Gabapentin: Tinnitus, Hearing Loss, Ototoxicity (Cause or Treatment?)

Gabapentin is a commonly-used medication for the treatment of neuropathic pain (e.g. peripheral neuropathy), restless leg syndrome, and seizure prevention & management – as well as other conditions like anxiety disorders & substance use disorders (off-label).

Although many find gabapentin effective as a treatment for the aforementioned medical conditions, some are concerned about the drug potentially causing ototoxicity, hearing loss, and/or tinnitus (ringing in the ears).

Table of Contents

Is gabapentin ototoxic?

Unclear. It is unclear as to whether gabapentin is legitimately “ototoxic” or directly toxic to the ears (cochlea, auditory nerve, vestibular system, etc.).

In my research, I found no strong evidence to substantiate the idea that gabapentin is ototoxic.

Gabapentin may have ototoxic potential in a small percentage of users – such that it may cause ototoxicity in rare cases, but there’s not much supporting evidence.

Hamed (2017) suggested that gabapentin may cause audio-vestibular dysfunction – but he provided no strong evidence of ototoxicity. (R)

The FDA packaging insert for gabapentin does NOT list ototoxicity, hearing loss, or tinnitus – as an adverse reaction of the drug. (R)

I only found ONE case report of hearing loss while on gabapentin, however, this case report had major confounding variables (other ototoxic drugs, medical conditions, etc.) AND hearing recovered after discontinuation of gabapentin.

There are a couple case reports of transient hearing loss while on gabapentin, however, these case reports have massive confounding variables (e.g. other ototoxic drugs, serious medical conditions, etc.) – and hearing recovered to some extent in both cases.

If gabapentin is legitimately ototoxic for select users, the ototoxicity likely occurs with high doses, medical comorbidities (renal impairment, hypertension, diabetes), and concurrent medication use (particularly if other meds have ototoxic potentials).

Does gabapentin cause hearing loss & tinnitus?

Rarely. Gabapentin is more likely to cause tinnitus (ringing in the ears) than hearing loss – but both have been reported in users.

A European Review by Altissimi et al. (2020) reported that gabapentin can induce “tinnitus” and “vertigo or dizziness” – but there was zero documentation of hearing loss & ototoxicity. (R)

Based on the research I’ve reviewed, it seems as though gabapentin infrequently causes tinnitus (ringing in the ears) in a small percentage of users and hearing loss (usually transient) in an even smaller percentage.

There is only ONE case report suggesting that gabapentin “probably” (“4” on the Naranjo probability scale) caused hearing loss in a 46-year-old woman.

However, there were so many confounds including: (1) other meds with ototoxic potential (furosemide, lisinopril, hydrochlorothiazide, oxycodone, omeprazole, etc.) AND (2) medical comorbidities (renal dysfunction & anuria, Class 3 morbid obesity, diabetes, hypertension).

In this case, the hearing loss was reversible such that hearing normalized following hemodialysis & gabapentin discontinuation.

There is also ONE related case report of hearing loss with pregabalin (a related compound in the “gabapentinoid” classification) – scoring a “6” on the Naranjo probability scale.

Still, this related case does NOT involve gabapentin & has numerous confounds including: (1) other medications (antidiabetic, antihypertensive, NSAIDs) & (2) medical comorbidities (diabetes, hypertension, disc herniation).

Additionally, in this tangential case, hearing improved within 5 days of reducing the pregabalin dose from 450 mg/day to 300 mg/day in divided doses.

How could gabapentin cause tinnitus & hearing loss? (Mechanisms)

Adverse reaction. Gabapentin is unlikely to cause tinnitus and/or hearing loss in most users.

Among the subset of gabapentin users who develop tinnitus and/or hearing loss, rapid cessation of gabapentin should reverse the tinnitus and/or hearing loss in most cases.

The small percentage of gabapentin users who develop tinnitus and/or hearing loss may be uniquely susceptible to these reactions due to: preexisting audio-vestibular problems; medical comorbidities; use of additional medications; long-term/high-dose gabapentin administration.

It’s also possible that gabapentin is directly toxic to some individuals due to: abnormal immune response, inflammatory reaction, genetics/epigenetics, and/or allergy – in response to gabapentin.

One expert, Hamed, speculates that gabapentin (and related drugs) could cause audio-vestibular dysfunction via: (1) delayed cochlear conduction; (2) auditory nerve & brainstem auditory pathway alterations; and/or (3) interference of repetitive firing within CNS neurons. (R)

As was mentioned, it’s also possible that tinnitus and/or hearing changes occur after gabapentin discontinuation – due to neurochemical fluctuations.

Can gabapentin withdrawal cause tinnitus?

Possibly. It’s possible that gabapentin withdrawal may cause tinnitus (ringing in the ears) via significant fluctuations in stimulatory & inhibitory neurotransmitters throughout the brain.

Perhaps in select gabapentin users who discontinue rapidly (“cold turkey”) from a high dosage, the withdrawal may trigger a surge in excitatory neurotransmission and excitotoxicity – ultimately causing tinnitus and/or hearing loss.

However, this is merely speculative and there’s no legitimate evidence to support the idea that gabapentin discontinuation causes tinnitus, hearing loss, or ototoxicity.

If gabapentin withdrawal is the direct cause of one’s tinnitus, then tinnitus should eventually abate once neurotransmission returns to homeostasis from an excitatory state.

We should also keep in mind that select gabapentin users may have preexisting tinnitus and/or develop tinnitus while on gabapentin (and maybe not realize it due to the sedating action of the drug).

When these individuals (preexisting tinnitus) stop using gabapentin – the tinnitus becomes significantly more noticeable due to the fact that gabapentin is no longer inducing an inhibitory effect within the CNS (voltage-gated ion channels & GABA).

This is why it’s common for individuals with certain types of tinnitus to use gabapentin to make the tinnitus less perceptible… if they stop gabapentin, it returns full-force.

Is hearing loss and/or tinnitus from gabapentin permanent?

Unclear. It is unknown as to whether hearing loss and/or tinnitus resulting from gabapentin is permanent.

It is clear that gabapentin-induced hearing loss may be reversible in some cases if: (1) identified early & (2) managed properly (gabapentin dosage reduction and/or discontinuation). (R)

If hearing loss and/or tinnitus occurs while using gabapentin, the goal should be to discontinue gabapentin (get levels down), check renal function & fix if abnormal, evaluate other medications used (ototoxic potential), and/or use otoprotective agents if necessary.

In the sole case report of gabapentin-related hearing loss, hearing status normalized a few days after gabapentin was discontinued – so there’s hope for most that it is reversible.

A similar case report of pregabalin-related hearing loss found that a dosage reduction (450 mg to 300 mg/day in divided doses) led to resolution of hearing impairment – supporting the idea that gabapentinoid hearing changes can be reversible.

Does gabapentin treat tinnitus?

Yes – in select patients. Research suggests that gabapentin appears helpful for a subset of patients with tinnitus.

Specifically, cases of: acoustic trauma tinnitus, typewriter tinnitus, post-viral (COVID) tinnitus, stroke-related tinnitus, and “central type” tinnitus – have benefited from gabapentin.

However, gabapentin appears to be ineffective for patients with subjective idiopathic tinnitus.

Broadly speaking, there’s insufficient evidence to support the mainstream use of gabapentin as a treatment for tinnitus – but it clearly seems to help specific groups of patients.

How gabapentin might treat tinnitus… (Mechanisms)

Calcium channel modulation

Gabapentin is thought to function as a GABA-modulator and alpha-2-delta calcium channel antagonist – and modulation of calcium channels may be its primary mechanism in the treatment of select cases of tinnitus.

A paper by Sziklai (2004) states that cytosolic CA2+ concentration is tightly controlled in outer hair cells (OHCs) – the highly specialized receptor and effector cells in the mammalian auditory epithelium. (R)

Abnormalities in CA2+ signaling might cause cochlear hypersensitivity and/or tinnitus of cochlear origin – and gabapentin may attenuate these abnormalities to reduce tinnitus perception.

A small study involving the drug nimodipine, a calcium channel antagonist (similar mechanism to gabapentin), improved tinnitus symptoms in 5/10 patients. (R)

Decreasing CNS arousal

Gabapentin may also make it easier to cope with tinnitus by reducing anxiety, improving sleep, and decreasing CNS arousal – via increasing inhibitory neurotransmission. (R1, R2)

Abraham Shulman states that gabapentin may reduce tinnitus symptoms by reducing “hyperexcitability” of the CNS. (R)

It is well-understood that tinnitus causes significant anxiety/distress in many – and increased anxiety/distress can exacerbate tinnitus perceptually.

This becomes a vicious circle: tinnitus -> anxiety, stress, insomnia -> increased perceived loudness of tinnitus -> worsening of anxiety, stress, insomnia -> etc.

Gabapentin may break this “vicious circle” feedback loop by counteracting anxiety, stress, and/or insomnia & simultaneously reducing CNS arousal – making the tinnitus less perceptible and/or bothersome.

Dr. Stephen Nagler’s take on gabapentin & tinnitus…

Dr. Nagler (medical doctor) responded to a member of TinnitusTalk who asked in 2015 if Neurontin (Gabapentin) has any adverse effects on tinnitus.

Specifically, the member asked if gabapentin was toxic to the auditory system.

Nagler’s response: “No” – implying that, in his professional opinion, gabapentin is not ototoxic. (R)

Nagler also states that he believes gabapentin is no more effective than a placebo in the treatment of tinnitus.

Gabapentin, tinnitus, hearing loss (research)

Included below are studies that documented tinnitus and/or hearing loss associated with gabapentin.

2008: Probable case of gabapentin-related reversible hearing loss in patient with acute renal failure (R)

  • Authors: Pierce et al.
  • Case: 46-year-old white woman

A 46-year-old white woman (BMI: 62.8 kg/m2) with a 6-year history of diabetes mellitus and previously normal renal function – presented to the ER with anuria, hearing loss, myoclonus, and confusion with hallucinations lasting 3 days.

Medications: Lisinopril (40 mg, QD), hydrochlorothiazide (25 mg, QD), furosemide (80 mg, QD), atorvastatin (10 mg, QD), omeprazole (20 mg, QD), salmeterol/fluticasone inhaler (100/50 mcg, 1 puff BID), insulin lispro, oxycodone CR (60 mg, TID), alprazolam (0.5 mg as needed), venlafaxine (150 mg).

Gabapentin: 300 mg (3x/day)

The patient’s symptoms (hearing loss, myoclonus, confusion) improved after 1 session of hemodialysis (~10 hours post-admission) and resolved at the time of discharge (4 days later).

On admission, gabapentin concentration was 17.6 microg/mL – and following hemodialysis gabapentin concentration was undetectable.

Why do the authors think gabapentin may have been the cause?

  1. Previous case reports of adverse effects (e.g. coma, myoclonus, altered mental status, tremulousness) occurred at gabapentin levels between 4.6-29.4 ug/mL.
  2. Hearing loss has been reported by the manufacturer of gabapentin during clinical trials at recommended doses (0.1-1% of users).
  3. The patient had high concentrations of gabapentin (17.6 ug/mL) – much higher than standard doses (perhaps increasing risk of adverse events).
  4. Hearing improved within 24 hours of hemodialysis (gabapentin is removed by hemodialysis – whereas other drugs were not).
  5. Naranjo Adverse Drug Reaction Probability Scale score for hearing loss associated with gabapentin was “4” (probable) – higher than furosemide at a “2” (possible) and other medications at “0” (doubtful).

Critical thinking…

This patient was using a barrage of medications at high doses AND had acute renal failure (drug concentrations were abnormally high).

It’s possible that the abnormally high dose of gabapentin disrupted normal processes within the inner ear and/or induced damage to cause hearing loss.

It is possible that there was a synergistic effect exerted by multiple drugs in this woman’s system – which disrupted processes within the inner ear and/or induced damage to cause hearing loss.

It’s also possible that gabapentin was only culpable for the changes in mental status – but not the hearing loss – as authors acknowledged cases of gabapentin overdose 60-85 ug/mL were not associated with hearing loss.

This woman was on many other drugs linked to hearing loss & tinnitus, including: furosemide (6-7% of users), lisinopril, hydrochlorothiazide, oxycodone, and omeprazole.

In this case, I suspect that other medications were more culpable for the reversible hearing loss than gabapentin – and that gabapentin was more likely to have caused other symptoms (e.g. altered mental status).

Using this case to suggest that gabapentin causes hearing loss is relatively irresponsible because there are too many confounds: other drugs (with ototoxic potential), acute renal failure, other medical conditions, etc.

2020: A probable case of pregabalin-related hearing loss (R)

  • Authors: Yilmaz et al.
  • Case: 68-year-old male
  • Conditions: Diabetes; hypertension; lumbar disc herniation
  • Medications: Antidiabetic; antihypertensive; NSAIDs
  • Pregabalin: 75 mg/night -> 150 mg/day -> 300 mg/day -> 450 mg/day

A 68-year-old male presented with a complaint of low back pain spreading from the right hip region to the tip of his toes (hot, pricking, throbbing) and “7/10” rating.

The patient had a history of diabetes, hypertension, and was diagnosed with lumbar disc herniation and started on pregabalin to help manage symptoms.

Pregabalin was ineffective at low doses so was titrated up to 450 mg/day – but approximately 5 days after taking this dose, the patient exhibited hearing loss.

The hearing test showed mixed-type hearing loss – severe in the right ear and mild in the left ear… dosage of pregabalin was decreased to 300 mg/day and hearing improved 5 days later.

The patient continued taking 300 mg/day in divided doses (150 mg x 2) and didn’t develop any additional problems.

Why do authors think pregabalin caused the hearing loss?

Authors noted that there are cases of adverse reactions to pregabalin such as: hepatotoxicity, visual hallucinations, heart failure, etc. – such that it has potential to be toxic in some cases.

Authors also mentioned cases of hearing loss associated with gabapentin in a patient with diabetes – similar to what was observed in this patient.

They also reference Top et al. who claim that sensorineural hearing loss can occur from gabapentin use in the presence of coronary artery disease, diabetes mellitus, and hypertension.

Authors claim that the improvement in hearing following pregabalin dosage reduction suggests that the hearing loss is related to pregabalin.

The Naranjo algorithm, a tool used to evaluate likelihood of an adverse drug reaction caused by a specific medication, scored pregabalin a “6” in likelihood of causing hearing loss – meaning “probable” or “highly probable.”

Critical thinking…

Firstly, Pregabalin is NOT the same as gabapentin – although it is similar… it’s unclear as to whether this patient would’ve experienced a similar hearing loss reaction with gabapentin.

Next – we must consider that a combination of preexisting conditions & medications used to manage them (antihypertensives, antidiabetic, NSAIDs) may have interacted with pregabalin to cause hearing loss.

Antihypertensive agents and NSAIDs can occasionally cause hearing loss – and the dosages of each were not mentioned by authors of the case report, making it difficult to know whether pregabalin was the only cause (vs. an interaction effect).

Given the fact that this patient experienced: (1) hearing loss after a pregabalin dosage increase from 300 mg/day to 450 mg/day & (2) hearing improvement after a pregabalin dosage reduction from 450 mg/day to 300 mg/day – it’s likely that pregabalin played some role in the hearing loss.

2017: The auditory & vestibular toxicities induced by antiepileptic drugs (R)

  • Author: Hamed

This article review states that long-term treatment with some antiepileptic drugs (AEDs) – including gabapentin – may cause sensorineural hearing loss & tinnitus, along with related adverse reactions (e.g. dizziness, disequilibrium, vestibular dysfunction, etc.).

The author, Hamed, emphasizes the importance of monitoring patients at high risk for developing audio-vestibular adverse reactions to gabapentin and related drugs.

Hamed believes that gabapentin and related drugs may cause hearing loss via modulation of GABA – an important neurotransmitter in the functions of inner & outer cochlear hair cells.

Gabapentin may potentiate GABA which could interfere with electromagnetic conductance of sound at the hair cells of the cochlea or conductance of nerve impulses.

Additionally, reduction in corticomotor excitability from gabapentin’s action may interfere with sustained high-frequency repetitive firing of neurons in the auditory system – resulting in hearing loss and/or tinnitus.

Risk factors for gabapentin tinnitus & hearing loss

Included below are some risk factors for gabapentin-related hearing loss, tinnitus (ringing in the ears), and ototoxicity.

Understand that this list is what I think after reading case reports of hearing loss & an expert opinion – and the risk factors are in no particular order.

  • High-dose OR overdose: High-dose gabapentin seems to increase one’s risk of hearing loss and/or tinnitus. Hearing loss is associated with abnormally high systemic concentrations of gabapentin.
  • Additional medications: Use of additional medications (especially if they have ototoxic potentials) may increase risk of hearing loss on gabapentin. Why? Multiple medications with ototoxic potentials may synergistically increase risk of ototoxicity.
  • Renal impairment or failure: Renal impairment, failure, or dysfunction is associated with hearing loss on gabapentin. This could be due to the fact that systemic levels of gabapentin become abnormally high & toxic to the ears.
  • Micronutrient deficiencies: Deficiencies in micronutrients may interfere with natural protection against drug-induced ototoxicity.
  • Comorbid health conditions: Various medical conditions such as hypertension, diabetes, obesity, etc. – may increase risk of hearing loss and tinnitus on gabapentin.
  • Old age & young age (infants/small children): It is thought that older adults and young infants & small children may be at increased risk of ototoxicity on gabapentin for a variety of reasons (including altered drug elimination).
  • Preexisting audio-vestibular dysfunction: Preexisting audio-vestibular problems such as hearing loss, tinnitus, etc. may increase risk of hearing loss & tinnitus on gabapentin.
  • Allergic reaction to gabapentin: An allergy to gabapentin might trigger inflammation and/or an immune response to gabapentin which could somehow affect hearing.
  • Long-term administration: Regular (daily) long-term use of gabapentin may increase risk of hearing loss and/or tinnitus.

Minimize risk of hearing loss & tinnitus with gabapentin

You can consider gabapentin alternatives if you are concerned about hearing loss and/or tinnitus – ask your doctor.

If you find gabapentin effective and/or need gabapentin for a medical condition, but are concerned with the risk of hearing loss and/or tinnitus – below are some strategies that may help minimize risk.

  • Check renal function: While on gabapentin, verify (at regular intervals) that your kidneys are functioning properly. Renal impairment significantly increases risk of toxicities.
  • Lowest necessary dose: Use the lowest dose of gabapentin that alleviates symptoms – and no more than this amount. High doses are associated with increased risk of ototoxicity compared to lower ones.
  • Divided dosing: The systemic level with one large dose may be more likely to cause toxicity than spacing the doses out (e.g. 150 mg x morn, aft, night vs. 450 mg at night).
  • Limit use if possible: If you don’t need gabapentin every day, it may be wise to only use it “as needed” – if trying to avoid toxicity. (This may be unrealistic for many users though, as the drug generally needs to be taken regularly to maintain its effect.)
  • Avoid other ototoxic agents: This should go without saying, but any additional medications (particularly with ototoxic potential) should be avoided if possible. Review medications you take and work with a doctor to avoid those that have the highest risk of ototoxicity.
  • Stop if tinnitus & hearing loss occur: If you experience tinnitus and/or hearing loss on gabapentin – inform your doctor ASAP. Don’t wait or hesitate. Stop gabapentin under the guidance of your doctor – this may increase odds of full recovery.
  • Avoid loud noise: Protect ears whenever around loud noises. Track decibels of ambient noise with phone and use earplugs or earmuffs if necessary.
  • Consider otoprotective agents: Consider taking otoprotective agents while using gabapentin – these may help preserve your hearing and protect against drug-induced damage. (Don’t take without medical approval – these may interact with your meds.)

Otoprotective supplements

Below are some supplements that may be otoprotective – this is the stack I’d take if at risk for ototoxicity, hearing loss, and/or tinnitus… but it may not do much.

These may interact in unforeseen ways with your medications – so don’t assume they are safe.

Verify safety with a medical doctor AND pharmacist before use.

Note: Links are affiliate links (I earn a commission if you buy through my link – cost is the same either way).

Did gabapentin really cause hearing loss and/or tinnitus?

May people likely develop hearing loss and/or gabapentin while using gabapentin – but that doesn’t mean gabapentin was the cause (correlation doesn’t equal causation).

Gabapentin tends to exert an inhibitory effect that causes decreased CNS arousal – which could in turn cause some individuals to be less reactive to loud sounds (such that they listen to music louder than usual OR don’t react to nearby high-decibel sounds by protecting ears).

Most people taking gabapentin are doing so for specific medical conditions – one of which is neuropathy. Certain conditions that cause neuropathy may end up damaging one’s hearing (especially if progressive).

It’s also possible that a subset of gabapentin users are taking the drug for conditions more common in older age – and that hearing would’ve deteriorated in old age regardless of whether gabapentin had been used.

Additionally, many gabapentin users are on other medications – some of which may have the potential to cause hearing loss and/or tinnitus.

While it’s certainly possible that gabapentin-induced ototoxicity, hearing loss, and/or tinnitus occurs in a subset of users, we must consider that the hearing loss may have occurred regardless of gabapentin administration.

What does Neil Bauman (PhD) think about gabapentin & hearing loss & tinnitus?

Neil Bauman runs the website HearingLossHelp and researches various medications that may cause ototoxicity, hearing loss, and tinnitus.

In his book “Ototoxic Drugs Exposed,” Neil assigns gabapentin a risk level of “4” (out of 5) – suggesting that it is likely to be ototoxic.

On his website, he notes that gabapentin causes tinnitus in a good number of the people that take it and that gabapentin is quite ototoxic. (R)

He reports that the AHF & PDR report: hearing loss in 0.1-1% of users; tinnitus in 0.1-1% of users; vertigo in >1% of users; ear pain in 0.1-1% of users – and cites a variety of anecdotes from his files of gabapentin users who’ve experienced these reactions.

Although my research doesn’t line up with Neil’s, I respect his work and think his thoughts on gabapentin are worth noting.

Neil claims to sift through raw data collected on ototoxic side effects of gabapentin submitted to various databases… so some might argue that his analysis might be more accurate than other reports.

Does gabapentin treat tinnitus? (Research)

Yes or Maybe (studies)

2022: Typewriter tinnitus treated with gabapentin (R)

  • Author: Sehested
  • Case: 43-year-old woman with typewriter tinnitus
  • Details: Typewriter tinnitus (TT) is a rare subtype of tinnitus and is usually treatable with carbamazepine. It is defined by characteristic staccato sounds (like a typewriter) and can be intermittent and chronic.
  • Cause: Compression of the 8th cranial nerve by a vascular loop of the anterior inferior cerebellar artery is thought to be the primary cause of typewriter tinnitus – which may be accompanied by symptoms such as: paroxysmal vertigo & hemifacial spasms.
  • Intervention: Gabapentin (900 mg/day)
  • Result: Middle-aged woman with typical symptoms and findings of typewriter tinnitus (TT) has excellent response to gabapentin (900 mg/day) such that it completely disappeared. Patient remained tinnitus free after 2 months.

Finding: Gabapentin (900 mg/day) may be an effective first-line treatment for the treatment of typewriter tinnitus (TT) – on par with carbamazepine.

2022: New onset tinnitus in the absence of hearing changes following COVID-19 (R)

  • Authors: Daher et al.
  • Case: 49-year-old male with severe tinnitus (post-COVID)
  • Exam: Audiometric evaluation revealed normal threshold through 8000 Hz with mild hearing loss at 16,000 Hz.
  • Intervention: Gabapentin (300 mg, 2x/day)
  • Result: Significant tinnitus improvement without any noticeable side effects.

Finding: Gabapentin may be effective for a subpopulation of patients suffering from tinnitus post-COVID infection.

2017: Short-term effect of gabapentin on subjective tinnitus in acoustic trauma (R)

  • Authors: Tabrizi et al.
  • Aim: Evaluate gabapentin on sensation of subjective tinnitus in acoustic trauma patients.
  • Methods: Double-blind, randomized, controlled trial involving 103 patients with tinnitus from acoustic trauma referred to ENT clinic. Received either: gabapentin (300 mg, b.i.d.) (N=55) OR placebo control (N=48).
  • Measures: Visual analog scale (VAS) – before/after 6 weeks of treatment. (>30% reduction in VAS = response to treatment)
  • Limitations: Small sample size, short-term study, only acoustic tinnitus, etc.
  • Results: VAS significantly decreased in both groups. Reduction was significantly greater in the gabapentin group vs. the control. (89% of gabapentin recipients responded vs. 58.3% of control recipients responded)

Finding: Gabapentin 300 mg (twice daily) for 6 weeks is an effective treatment for acoustic tinnitus. (The placebo effect also seems effective.)

2012: Successful amelioration of tinnitus in a stroke patient by low-dose gabapentin (R)

  • Authors: Chen & Yin
  • Case details: Mixed sensorineural and conduction hearing loss following a stroke.
  • Cause: Right ganglionic hemorrhage (stroke) & preexisting postherpetic thoracic neuralgia.
  • Intervention: Low-dose gabapentin.
  • Result: Significant tinnitus improvement on gabapentin & recurrence of tinnitus after discontinuation of gabapentin – supporting the idea that gabapentin effectively manages this patient’s tinnitus.

Finding: Low-dose gabapentin may benefit a subgroup of tinnitus patients with secondary contributing factors such as stroke.

2006: Effect of gabapentin on the sensation and impact of tinnitus (R)

  • Authors: Bauer & Brozoski
  • Aim: Evaluate efficacy of gabapentin in chronic tinnitus in 2 populations: (1) acoustic trauma-related tinnitus & (2) tinnitus without acoustic trauma.
  • Methods: Prospective, placebo-controlled, single-blind trial with 39 tinnitus patients (20 trauma & 19 non-trauma) with moderate-to-severe tinnitus lasting at least 1 year. Tinnitus etiology was categorized by pure-tone audiogram & personal history.
  • Intervention: All 39 participants received gabapentin in an ascending-descending dose series over a 20-week period (peak dose: 2,400 mg/day).
  • Results: Tinnitus annoyance significantly improved for the acoustic trauma group. Tinnitus loudness significantly improved for the acoustic trauma high-response subgroup at 1,800-2,400 mg of gabapentin per day.

Finding: Gabapentin appears effective in reducing subjective & objective aspects of tinnitus in some individuals – with best responses obtained in those with acoustic trauma.

2002: GABAA-benzodiazepine chloride receptor-targeted therapy for tinnitus control (R)

  • Authors: Shulman et al.
  • Aim: Establish neuropharmacological tinnitus control with medication directed to restore GABA-BZD-chloride receptor deficiency in tinnitus patients with central-type tinnitus.
  • Methods: 30 tinnitus patients underwent audiological protocols, brain MRI & PET scans, and were treated with gabapentin and clonazepam for 4-6 weeks. Maintenance doses were continued when tinnitus control was positive. Intake & outcome questionnaires were completed.
  • Results: No patient experienced an increase in tinnitus intensity or annoyance. Patients with central type tinnitus exhibited significant tinnitus control with GABA-BZD-directed medication.

Finding: Gabapentin and/or clonazepam may help reduce symptoms of certain types of tinnitus (particularly “central types”).

2001: Gabapentin for the treatment of tinnitus (case report) (R)

  • Author: Zapp
  • Case: Man with tinnitus of 10-month duration
  • Dose: 500 mg/day (divided doses)
  • Result: Gabapentin helped the man become “tinnitus free” for ~23 days per month – and reduced its perception by ~75% for the remaining days of the month.

I wasn’t able to access the full case report here to read all of the details, but it seems as though this man’s tinnitus was distressing enough to seek medical treatment.

A medical doctor prescribed gabapentin at a dosage of 500 mg/day – taken in divided doses (probably 200 mg in the afternoon & 300 mg in the evening or something).

Since this is a case report, the result cannot be extrapolated to all patients with tinnitus… it’s possible that this man would’ve responded similarly to a placebo pill.

Finding: Gabapentin at a dosage of 500 mg/day (in divided doses) effectively treated a man’s tinnitus – and remained “noise-free” and “pain-free” at a 2-year follow-up.

Insufficient evidence or ineffective (studies)

2022: Analysis of Gabapentin’s efficacy in tinnitus treatment (Systematic Review) (R)

  • Authors: Tavares & Bahmad
  • Aim: Determine the efficacy of gabapentin in tinnitus via systematic review.
  • Methods: Identify and evaluate high-quality studies (prospective, double-blind, randomized, placebo-controlled) in which the effect of gabapentin on tinnitus was evaluated.
  • Data: A total of 4 studies met inclusion criteria from 129 studies evaluated. Single-blind, non-randomized, non-controlled trials, case reports, and observational studies were excluded.
  • Studies: (1) Witsell et al.; (2) Piccirillo et al; (3) Dehkordi et al.; (4) Goljanian Tabrizi et al.
  • Limitations: Methodological differences (treatment period, max dosages, outcome measure instruments); tinnitus heterogeneity (e.g. acoustic trauma vs. subjective tinnitus); no meta-analysis.

Finding: Insufficient evidence to recommend gabapentin for the treatment of tinnitus.

2011: Gabapentin for tinnitus (Systematic Review) (R)

  • Authors: Aazh et al.
  • Aim: Assess effect of gabapentin in tinnitus via systematic review.
  • Methods: Isolate double-blind RCTs for analysis that meet inclusion criteria. Assess bias with Cochrane Collaboration tool.
  • Data: 2 studies met inclusion criteria (14 studies excluded).
  • Limitations: Heterogeneities in tinnitus handicap scores, duration of tinnitus, severity of hearing loss.

Finding: Gabapentin was NOT superior to a placebo in primary outcome measures. However, due to bias risk and heterogeneities among patients – gabapentin’s effect on tinnitus remains unclear.

2008: Gabapentin effectiveness on the sensation of subjective idiopathic tinnitus (R)

  • Authors: Bakhshaee et al.
  • Aim: Evaluate gabapentin on sensation of subjective idiopathic tinnitus.
  • Methods: Prospective, placebo-controlled, double-blind clinical trial involving patients with moderate-to-severe idiopathic subjective tinnitus for 6+ months. Received gabapentin with ascending dosages over 4 weeks (peak dose: 900 mg/day) or a placebo.
  • Measures: Subjective response; tinnitus questionnaire; tinnitus severity index; loudness perception.
  • Limitations: Extremely small sample; physiological subtype of tinnitus.
  • Results: No significant subjective improvement in tinnitus annoyance for patients (37%) vs. controls (42%).

Finding: Insufficient evidence to support gabapentin for the treatment of tinnitus.

2007: Relief of idiopathic subjective tinnitus: gabapentin effective? (R)

  • Authors: Piccirillo et al.
  • Aim: Assess therapeutic benefit of gabapentin in subjective idiopathic tinnitus.
  • Methods: 8-week, double-blind, randomized clinical trial with 135 patients with severe idiopathic tinnitus (6+ months).
  • Intervention: Gabapentin (900-3600/day) vs. placebo (lactose) – for 8 weeks.
  • Measure: Change in Tinnitus Handicap Inventory score from baseline to endpoint.
  • Limitations: Possible variance in physiological underpinnings of tinnitus; placebo response.
  • Results: Change in Tinnitus Handicap Inventory from baseline to week 8 was 11.2 for the entire cohort. Gabapentin recipients (59 subjects) exhibited change of ~11.3 vs. placebo recipients (56 subjects) exhibited change of ~11.

Finding: Gabapentin is no more effective than a placebo for the relief of subjective idiopathic tinnitus.

2007: Treatment of tinnitus with gabapentin (pilot study) (R)

  • Authors: Witsell et al.
  • Aim: Evaluate efficacy of gabapentin on disease-specific quality of life in patients with tinnitus.
  • Methods: Randomized, double-blind, placebo-controlled clinical trial involving 76 adults (18-70) with non-pulsatile, subjective tinnitus lasting 3+ months. 52 patients received gabapentin (1800 mg/day) vs. 24 patients received a placebo – for a 5-week period.
  • Measures: Tinnitus Handicap Inventory; POMS rating scale; subjective tinnitus severity.
  • Limitations: Sample size; strong placebo effect; tinnitus heterogeneity; etc.
  • Results: No significant differences were observed between gabapentin recipients and placebo recipients after 5 weeks.

Finding: Insufficient evidence to support gabapentin in the treatment of tinnitus.

Gabapentin for tinnitus treatment (anecdotes)

Below are a few anecdotes in which gabapentin was reported to improve tinnitus.

  • Anecdote #1: I’ve been taking 2000 mg gabapentin and alprazolam to treat tinnitus – along with sertraline. This combination helps take the edge off and makes my tinnitus much more manageable.
  • Anecdote #2: Gabapentin completely resolved my tinnitus. Whenever I stop using gabapentin, my tinnitus returns… that’s why I keep taking it and it’s never been a problem.
  • Anecdote #3: Within 1 day of taking gabapentin, my tinnitus volume decreased by half. Although it’s not a complete cure, it significantly improved my symptoms – making tinnitus much easier to bear.
  • Anecdote #4: I have neuropathy and was prescribed gabapentin… it helped my neuropathy and completely resolved my loud buzzing tinnitus that annoyed me for years.
  • Anecdote #5: I have neurological tinnitus and high doses of gabapentin made my tinnitus disappear. I had roaring tinnitus for years and with 3000 mg gabapentin, the tinnitus was completely gone.

Gabapentin caused tinnitus & hearing loss (anecdotes)

Included below are anecdotes of individuals who’ve experienced hearing loss and/or tinnitus while using gabapentin.

Keep in mind that many of these individuals do not report: dosage, preexisting conditions, other medications used, etc. – such that it’s tough to know whether gabapentin was the most likely cause.

  • Anecdote #1: I’ve been on gabapentin 1200 mg/day for 2 months and developed a loud roaring noise in my ears along with pain. I went to an ENT but he found nothing wrong. I think it’s from the medication.
  • Anecdote #2: I’ve been taking gabapentin to manage my epilepsy and eventually developed tinnitus in both ears along with dizziness and vertigo – plus ear pain. I have also noticed a bit of hearing loss.
  • Anecdote #3: I was taking gabapentin at 100 mg/night before bed for a week. After a week my ears began ringing loudly. However, I have Ramsay Hunt Syndrome and am not sure if that was the cause.
  • Anecdote #4: I used gabapentin at a dose of 300 mg, 3x per day and lost hearing in both ears. I had some hearing loss but it became worse after a year on gabapentin (mild to moderate).
  • Anecdote #5: I used gabapentin for months to treat hot flashes but developed tinnitus. It works amazingly for my hot flashes but now my ears ring all the time and I hate it.
  • Anecdote #6: I went completely deaf from gabapentin… took the drug for one month then woke up with tinnitus and inability to hear in both ears. I stopped the drug and most of my hearing came back within 1 month.

Have thoughts on gabapentin & tinnitus & hearing loss?

I’ve taken gabapentin for a relatively short-term at a fairly low dose (300 mg/night) and didn’t experience any changes in hearing over a 3-4 month period.

Have you experienced any tinnitus and/or hearing loss from using gabapentin? (What dosage did you take? Do you have any preexisting conditions? Do you use other meds?)

Or… did you find gabapentin helpful for the treatment of preexisting tinnitus (What dosage did you take & how effective was it?)

Feel free to share your thoughts, experiences, and/or additional research related to gabapentin & hearing loss/tinnitus in the comments.

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