Imipramine Tinnitus: incidence study

A chart review of 475 patients treated with imipramine revealed 5 patients who developed tinnitus during therapy. Patients were aged 23-55 years and had no previous history of otological complaints .

After a major depressive episode of 2-12 months' duration, patients received imipramine, gradually increased to 150-250 mg/day. In the second or third week of therapy, within 3-7 days of reaching this dosage, patients began to complain of tinnitus. Combined plasma imipramine­desipramine levels at this time were 200-450 (mean = 322) ng/ml. Neurological and ENT examinations revealed a fine, bilateral hand tremor in 1 patient but were otherwise normal. Tinnitus resolved without specific treatment in 2-4 weeks despite increases in imipramine dose in 3 patients and maintenance of dose in 2. One patient began treatment with chlorpromazine 200-300 mg/day and thiothixene 15 mg/day was instituted in another patient during this time. The hand tremor persisted for 1 week after resolution of tinnitus and alprazolam 2-3 mg/day was instituted to reduce persistent anxiety symptoms in this patient. At 6-month follow-up, in addition to other medications, patients were taking imipramine 150-300 (meal = 210) mg/day, had plasma levels of 200-500 (mean = 335) ng/ml and had moderate or good improvement of depressive symptoms. Tinnitus had not recurred in any patient at this time.

The authors concluded that " , , Unnnus develops IdlosyncraUca"y as a side .ffect of Imipramine, , , ' but " , , can be expected to subside within a month', landon R. Grunhaus L. Graden JF. Journal of Clinical Psychiatry 48: 109·111. Mar 1987

8 REACTIONS" 11 July 1987 0157-7277/87/0711-OOO8/0S01.oo/0 © ADIS Press