Hydroxyzine is not commonly associated with tinnitus, and ear ringing does not appear on its official FDA-approved side effect list. However, hydroxyzine has been flagged in at least one pharmacological review as a “possible candidate” for ototoxicity, meaning it could theoretically affect hearing in some people. The picture is complicated by the fact that hydroxyzine has also been studied as a treatment that may actually reduce tinnitus perception.
What the FDA Label Says
The official prescribing information for hydroxyzine hydrochloride lists side effects that are “usually mild and transitory.” The recognized effects include dry mouth, drowsiness, and rare involuntary motor activity like tremor. In postmarketing reports (side effects collected after the drug reached the market), the FDA notes headache, hallucination, allergic reactions, and skin issues like rash and itching. Tinnitus is not mentioned anywhere on the label, either in the original clinical data or in postmarketing surveillance.
This doesn’t guarantee hydroxyzine can never cause ear ringing. Postmarketing reports depend on patients and doctors recognizing a connection and filing a report. Rare side effects can go underreported for years. But it does mean that across decades of widespread use, tinnitus hasn’t been flagged often enough to earn a spot on the official list.
Why It’s Flagged as Potentially Ototoxic
A 2024 review in Frontiers in Molecular Neuroscience, which cataloged drugs with potential to damage hearing, listed hydroxyzine among medications identified as “possible candidates” for ototoxicity. It appeared alongside other less obvious drugs like cimetidine (an acid reflux medication) and sucralfate (a stomach ulcer treatment). The review cited earlier research from 2019 as the basis for including hydroxyzine.
For any drug to damage hearing, it needs to cross the blood-labyrinth barrier, a protective boundary that separates your bloodstream from the delicate structures of the inner ear. Once inside the cochlea, a drug can potentially harm the tiny hair cells responsible for detecting sound, the nerve fibers that carry signals to the brain, or both. How easily a drug crosses this barrier depends on its chemical properties, including size, fat solubility, and polarity. Inflammation or infection can also make the barrier more permeable.
What the review did not establish is how frequently hydroxyzine might cause this kind of damage, at what doses, or in which patients. Being listed as a “possible candidate” is a lower tier of concern than drugs with well-documented ototoxicity, like certain antibiotics or chemotherapy agents that carry explicit hearing-loss warnings.
Hydroxyzine May Actually Help Tinnitus
Interestingly, hydroxyzine has been studied not as a cause of tinnitus but as part of a treatment for it. A clinical study published in Otology and Neurotology found that when hydroxyzine was combined with sulpiride (a medication that affects dopamine), patients experienced an 81% reduction in their tinnitus perception. Patients taking sulpiride alone saw a 56% reduction. On a visual scale where patients rated their tinnitus severity, scores dropped from 7.8 to 5.1 in the combination group, compared to 7.8 to 6.3 with sulpiride alone.
This likely relates to hydroxyzine’s core properties. It is an antihistamine with strong anti-anxiety and sedating effects. Tinnitus perception is heavily influenced by the nervous system’s arousal state. When you’re anxious or hypervigilant, tinnitus often feels louder and more intrusive. By reducing anxiety and calming the central nervous system, hydroxyzine may lower the brain’s amplification of the ringing signal. This is why some clinicians prescribe it off-label to help people cope with existing tinnitus, particularly when anxiety or sleep disruption is a major part of the problem.
What to Make of Mixed Signals
The situation with hydroxyzine and tinnitus is genuinely ambiguous. On one hand, it appears on a list of drugs with theoretical ototoxic potential. On the other, it has demonstrated the ability to reduce tinnitus perception in a clinical setting. These aren’t necessarily contradictory. A drug could, in rare cases or at high doses, irritate inner ear structures while simultaneously calming the nervous system’s response to tinnitus at standard doses.
If you started noticing ear ringing after beginning hydroxyzine, the timing could be coincidental. Tinnitus is extremely common, affecting roughly 10 to 15% of adults, and it often appears or worsens during periods of stress, sleep disruption, or medication changes of any kind. That said, your experience is worth reporting to whoever prescribed the medication. A simple test is whether the ringing fades after stopping the drug (with your prescriber’s guidance), which would suggest a connection, or persists regardless, which would point to other causes.
The bottom line: hydroxyzine causing tinnitus is theoretically possible but not well-documented. It is far more commonly used to help manage tinnitus-related distress than it is reported to trigger ear ringing in the first place.