Tinnitus and Nabumetone for TMJ

[Mau Rice]

Hello Dr. Nagler,

I'm reading your list of ototoxic meds.

I understand in certain situations the drug Nabumetone might or has been prescribed for TMJ.

In the sense that it might be helping the TMJ, it might help the tinnitus as well, if the tinnitus is caused by TMJ.

I'm curious, why did you mention that specific one as one to avoid?

Thanks.

 

[Dr. Nagler]

Hello @Mau Rice -

Thank you for your question.

I am attaching my list of "Drugs To Avoid" to this response for those who might be interested. I do try to stay away from the term "ototoxic" because I find it to be nebulous and confusing. I am much more concerned about a drug that has the potential to permanently damage the auditory system than I am about a drug that on rare occasion has been reported to temporarily aggravate tinnitus without damaging the auditory system. I mean, just about everything in the world has been reported to on rare occasion temporarily aggravate tinnitus!

Regarding nabumetone (Relafen), it is a non-steroidal anti-inflammatory drug (NSAID) from the same family as ibuprofen (Motrin), naproxen (Aleve), and numerous others. I recommend trying to stay away from nabumetone in particular because I am aware of five or six individuals who developed permanent tinnitus while on nabumetone even though it does not cause permanent auditory damage. The five or six cases would be considered to be "anecdotal reports" (i.e., there are no good data supporting my recommendation), but since there are any number of other NSAIDs that can be used whenever one might use nabumetone, I suggest discussing the matter with your doctor and trying to avoid that particular NSAID. In the case of TMJ, since you asked, there is nothing magic about nabumetone as opposed to other NSAIDs.

Hope this helps.

Stephen M. Nagler, M.D.

 

[Dr. Nagler]

@Mau Rice (and All) -

Please allow me to clarify a bit regarding what I mean about "anecdotal reports" as opposed to "good data."

The back story ...

Twenty-five years ago I myself developed severe intrusive tinnitus after three days on nabumetone (Relafen). I had never experienced tinnitus prior to that time, and I attributed it all to the nabumetone. My tinnitus has not changed since its onset. It is still the same cross between a screaming teakettle and a roaring jet turbine 24/7 that it was early on, when it pretty-much put me in bed for the better part of a year. And it was all because of the nabumetone. Or better stated, it was apparently all because of the nabumetone.

You see, for years I attributed my tinnitus to the nabumetone. But in retrospect it might not have been the nabumetone at all. As it turns out, back around the time of the onset of my tinnitus I was a marathon runner (many beers and pizzas ago), and to kill the boredom during my longer practice runs, I used to wear a Sony Walkman (google it!) around my waist and blast the music through headphones. So it may well be that my tinnitus was due entirely to noise ototoxicity - and the fact that I was on nabumetone may have been purely coincidental.

Anyway, working with tinnitus patients in my clinic and helping my colleagues with their own patients, my ears always perked up (no pun intended) when I heard of those who had been on nabumetone when their tinnitus began. There were a total of four or five patients over the past quarter century as best I can recall. But if you think about it, I was looking at a highly skewed population. I was ignoring the enormous number of folks who never developed tinnitus on nabumetone. Moreover, I was discounting any other factors that may have been at play (like my marathon-running).

So that is the difference between anecdotal reports and good data.

Where things stand now ...

No matter how hard I try, I cannot seem to get past the fact that I had started nabumetone three days prior to the onset of a condition that changed the course of my entire life, and I cannot seem to get past the fact that I am aware of a handful of other folks for whom the same holds true. So what I do with that sort of information, which might possibly be of value, but which on the other hand might be completely misleading? The best I can do appears in the final paragraph in my article on "Drugs To Avoid."

Hope this helps.

Stephen M. Nagler, M.D.