Gout Drugs & tinnitus

[Paul]

Hi, Ive had gout before but not as severe as I have now. Last attack was a couple of years ago, and I dived straight into my Naproxyn, which to be fair sorted it out quickly. However! since then I’ve caught tinnitus, I’ve come to terms with it, now, but all the gout drugs I’ve got all cause tinnitus, I’d rather have temporary pain than suffer worsening my tinnitus. I think i got gout by not properly re hydrating after doing 50+ miles on my bike, then eating a monster steak, washing it down with a load of ale!!
I cant exercise because I cant walk, stopped the steak(for good) stopped beer(not for good).
Drinking loads of water, eating all the horrid stuff that’s supposed to make me better but its not going away, any suggestions please??

[Keith Taylor]

Bloody hell, Paul! How has your doctor let you get in this mess? 🙁

I’m sure we can find a way out of it, but I need more information from you. I also need to explain some facts about gout. Because, reading between the lines of some of your statements, I think you’ve been misled. That’s not too important for now. 2 things are vital:

Gout Pain Control
As you’ve fallen foul of the naproxen/tinnitus problem, we need to find a way to get your pain under control. Giving up exercise is a bad thing, though sometimes with gout, we need to slow it down to a gentler pace. So, we need to find a tinnitus-free alternative to naproxen that will allow you to get back to your cycling. Have you discussed alternatives to naproxen with your doctor? You mention gout drugs as if you’ve tried more than one.

Can you give details of all the drugs that you’ve tried, together with dose. I hope I can suggest some alternatives, if your doctor can’t.

This needs to be a short term solution. As you’ve experienced – long term pain relief for gout causes more problems than it solves. I put pain control first. But, most important is…

Uric Acid Control
You need to get your uric acid safe. Then, the need for pain control goes away. It’s usually very easy to do this. The starting point is always your uric acid level. Get a blood test and post your uric acid test result here. Please be sure to include all the test result details. Including, date (at least month and year), scale used (mg/dL, mmol/L, or μmol/L), and the number. I recommend getting a 24-hour urine test for uric acid excretion rate. It’s not essential, but it does help you make the best choice of uric acid lowering treatment.

Paul, it’s a shame that you’ve had to endure this needless suffering. And, a greater shame that it will get worse unless we act now. Let’s work together to get your gout under control, for good.

[Patrick]

Paul,

I’m not sure of the correlation between Gout drugs and Tinnitus (ringing or buzzing in the ears), but is Naproxen the only Gout drug you are taking? You didn’t mention the names of any other drugs. Naproxen is just an anti inflammatory drug and I’m not sure there is a connection between the two conditions.

If I were you, I’d be more concerned that the Tinnitus is happening because of Hypertension (high blood pressure). When a person has Hypertension, there are several very concerning health effects. Bloody noses, headaches, dizziness, blurry vision and Tinnitus are all common conditions and should be discussed immediately with your doctor.

You DID mention steaks, alcohol and the inability to exercise though. I don’t know how old you are, or what type of physical condition you are in, but I’d highly recommend a full physical with a complete blood work up. If only for peace of mind, but to esentially rule out hypertension and worse yet, a stroke.

[Keith Taylor]

Patrick, your final sentence reminds me of the FDA extra warning notice from July last year:

FDA is strengthening an existing warning in prescription drug labels and over-the-counter (OTC) Drug Facts labels to indicate that nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the chance of a heart attack or stroke, either of which can lead to death. Those serious side effects can occur as early as the first few weeks of using an NSAID, and the risk might rise the longer people take NSAIDs. (Although aspirin is also an NSAID, this revised warning doesn’t apply to aspirin.)

The OTC drugs in this group are used for the temporary relief of pain and fever. […] Prescription NSAIDs are an important treatment for the symptoms of many debilitating conditions, including osteoarthritis, rheumatoid arthritis‎, gout and other rheumatological and painful conditions.

The consumer notice specifically mentions ibuprofen (Motrin, Advil) and naproxen (Aleve). We commonly discuss diclofenac (Voltaren) and indomethacin (Indocin). There are others, and NSAIDs are often active in many medicines such as cold and flu relief.

All that, combined with the destructive effects of uric acid crystals, should persuade every gout sufferer to get uric acid safe as soon as possible. I hope Paul can get his uric acid under control soon.

C’mon Paul – we’re here to help.

[Keith Taylor]

Prompted by a recent message about allopurinol and tinnitus, this topic seems the best place for me to summarize my research into the problem. Especially since this is about naproxen and tinnitus. Because, naproxen is a Non Steroidal Anti-Inflammatory Drug. And, NSAIDs are the most common gout drugs associated with tinnitus.

Gout Drugs and Tinnitus Science
There’s a useful 2011 report, “Pharmacological drugs inducing ototoxicity,
vestibular symptoms and tinnitus” that lists the following NSAIDs associated with tinnitus: Aceclofenac; Celecoxib; Dexibuprofene; Dexketoprofene; Diclofenac potassium; Diclofenac sodium; Diclofenac + misoprostol; Etoricoxib; Flurbiprofen; Ibuprofen; Indomethacin; Ketoprofen; Mefenamic acid; Meloxicam; Nabumetone; Naproxen; Piroxicam; Sulindac; Tenoxicam; Tiaprofenic acid. It does not associate allopurinol with gout. But, it does associate it with vertigo.

I have only extracted gout drugs from the lists in that report. But, it does include drugs for other conditions that gout sufferers commonly take medications for.

The indomethacin connection is mentioned in the product label as an adverse reaction with incidence greater than 1%. Also, not in the report, is Uloric (febuxostat), where tinnitus is listed on the label as an adverse event with incidence less than 1%.

Tinnitus in the Gout forum
Oct 2009 Diuretics and gout: “Lasix worsens tinnitus”. Lasix is taken for high blood pressure.

Sep 2011 I have the allopurinol blues: After switching from allopurinol to Uloric (febuxostat),”I have a history of tinnitus (ringing in the ears) that normally comes and goes every few days, and usually occurs in the evening. Since my first dose of Uloric, the tinnitus has been persistent, and the volume is up a notch”.

May 2012 The Febuxostat Debate: “when i was taking indomethican for gout I was having that problem and I found out that its called tinnitus”.

Aug 2012 The Febuxostat Debate: “Im suffering from one of the listed adverse effects of Fexuxostat but I am most reluctant to stop the medication as it has changed my life for the better. Unfortunately the tinnitus is becoming very difficult to tolerate”. Febuxostat tis the generic name for the uric acid lowering drug, Uloric (AKA Feburic and other brands).

Various Uric acid >10 for years, allergic to allopurinol, uloric safe?: One gout patient claimed indomethacin caused tinnitus, which disappeared after switching to diclofenac. But, another gout patient claimed diclofenac caused him tinnitus. Finally, the point was made that all NSAIDs can cause tinnitus.

May 2017 High Uric Acid with high blood sugar: “there is one point that keep us hesitant in increasing the dosage is because my husband is having tinnitus since starting Allopurinol. Of course all the readings & even dr. said the medicine is the not cause, but we dont know”.

That final point prompts me to offer a note of caution when we think of any side effects – not just tinnitus. Because, as humans, we always tend to connect events, even if there is no connection. So, the only way to prove it is a gout drug that is causing your tinnitus is to switch to an alternative. But, that is particularly difficult with NSAIDs. Because, all NSAIDs can cause tinnitus. Although, individuals might find that one type of NSAID is better than others.

What is your experience with tinnitus and gout drugs?

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Can Gout Drugs Cause Tinnitus?
[image courtesy Mayo]

[Cindy]

Not sure if I should continue the subject here … but I’ll do it now & if Keith you think that this should be somewhere else, please feel free to do so.

I’ve been reading about Tinnitus on the web & found something that may worth more readings. According to Chinese medicine, a tinnitus can be caused by a weakened kidney function. As allopurinol does in fact have some effect on the kidney, my husband’s tinnitus could actually be because of allopurinol. Though so far his kidney functions read OK from the blood tests we’ve been doing, I guess each person’s side effects and reactions to the drugs are different. & though kidney function is affected but yet not to point of “damage” which can be seen from the blood tests. I need to get more information & maybe if possible seek some Chinese dr’s point of view.

[Keith Taylor]

“As allopurinol does in fact have some effect on the kidney”

Cindy, everything I’ve read so far suggests that allopurinol helps protect kidneys (and heart). Please can you post the source of your information so that I can check it.

Thanks

PS I based that mainly on what I wrote in Allopurinol Tablets & Kidney Disease. So, I’ll check to see if there is any more recent relevant information. Because that is over 10 years old.

[Keith Taylor]

Further to my last post. Indeed, there has been some more recent research. It tends to confirm that allopurinol is generally helpful to kidneys. But, data is still inconclusive. Anyway, I’ve updated my article to reflect this recent research.

I’ve also take a look at the wider picture of tinnitus. There are many things that can cause it, and often the condition is temporary. So, as always, if tinnitus becomes unbearable, you have to seek medical attention.

We know that gout can affect the ears. Therefore, it seems logical that sudden dissolving of uric acid crystals could cause temporary tinnitus. But, I cannot find any research that supports my theory.

[Author]

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