520596
letter2014
AOPXXX10.1177/1060028013520596Annals of PharmacotherapyKekilli et al
Letter Annals of Pharmacotherapy 2014, Vol. 48(7) 943 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1060028013520596 aop.sagepub.com
Rabeprazole-Induced Tinnitus
TO THE EDITOR: Tinnitus could be defined as perception of noise sensation of sound in the absence of a corresponding external acoustic stimulus.1 Rabeprazole is a proton pump inhibitor used to treat acid-related gastrointestinal disorders including esophagitis, peptic ulcer, and gastroesophageal reflux disease (GERD). As a class of proton pump inhibitors, it has been implicated in several case reports as a cause of colestatic liver injury2 and acute interstitial nephritis.3 To date, rabeprazole-induced tinnitus has not been described.
Case Report A 39-year-old male patient experienced tinnitus after taking 2 doses of oral 20 mg rabeprazole. His medical history included nonerosive GERD-associated complaints, which had gradually worsened over the past 2 weeks. Records revealed that rabeprazole was started for the first time on admission. His past medical history and family history were unremarkable. He denied ever using alcohol, any herbal or folk remedies, and over-the-counter agents. Physical examination including the neurological system was within limits. Complete blood count and biochemical tests were all within normal ranges. After cessation of rabeprazole, the patient was consulted to an otorhinolaryngologist but no pathologic findings could be detected. Forty-eight hours after withdrawal of rabeprazole, tinnitus was resolved spontaneously. However, 2 days later, he restarted rabeprazole himself because of his repeated GERD symptoms. Three days after starting rabeprazole, tinnitus started again. It has been confirmed again that he had not used any other medication, herbal product, or alcohol, and rabeprazole was stopped again. Tinnitus was resolved in the following days.
Discussion Tinnitus is a common medical symptom that can be debilitating and sometimes life-changing.4 It may be associated with acute intoxication and long-term administration of a wide range of drugs. Although major implicated drug classes are the aminoglycosides and other antimicrobials, diuretics, anti-inflammatory agents, antineoplastic drugs, and some topically administered agents,5 rabeprazolinduced tinnitus has not been reported previously. Rabeprazole is an antisecretory drug in the class of proton pump inhibitors commonly prescribed for treating ulcers of the stomach and duodenum and erosive or
ulcerative GERD. Although no studies have shown that rabeprazole causes tinnitus or the mechanism by which it causes tinnitus, it can be speculated that the metabolites of the drug itself act or deposit as circulating immune complexes. Moreover, biochemical and electrophysiologic changes triggered by rabeprazole in the inner ear and impulse transmission in the eighth cranial nerve impulse transmission may cause tinnitus.5 The Naranjo adverse drug reaction probability scale was used to assess the adverse drug reaction and a score of 8 was reached, suggesting a probable causal relation between rabeprazole and tinnitus.6 Although it is generally accepted that rabeprazole is a safe and effective therapeutic agent for treatment of GERD, peptic ulcer, and duodenal ulcer, clinicians should be aware of potential side effects of this drug, including tinnitus. Dose reductions or even discontinuation of the drug may be needed in such circumstances. Murat Kekilli, MD Hitit University Corum Training and Research Hospital, Corum, Turkey Alpaslan Tanoglu, MD GATA Haydarpasa Training Hospital, Istanbul, Turkey Serkan Ocal, MD Hitit University Corum Training and Research Hospital, Corum, Turkey Yavuz Beyazit Canakkale State Hospital, Canakkale, Turkey [email protected] References 1. Langguth B, Kreuzer PM, Kleinjung T, De Ridder D. Tinnitus: causes and clinical management. Lancet Neurol. 2013;12:920-930. 2. Aktaş B, Başar Ö, Altinbaş A, Ekiz F, Yüksel O. Rabeprazoleinduced acute cholestatic liver injury. Turk J Gastroenterol. 2012;23:309-310. 3. Geevasinga N, Coleman PL, Roger SD. Rabeprazole-induced acute interstitial nephritis. Nephrology (Carlton). 2005;10:7-9. 4. Baguley D, McFerran D, Hall D. Tinnitus. Lancet. 2013;382:1600-1607. 5. Seligmann H, Podoshin L, Ben-David J, Fradis M, Goldsher M. Drug-induced tinnitus and other hearing disorders. Drug Saf. 1996;14:198-212. 6. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharacol Ther. 1981;30:239-245.
Downloaded from aop.sagepub.com at CARLETON UNIV on June 23, 2014
letter2014
AOPXXX10.1177/1060028013520596Annals of PharmacotherapyKekilli et al
Letter Annals of Pharmacotherapy 2014, Vol. 48(7) 943 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1060028013520596 aop.sagepub.com
Rabeprazole-Induced Tinnitus
TO THE EDITOR: Tinnitus could be defined as perception of noise sensation of sound in the absence of a corresponding external acoustic stimulus.1 Rabeprazole is a proton pump inhibitor used to treat acid-related gastrointestinal disorders including esophagitis, peptic ulcer, and gastroesophageal reflux disease (GERD). As a class of proton pump inhibitors, it has been implicated in several case reports as a cause of colestatic liver injury2 and acute interstitial nephritis.3 To date, rabeprazole-induced tinnitus has not been described.
Case Report A 39-year-old male patient experienced tinnitus after taking 2 doses of oral 20 mg rabeprazole. His medical history included nonerosive GERD-associated complaints, which had gradually worsened over the past 2 weeks. Records revealed that rabeprazole was started for the first time on admission. His past medical history and family history were unremarkable. He denied ever using alcohol, any herbal or folk remedies, and over-the-counter agents. Physical examination including the neurological system was within limits. Complete blood count and biochemical tests were all within normal ranges. After cessation of rabeprazole, the patient was consulted to an otorhinolaryngologist but no pathologic findings could be detected. Forty-eight hours after withdrawal of rabeprazole, tinnitus was resolved spontaneously. However, 2 days later, he restarted rabeprazole himself because of his repeated GERD symptoms. Three days after starting rabeprazole, tinnitus started again. It has been confirmed again that he had not used any other medication, herbal product, or alcohol, and rabeprazole was stopped again. Tinnitus was resolved in the following days.
Discussion Tinnitus is a common medical symptom that can be debilitating and sometimes life-changing.4 It may be associated with acute intoxication and long-term administration of a wide range of drugs. Although major implicated drug classes are the aminoglycosides and other antimicrobials, diuretics, anti-inflammatory agents, antineoplastic drugs, and some topically administered agents,5 rabeprazolinduced tinnitus has not been reported previously. Rabeprazole is an antisecretory drug in the class of proton pump inhibitors commonly prescribed for treating ulcers of the stomach and duodenum and erosive or
ulcerative GERD. Although no studies have shown that rabeprazole causes tinnitus or the mechanism by which it causes tinnitus, it can be speculated that the metabolites of the drug itself act or deposit as circulating immune complexes. Moreover, biochemical and electrophysiologic changes triggered by rabeprazole in the inner ear and impulse transmission in the eighth cranial nerve impulse transmission may cause tinnitus.5 The Naranjo adverse drug reaction probability scale was used to assess the adverse drug reaction and a score of 8 was reached, suggesting a probable causal relation between rabeprazole and tinnitus.6 Although it is generally accepted that rabeprazole is a safe and effective therapeutic agent for treatment of GERD, peptic ulcer, and duodenal ulcer, clinicians should be aware of potential side effects of this drug, including tinnitus. Dose reductions or even discontinuation of the drug may be needed in such circumstances. Murat Kekilli, MD Hitit University Corum Training and Research Hospital, Corum, Turkey Alpaslan Tanoglu, MD GATA Haydarpasa Training Hospital, Istanbul, Turkey Serkan Ocal, MD Hitit University Corum Training and Research Hospital, Corum, Turkey Yavuz Beyazit Canakkale State Hospital, Canakkale, Turkey [email protected] References 1. Langguth B, Kreuzer PM, Kleinjung T, De Ridder D. Tinnitus: causes and clinical management. Lancet Neurol. 2013;12:920-930. 2. Aktaş B, Başar Ö, Altinbaş A, Ekiz F, Yüksel O. Rabeprazoleinduced acute cholestatic liver injury. Turk J Gastroenterol. 2012;23:309-310. 3. Geevasinga N, Coleman PL, Roger SD. Rabeprazole-induced acute interstitial nephritis. Nephrology (Carlton). 2005;10:7-9. 4. Baguley D, McFerran D, Hall D. Tinnitus. Lancet. 2013;382:1600-1607. 5. Seligmann H, Podoshin L, Ben-David J, Fradis M, Goldsher M. Drug-induced tinnitus and other hearing disorders. Drug Saf. 1996;14:198-212. 6. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharacol Ther. 1981;30:239-245.
Downloaded from aop.sagepub.com at CARLETON UNIV on June 23, 2014
