The pharmacology of ototoxic drugs

This article briefly reviews the nature of the toxic effects of drugs on the inner ear and the incidence of ototoxic side effects in man. There follows a more detailed discussion of the most important groups of ototoxic drugs which are identified as the aminoglycoside antibiotics, the "loop" diuretics, quinine and chloroquine, the salicylates and some antitumour drugs. Attention is drawn to the synergistic interaction between aminoglycoside antibiotics and "loop" diuretics and the predisposition to ototoxicity if the drugs are given to subjects with renal impairment. The comparative ototoxicological potential of individual aminoglycosides is discussed and their toxic effects on the kidney and the neuromuscular junction summarized. The importance of an understanding of the pharmacokinetics of aminoglycosides both in relation to toxicity and the rational control of therapy is emphasized.