdrawal); or (3) be noticed (preexisting but unaware due to regular benzo usage) – during withdrawal.

Preexisting tinnitus

A person may have had tinnitus or developed tinnitus on a benzodiazepine – but lacked full awareness of it due to ongoing benzodiazepine usage (reduces alertness, anxiety, etc.).

Reducing the dosage or stopping the benzodiazepine could cause awareness of the preexisting tinnitus to surge.

Somatic tinnitus (anxiety spike)

Perception of phantom sounds as tinnitus due to heightened anxiety, neck tension, and possibly bruxism resulting from alprazolam discontinuation.

If a person has preexisting tinnitus, there may be a “somatic” amplification of the sound due to increased arousal and subsequent hyperfixation.

Neurochemical changes

Dramatic changes in concentrations of various neurotransmitters throughout the brain (perhaps coupled with autonomic nervous system activational changes) could cause tinnitus.

In most cases, tinnitus from neurochemical changes in withdrawal will subside when neurochemistry recalibrates to baseline.

Excitotoxicity in withdrawal

It’s possible that failure to gradually taper off of alprazolam (e.g. cold turkey cessation) might cause significant “rebound excitatory neurotransmission” in withdrawal wherein excitotoxicity occurs and parts of the inner ear (e.g. cilia) or auditory processing regions are damaged.

Noise-induced hearing damage

Such as from excessive or loud noise exposure, listening to loud music, or attending a concert without hearing protection during alprazolam withdrawal.

Anxiety, stress, insomnia (?)

Researchers have hypothesized that anxiety/stress and insomnia might be capable of causing or exacerbating tinnitus in some individuals via: changes in blood flow to the inner ear, oxidative stress/inflammation, and excitotoxicity.

Because anxiety/stress can significantly increase in alprazolam withdrawal – this could be why tinnitus occurs.

Blood flow & blood pressure fluctuations

Blood flow to the brain may change during alprazolam withdrawal – and blood pressure may fluctuate or spike in some cases as a rebound effect.

These may be particularly noticeable if alprazolam is stopped without a gradual taper. (R)

Oxidative stress & inflammation

In withdrawal from alprazolam, oxidative stress and inflammation may increase in certain areas of the brain such as to induce tinnitus or amplify preexisting tinnitus.

Note: Just because tinnitus occurs during alprazolam withdrawal does NOT mean it’s indicative of audio-vestibular damage or that it’ll be permanent. In many cases withdrawal-related tinnitus will diminish following an extended period post-withdrawal.

Tinnitus Associated with Benzodiazepine Withdrawal Syndrome: Case Report & Literature Review (Laskey) (2020)

A patient developed tinnitus within 7 weeks of gradual reduction of clonazepam dose to 50% of the original dose in an outpatient clinic. (R)

The persistence of these symptoms prevented further dose reductions.

Upon review of the available literature, several other cases were identified describing development of tinnitus upon discontinuation or tapering of a benzodiazepine.

Providers must be prepared to individualize benzodiazepine tapers and be vigilant about emergence of withdrawal symptoms to prevent undue stress in patients.

• 40-year-old while male with well-controlled anxiety for 14 years on venlafaxine XR (150 mg, daily) & clonazepam (1 mg, twice daily). Medical history: Hyperlipidemia, lumbar spondylolysis.
• Recent labs CBC, lipids, metabolic panel): Within normal limits except elevated total cholesterol, triglycerides, and LDL.
• Patient wanted to taper off both venlafaxine and clonazepam – and a slow taper was initiated for clonazepam while continuing venlafaxine.
• After 5 weeks, the patient had tapered down to 0.75 mg clonazepam twice daily (25% dose reduction).
• Week 7: Decreased dosage to 1 mg daily in the morning (despite recommendation to split the dosing 0.5 mg AM & 0.5 mg PM). Reported difficulty concentrating, tinnitus, and difficulty sleeping (as a result of tinnitus).
• Week 9: Continued tinnitus and worsening of anxiety. Dosage was maintained.
• Week 11: Tachycardia (130 BPM) followed by dosage increase to 1.5 mg per day (0.5 mg AM & 1 mg PM). Anxiety and tinnitus still present but more manageable.
• Week 15 & 23: Tinnitus improved in severity but impact on sleep varied. Patient offered ENT consult but declined. Tinnitus still interferes with patient’s sleep at times.

Things to consider: Preexisting tinnitus (but less aware of it due to higher dose clonazepam); somatic tinnitus (during withdrawal from high anxiety); tinnitus from other health conditions; tinnitus from neurochemical changes in withdrawal; excitotoxicity in withdrawal; loud noise exposure (during withdrawal); impact of venlafaxine while reducing clonazepam; transient tinnitus; etc.

Additional evidence: Tinnitus in Benzodiazepine Withdrawal

Tinnitus can occur during benzodiazepine withdrawal, but is infrequently reported as a symptom.

Schweizer et al. (1990): 63 patients on daily benzos for 12+ months with a 25% dose reduction per week taper. 9/63 reported tinnitus as a withdrawal symptom. (R)

• 7/25 patients tapering off of long half-life benzos (diazepam & clorazepate) experienced tinnitus.
• 2/38 patients tapering off of short half-life benzos (alprazolam & lorazepam) experienced tinnitus.

These results were unexpected given the conventional advice to convert patients on short-acting benzodiazepines to longer-acting benzodiazepines during withdrawal.

Ashton et al. (1984): 12 patients using benzos for 3-22 years were tapered off by converting to diazepam for the final taper.

Doses were reduced by 25-50% per day and administered 2-3 times per day. Tapering was usually completed within 2 weeks. (R)

• 7/12 patients had tinnitus at baseline and 1 patient was on benzodiazepines for the treatment to tinnitus.
• After the taper initiation, 9/12 patients reported tinnitus after 2 weeks of benzodiazepine discontinuation.
• The number of patients experiencing tinnitus and the severity of tinnitus decreased as time went on.
• This study is limited by the sheer number of individuals experiencing tinnitus at baseline.

Alprazolam may increase susceptibility to noise-induced hearing loss…

There’s some research suggesting that alprazolam might increase susceptibility to noise-induced hearing loss by altering acoustic reflex thresholds.

Though results in the study below were not “statistically significant” – there were trends toward higher reflex thresholds at various frequencies.

Additionally, authors of the paper speculate that persons with preexisting medical conditions and/or using substances that potentiate alprazolam’s effect – could be at higher risk of noise-induced hearing loss on alprazolam.

Assuming loud noise exposure is avoided during alprazolam use – this shouldn’t be much of a concern.

That said, it is something to beware of if you’re a regular alprazolam user.

Effect of alprazolam on acoustic stapedius reflex thresholds?

Ozturk et al. (2014): Use of alprazolam in healthy adults does NOT significantly increase risk of acoustic trauma at most of the frequencies.

Use of alprazolam with agents potentiating the effect of alprazolam may increase this risk. (R)

• As a CNS inhibitor, alprazolam may cause changes in the reflex thresholds by affecting the acoustic stapedial reflex (ASR) arc.
• ASR is an autonomic reflex that protects the inner ear from high noise and sounds – and selects the frequency during hearing.
• Neural pathway for the ASR is: cochlea, 8^th nerve, ventral cochlear nucleus, superior olivary complex, facial motor nucleus, and stapedial branch of 7^th
• 31 healthy volunteers participated in a study in which basal ASR threshold were measured at baseline and again ~2 hours after oral alprazolam (1 mg) ingestion.
• Average values of ASR thresholds before & after alprazolam use were compared.
• Only the left ipsilateral and contralateral 2000 Hz increases were significantly different.
• Left ipsilateral and contralateral 500 Hz, 1000 Hz, 4000 Hz and the right ipsilateral and contralateral 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz measurements revealed no differences.
• An increase in ART thresholds was generally observed after the intake of alprazolam – but this was NOT significant.

What can we learn here?

After first use of alprazolam, ART thresholds increased – leaving the cochlea slightly unprotected against sudden sounds – although not statistically significant (with the exception of 2 values).

This study was limited by the fact that it involved just a single dose of alprazolam (rather than chronic/ongoing dosing) in healthy patients.

With chronic dosing and/or non-healthy patients, ART threshold might be affected differently.

In patients with anxiety, the anxiety itself might be capable of partially depressing central reflexes or stimulating other reflexes due to increased alertness.

(Anxiety seems to attenuate the light reflex due to decrease in parasympathetic activity & increase in sympathetic activity.)

Use of alprazolam with other agents that increase its effect (e.g. alcohol) might increase ART threshold which could increase susceptibility to inner ear injury from loud sounds.

Patients with middle ear and/or inner ear diseases may also be at increased risk of noise-induced damage while using alprazolam and other benzodiazepines.

In healthy patients who use alprazolam intermittently as a standalone agent – it probably does NOT increase risk of cochlear acoustic damage.

Reduced arousal & louder music? (Caution)

Alprazolam decreases activation of the CNS and reduces sympathetic activation in the PNS (while increasing parasympathetic tone).

The effects of this are multifold: (1) lower levels of alertness; (2) reduced perceptual ability; (3) decreased reaction to loud sounds; (4) diminished internal “stimulation.”

In some cases, this may cause a subset of individuals to do things like: play music at a louder volume, seek out louder events (e.g. live music gigs), etc. without realizing it.

This increased “thrill” seeking to offset the CNS/PNS inhibition – coupled with potentially increased acoustic reflex thresholds may be a recipe for noise-induced hearing loss and tinnitus on alprazolam.

Individuals taking the alprazolam may think that it was the medication that caused the tinnitus and hearing loss (via some toxic mechanism) – when instead it may have been a combination of preference changes (louder music, more frequent noise exposure, less precaution/hearing protection, etc.).

Alprazolam: Tinnitus treatment or cause?

In most cases, alprazolam is an effective treatment for tinnitus – particularly when utilized on a short-term or “as-needed” basis.

Why? It tends to decrease the perceived loudness of tinnitus and/or attenuate psychological distress reactions to tinnitus (e.g. anxiety, panic, insomnia, etc.).

As was already mentioned, some studies found that alprazolam caused lower rates of tinnitus than placebo (which is relatively unheard of).

Additionally, there are a significantly greater number of favorable (i.e. therapeutic) anecdotes associated with alprazolam for tinnitus – than those reporting alprazolam caused or worsened tinnitus.

This is not to suggest that alprazolam can’t cause tinnitus – because some individuals have reported that it can.

If I had to guess why it causes tinnitus in a small percentage of individuals (assuming we can rule out confounds like noise exposure) – I’d hypothesize: (1) paradoxical neurochemical response; (2) genetic factors; (3) allergy or sensitivity to alprazolam; (4) interactions with other substances ingested or preexisting medical conditions.

Alprazolam caused or worsened tinnitus (Anecdotes)

It should be noted that for every anecdote of alprazolam causing or worsening tinnitus – there are probably 10-50-fold more suggesting that alprazolam reduces tinnitus OR that it had no effect.

Anecdote #1: Takes Xanax (0.25 mg) infrequently (about once a month) and has tinnitus with many tones. Xanax consistently seems to make one specific tinnitus tone worse. On one occasion it spiked the tone for over a week.

(This individual may be particularly sensitive to medications or might experience a nocebo-type tinnitus – as he also reported a tinnitus spike from an antifungal skin cream. Individual later reported deriving benefit from Xanax.)

Anecdote #2: Tinnitus always seems louder after taking Xanax and lying in bed. The next day the increased loudness subsided though.

(Tinnitus may not have been from the Xanax – as individual admitted that lying in bed without Xanax also increases tinnitus volume.)

Anecdote #3: Experienced tinnitus for the first time while taking Xanax (0.5 mg) and Lopressor.

(Lopressor (metoprolol) is more likely to cause tinnitus than Xanax via modulation of blood pressure – but there may have been some synergistic reaction as well.)

Anecdote #4: Tinnitus started while using Xanax for anxiety secondary to a different medical problem. Woke up ~1 hour after taking it and ears were “ringing like crazy” and haven’t stopped since. Interestingly though, this individual later attained modest tinnitus relief with continued usage of Xanax.

(It is unlikely that Xanax would cause tinnitus – but then help reduce its volume with continued usage. Furthermore, individual had a medical condition causing significant anxiety. It’s possible that the medical condition triggered the tinnitus onset.)

Note: Most of the time when alprazolam “causes” or “worsens” tinnitus – the tinnitus reverts back to baseline after the medication is stopped.

• Additionally, there may have been a nocebo or somatic effect in some cases wherein tinnitus seemed louder when first administering alprazolam due to anxiety.
• Moreover, none of these cases has me convinced that the Xanax actually caused or permanently worsened tinnitus.

Expert Opinions: Alprazolam & Tinnitus, Hearing Loss, Ototoxicity

Included below are opinions from Dr. Stephen Nagler (a medical doctor answers questions about tinnitus and ototoxicity); Neil Bauman (elite researcher of audio-vestibular events); and a “European Review” of audio-vestibular side effects associated with drugs.

To save you time: There’s no strong evidence that alprazolam (Xanax) causes ototoxicity, hearing loss, or tinnitus.

Even Neil Bauman who tends to be extremely liberal (relative to most doctors) in suggesting risk – assigns relatively low risk to alprazolam with regard to causing ototoxicity, hearing loss, and tinnitus.

Dr. Stephen Nagler (2014)

Neil Bauman (PhD) & Alprazolam…

Neil wrote a book called “Ototoxic Drugs Exposed” (which I highly recommend).

While Neil gets significant criticism from individuals across the web who assume he’s embellishing rates of tinnitus/hearing loss associated with various drugs and/or fearmongering in order to sell books – I disagree with this take.

Neil has spent a considerable amount of time researching rates of adverse audio-vestibular events associated with pharmaceutical drugs – probably more than anyone else I’m aware of.

I’m not 100% sure of his methods, but I believe he counts all cases of audio-vestibular reactions (e.g. tinnitus, hearing loss, ototoxicity, vestibulotoxicity) in the: PDR; CPS; and FDA reporting system – and assigns numeric risk.

According to notes from the book, things that increase risk of tinnitus on alprazolam include: rapid or “cold turkey” withdrawal; long-term use (e.g. years); grapefruit & grapefruit juice (can amplify alprazolam’s effect via altering pharmacokinetics).

Drugs Inducing Hearing Loss, Tinnitus, Dizziness, Vertigo (2020) (R)

Altissimi et al. performed a comprehensive analysis of audio-vestibular side effects of commercially available drugs based on the British National Formulary, a pharmaceutical reference book that contains a wide range of useful information and advice on prescription and pharmacology.

It should be mentioned that it’s unclear as to whether the British National Formulary tracks postmarketing rates of adverse events associated with every drug.

If the British National Formulary merely contains standard adverse events data from drug manufacturers – it might lack accuracy.

Supplements that might prevent tinnitus & hearing loss on alprazolam

Prior to using any supplements, verify with a medical doctor that they are safe and effective for you based on: current medical status, medical history, and medication usage.

Included below are some substances that might protect against tinnitus and/or hearing damage.

Note: It is unclear as to whether these substances could interact with each other or alprazolam. Consult a medical doctor and/or pharmacist to ensure safety before usage.

• Magnesium (citrate, glycinate, threonate)
• Taurine
• NAC or Glutathione
• Multivitamin
• Alpha-GPC
• Vitamin D
• Vitamin C
• Vitamin A
• Vitamin E
• Ubiquinol
• Alpha Lipoic Acid
• Calcium-D-Glucarate
• Melatonin
• B-Complex Vitamins

Note: The above links are affiliate links and I earn a small commission if you buy through me. Price is the same regardless.

Note: It’s possible that certain supplements may be synergistic with alprazolam in raising acoustic reflex thresholds – which might increase susceptibility to noise-induced hearing loss.

Risk factors for alprazolam-induced tinnitus & hearing loss

• Rapid withdrawal
• High-dose alprazolam
• Long-term use
• Ingestion with other substances: Particularly if these substances have ototoxic potential, alter processes within the inner ear, and/or are associated with tinnitus. Any substance that is synergistic with alprazolam may also increase acoustic reflex thresholds – making one more prone to noise-induced hearing loss.
• Exposure to loud noises: Because alprazolam lowers arousal and inhibition, many people may feel less discomfort with loud music and/or increase music volume louder than they would without it.
• Older age
• High stress & poor sleep
• Organ dysfunction
• Certain medical conditions
• Preexisting hearing loss & tinnitus
• Smoke exposure
• Allergy or sensitivity to alprazolam

How to reduce risk of alprazolam tinnitus & hearing loss

Included below are some strategies that I think may help reduce risk of tinnitus and/or hearing loss with alprazolam.

1. Minimum effective dose: Use the lowest necessary dose to attain symptom relief.
2. Minimum usage frequency: Use alprazolam as minimally as needed to treat your condition.
3. Limit treatment length: If possible, use alprazolam only for a short-term rather than continue indefinitely.
4. Avoid ingestion with other substances (interaction effects): Beware of possible interaction effects between alprazolam and any substances you ingest (including alcohol and grapefruit juice).
5. Contact doctor if tinnitus or hearing changes are noticed: If you notice tinnitus or hearing changes while on alprazolam – inform a medical doctor immediately.
6. Nutrient-rich diet: Consuming a nutrient-rich diet may help protect the ears from damage while on medications.
7. Quality sleep: Getting enough quality sleep each night can help reduce oxidative stress and inflammation – and promote repair throughout the body.
8. Stress reduction/management: Managing stress and relaxing on a regular basis may reduce the burden of tinnitus and risk of hearing loss.
9. Zero loud noises & hearing protection: Avoid loud noises while using alprazolam and consider using hearing protection (earplugs, noise-reduction earmuffs, etc.).
10. Otoprotective supplements: Certain supplements may help prevent tinnitus and/or hearing changes on alprazolam or during withdrawal.
11. Adequate hydration: Drinking enough water might help reduce likelihood of tinnitus.
12. Organ function tests: Ensure that your liver and kidneys are functioning normally so that alprazolam doesn’t accumulate in your system.
13. Gradual withdrawal: Whenever stopping alprazolam, it is smart to titrate the dosage very slowly with the guidance of a medical doctor.

My thoughts re: alprazolam causing tinnitus, hearing loss, ototoxicity?

Tinnitus

Tinnitus is unlikely to be caused by alprazolam directly for most individuals – particularly when utilized for a short-term or sparingly (as-needed).

Tinnitus might occur or worsen during alprazolam discontinuation for a variety of reasons including: neurochemical fluctuations; heightened arousal; rebound excitatory neurotransmission & stress hormones; poor sleep; oxidative stress/inflammation; and blood flow/pressure changes.

• Neurochemical tinnitus: Most who report tinnitus in withdrawal may develop a perceptual tinnitus caused by alterations in neurotransmitters – rather than from actual inflammation or damage within the inner ear.
• Inflammatory tinnitus: Some individuals might end up with chronic inflammation within inner ear structures or brain regions during withdrawal – such that the tinnitus is originating from the inner ear and/or the brain.
• Damage-induced tinnitus: It has been hypothesized by some that elevated excitatory neurotransmission and stress hormones in withdrawal might cause actual insult/damage to inner ear structures such that tinnitus becomes permanent. (This would likely be accompanied by hearing loss.)

Most people will NOT experience tinnitus OR hearing changes while withdrawing from alprazolam.

Some individuals with preexisting tinnitus may perceive the tinnitus as being “louder” than usual due to increased arousal during withdrawal.

Some individuals may mistakenly believe “phantom sounds” (false sounds generated by the brain in ultra-quiet environments) are “tinnitus” during alprazolam withdrawal.

This is due to heightened arousal and neurotransmitter changes – causing hyperfixation on bodily sensations.

Slow alprazolam withdrawal under the guidance of a medical doctor should minimize likelihood of experiencing tinnitus and/or hearing changes during withdrawal.

A majority of individuals who experience tinnitus in alprazolam withdrawal will eventually recover from it (assuming the tinnitus was a legitimate byproduct of withdrawal).

Hearing loss & ototoxicity

Alprazolam is unlikely to cause hearing loss or ototoxicity for most individuals – regardless of usage length/duration.

There’s no strong evidence to support the idea that alprazolam is ototoxic or that it is associated with high rates of hearing loss.

Hearing loss and/or ototoxicity could theoretically occur in the event of: overdose; allergy/sensitivity reactions; interactions with other substances; and/or medical contraindications.

If hearing loss and/or ototoxicity occur with alprazolam, it may be possible to recover if treated promptly by a medical doctor (e.g. with corticosteroids).

However, it’s important to emphasize that the aforementioned possibilities are hypothetical and NOT substantiated by any credible scientific data.

(I could NOT find a single case report of hearing loss associated with alprazolam specifically.)

Susceptibility to noise-induced hearing loss…

There’s some preliminary evidence suggesting that alprazolam could alter acoustic reflexes (such as increasing acoustic stapedial reflex threshold) – which might increase susceptibility to hearing loss and subsequent tinnitus development following exposure to certain noises/loud sounds.

Note: This susceptibility to noise-induced hearing loss via altered acoustic reflexes may be potentiated by other CNS depressants or substances synergistic with alprazolam.

My experience with alprazolam: Any tinnitus or hearing loss?

I take alprazolam on an “as needed” basis for the management of chronic sleep maintenance insomnia (i.e. middle insomnia) – and try to avoid using it if possible. (Read: Alprazolam for Insomnia).

When I take alprazolam, I use the lowest dose that works to induce ~2-3 additional hours of sleep – for me the dose is 0.25 mg.

I do NOT have any significant tinnitus or hearing loss at the time of writing this article.

I may have mild tinnitus in one or both ears – but I assume that these are phantom sounds (it’s impossible to know one way or another).

When I use alprazolam for sleep – it seems to quiet or dull the preexisting “phantom sounds.” I suspect it achieves this by significantly increasing GABAergic transmission – which blunts or interferes with perceptual awareness.

About 15+ years ago I used alprazolam XR (extended-release) on a regular basis for a few months and then stopped “cold turkey.”

During this withdrawal I experienced a massive increase in anxiety and some mild tinnitus (which exacerbated anxiety).

Eventually the tinnitus that emerged following alprazolam withdrawal completely faded away.

I suspect a combination of supplements, healthy habits, readjustment/recalibration of neurotransmitters, and eventually getting stress under control helped.

Have you experienced tinnitus and/or hearing loss from alprazolam?

How confident are you that the alprazolam was the cause of your tinnitus and/or hearing loss? If you’re very confident – why are you so confident?

Have you ruled out things like: usage of other medications & drugs, chronic nutrient deficiencies, medical conditions that affect hearing, infections (e.g. SARS-COV-2), and/or loud noise exposures?

If you started experiencing tinnitus (ringing in the ears) on alprazolam or during alprazolam withdrawal, have you considered that it might: (1) be related to transient neurotransmitter fluctuations (such that it’ll eventually dissipate) OR (2) actually be “phantom sounds” created by the brain in response to stress and/or quiet environments?

If you’re still very confident that alprazolam is the underlying cause of your tinnitus and/or hearing loss – feel free to provide additional details in your comment:

• Duration of alprazolam use
• Dosage of alprazolam taken
• Frequency of alprazolam administration
• Reason(s) for using alprazolam
• Other meds/substances used (e.g. caffeine, nicotine, etc.)
• Medical conditions
• Age, BMI, general health
• Stress level & sleep quality
• Tinnitus and/or hearing loss prior to alprazolam (?)

If you haven’t experienced any change in hearing while using alprazolam – feel free to drop a comment as well.