Drug class	Specific agents	Comments
Anti-inflammatory agents	Aspirin	Especially doses > 2.7 g per day
	Nonsteroidal anti-inflammatory drugs	All agents implicated
	Sulfasalazine (Azulfidine)	—
Antimalarial agents	Quinine and chloroquine (Aralen)	—
Antimicrobial agents	Aminoglycosides	Tinnitus usually is an initial sign of ototoxicity, often with rapid progression to hearing loss; hearing loss or tinnitus that persists two to three weeks after discontinuing the drug is likely permanent
	Macrolides	Erythromycin: rare at dosages < 2 g per day
	Tetracyclines: doxycycline, minocycline (Minocin)	Higher risk in women; symptom onset one to three days after initiation of therapy
	Vancomycin	Rare if not used with other ototoxic agents
	Other anti-infectives: imipenem/cilastatin (Primaxin), linezolid (Zyvox), sulfonamides, fluoroquinolones, voriconazole (Vfend), amphotericin B, ganciclovir (Cytovene), ribavirin (Rebetol)	—
Antineoplastic agents	Vinca alkaloids, etoposide, protein kinase inhibitors, platinum derivatives	—
Loop diuretics	All agents implicated	Highest risk with high doses and/or rapid infusions
Miscellaneous agents	Antiarrhythmics, anticonvulsants, antihypertensives, antiulcer drugs, hormones, psychotropic drugs, atorvastatin (Lipitor), bupropion (Wellbutrin), risedronate (Actonel), varenicline (Chantix)	—
Regional anesthetics	Lidocaine (Xylocaine), bupivacaine (Marcaine)	—
Topical agents	Topical otic preparations containing ototoxic drugs	—