COUNCIL ON AGING - ORANGE COUNTY hEALThCARE problems may have on a patient's quality of life after drug therapy. In cases where alternatives are possible, it is best to avoid ototoxic medications, especially in the elderly and patients with preexisting hearing loss or additional risk factors for increased ototoxicity. Need for Greater Ototoxicity Testing When evaluating a medication for ototoxicity, it is important to consider the fact that the FDA does not have Good Clinical Practice guidelines for monitoring ototoxicity in the clinical trials of new drugs. Testing of inner ear function typically is not required unless the new investigational pharmacological agent is within a drug class known to cause ototoxicity as a side effect. As a result, the issue of ototoxicity usually is discovered only after enough people have suffered the consequences of ototoxicity, and health care professionals make the correlation. Because of the uncertainty about medications that may cause ototoxicity, it is important to advise patients to report any issues such as the emergence or worsening of tinnitus when new medications are started or does are increased. The sidebar provides a summary of reminders that can help to minimize the risk of ototoxicity. Mark D. Coggins was recognized by the Commission for Certification in Geriatric Pharmacy with the 2010 Excellence in Geriatric Pharmacy Practice Award. Excerpts of this article obtained from May/June 2014 Today's Geriatric Medicine Magazine. The full article can be viewed at www.todaysgeriatricmedicine.com Council On Aging-Orange County | 714-479-0107 | www.coaoc.org TIPS TO REDUCE OTOTOXICITY RISK n Familiarize yourself with ototoxic medications and their associated risks. n Recognizing ototoxicity early on can lead to earlier identification and possible prevent permanent damage n Do not treat the elderly and others with pre-existing hearing loss with ototoxic drugs if other effective alternatives are available. n Recognize that combination therapy of ototoxic medications increases the risk of hearing loss. n Discuss with patients the potential for ototoxicity of any drugs n Use the lowest effective dose possible, and closely monitor blood levels of known ototoxic medications. n Remind patients to minimize their exposure to loud noises when taking ototoxic medications and to immediately report any hearing changes when new medications are added or a dosage is changed as part of their treatment regimen. n Inform patients that over the counter medications such as aspirin and NSAIDs can be toxic. n Encourage patients to report any changes in hearing immediately, especially when new medications are added or dosages are increased. n when possible, assess patients' hearing before starting ototoxic medications and monitor during treatment as symptoms alone are not always reliable. Answers Guide 2015 45http://www.todaysgeriatricmedicine.com http://www.coaoc.org