Can Losartan Cause Ringing in the Ears?

Losartan is not a well-established cause of tinnitus. While ringing in the ears is listed as a rare post-marketing report on some drug labels, the clinical evidence runs in the opposite direction: studies comparing different blood pressure medications consistently find that losartan and related drugs are associated with lower rates of tinnitus than many alternatives, and animal research suggests losartan may actually protect inner ear function. The more likely explanation when tinnitus appears alongside losartan use is the underlying condition the drug is treating.

What Direct Comparisons Between Blood Pressure Drugs Show

One of the most informative studies on this question directly compared tinnitus rates among patients taking different classes of blood pressure medication. In a prospective observational study, patients on angiotensin II receptor blockers (the class losartan belongs to) reported tinnitus at a rate of about 14%, which was significantly lower than the roughly 27% rate seen in patients taking diuretics. The ARB group also had lower rates than patients on alpha-blockers, who reported tinnitus about 22% of the time.¹

That pattern is worth sitting with. If losartan were a meaningful cause of tinnitus, you would expect ARB users to have elevated rates compared to other drug classes. Instead, the opposite shows up. The group on ARBs had one of the lowest tinnitus rates in the entire study, statistically indistinguishable from the group on statin therapy (about 12%), which is not a drug class associated with ear problems at all.

This does not mean that no one taking losartan will ever experience ringing in their ears. It means that when researchers actually measure tinnitus rates across drug classes, losartan’s class does not stand out as a cause. The ringing, in most of these patients, is coming from somewhere else.

Hypertension Itself Is the More Likely Culprit

High blood pressure is independently associated with tinnitus, and this is where most of the confusion about losartan and ear ringing probably originates. A meta-analysis pooling data from multiple studies found that people with hypertension had roughly 37% higher odds of experiencing tinnitus compared to those without it.² A systematic review reached a similar conclusion, noting that studies looking at whether hypertensive patients had tinnitus tended to find a link, though a definitive cause-and-effect relationship remained uncertain.³

There is an additional wrinkle worth understanding. One study found that while hypertension was significantly more common in tinnitus patients, the association disappeared when researchers adjusted for hearing loss.⁴ This suggests that the link between high blood pressure and tinnitus may run through hearing damage rather than being a direct vascular effect of elevated pressure. In other words, high blood pressure contributes to gradual hearing loss over time, and hearing loss is one of the strongest risk factors for tinnitus.

The practical consequence of this is straightforward. If you start losartan for hypertension and notice ringing in your ears, the most likely explanation is that your blood pressure has been high long enough to affect your hearing, not that the medication itself is doing the damage. The timing feels causal because you are paying more attention to your health, but the underlying process was already underway.

Sudden Blood Pressure Drops and Tinnitus Onset

There is one mechanism by which starting a blood pressure medication can genuinely trigger tinnitus, and it is not specific to losartan. The same observational study that compared drug classes found that in about 12% of patients who developed tinnitus, the onset correlated with a sudden drop in systolic blood pressure below 140 mmHg.¹ The inner ear is exquisitely sensitive to changes in blood flow. When blood pressure drops quickly, the tiny vessels supplying the cochlea may temporarily deliver less blood than the inner ear needs, producing transient ringing or buzzing.

This could happen with any antihypertensive, not just losartan. If you’ve been walking around with a systolic pressure of 170 and your new medication brings it down to 130 over a few days, that rapid shift can produce symptoms. Typically, this kind of tinnitus settles as your body adjusts to the new blood pressure level. If ringing shows up in the first week or two of starting losartan and then fades, this hemodynamic shift is a plausible explanation.

Evidence That Losartan May Actually Protect the Inner Ear

The research story on losartan and hearing gets genuinely interesting when you look at the experimental evidence, because it points in a direction most people would not expect. In an animal model of type 2 diabetes, diabetic rats developed significant hearing impairment, with hearing thresholds around 45 decibels compared to about 35 decibels in healthy controls. But diabetic rats treated with losartan maintained hearing thresholds nearly identical to the healthy animals, at around 36 decibels. The untreated diabetic rats also showed structural damage to the stria vascularis, a critical blood-vessel-rich tissue in the inner ear, while the losartan-treated group was protected from that damage.⁵

This protective effect makes biological sense. The inner ear contains angiotensin II receptors, and the renin-angiotensin system plays a role in regulating cochlear blood flow. Research in guinea pigs has shown that angiotensin peptides can increase blood flow to the cochlea, likely through a mechanism involving nitric oxide release from the cells lining blood vessels.⁶ By blocking the angiotensin II type 1 receptor, losartan appears to shift the balance of signaling in the inner ear’s vasculature in a way that reduces inflammation and preserves the delicate structures responsible for hearing.

Perhaps the most striking evidence comes from research on vestibular schwannomas, benign tumors that grow on the hearing nerve and commonly cause progressive hearing loss. In rodent models, losartan treatment normalized the tumor microenvironment, reduced inflammatory signaling, and prevented hearing loss. When researchers looked at human patient data, they found that patients with vestibular schwannomas who happened to be taking ARBs for their blood pressure showed no progression of tumor-related hearing loss, while patients on other antihypertensives or no blood pressure medication all experienced significant hearing decline.⁷ A subsequent clinical analysis confirmed this finding, reporting zero hearing loss progression events among patients taking ARBs across a combined follow-up period of over 36 patient-years.⁸

None of this means losartan is a tinnitus treatment. The research is about hearing preservation, not tinnitus reversal, and the vestibular schwannoma findings apply to a specific clinical situation. But the overall direction of the evidence is clear: losartan appears to be ear-friendly, not ear-harmful.

Blood Pressure Medications That Are More Strongly Linked to Tinnitus

If you’re taking losartan alongside other medications and experiencing tinnitus, some of those other drugs are more plausible suspects. Diuretics consistently show higher tinnitus rates than other antihypertensive classes. In the head-to-head comparison mentioned earlier, diuretic users reported tinnitus at roughly double the rate of ARB users.¹ Loop diuretics like furosemide are well-known ototoxic agents at higher doses, and even thiazide diuretics, commonly prescribed for blood pressure, carry some risk.

Beyond blood pressure drugs, an analysis of the Italian spontaneous adverse drug reaction database identified several medication classes with strong signals for ear-related side effects. Iron-chelating agents, certain anti-tuberculosis drugs like ethambutol, the glaucoma medication timolol in combination formulations, and hormonal agents like tamoxifen all showed statistically significant associations with hearing problems or tinnitus.⁹ ARBs as a class did not show up as a signal in that analysis.

Common over-the-counter medications also deserve attention. High-dose aspirin, nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen, and certain antibiotics (particularly aminoglycosides) are established causes of tinnitus. If you are taking any of these alongside losartan, they are more likely culprits than the losartan itself.

Why Drug Labels Can Be Misleading on Rare Side Effects

If losartan’s prescribing information mentions tinnitus, why isn’t it considered a real side effect? The answer has to do with how drug labels get written. Post-marketing surveillance collects reports from patients and doctors who notice a symptom while taking a medication. If enough reports come in, the symptom gets added to the label, even without evidence that the drug actually caused it. Since tens of millions of people worldwide take losartan, and tinnitus affects a sizable fraction of the general adult population regardless of what medications they take, a certain number of tinnitus reports are statistically inevitable even if losartan has no effect on the ear at all.

The Italian pharmacovigilance analysis illustrates how this kind of sorting works in practice. Researchers looked for “disproportionality signals,” which means they checked whether a drug was reported alongside a particular side effect more often than you would expect by chance. The drugs that flagged for ototoxicity were ones with extremely high reporting ratios, like deferasirox with a ratio above 40 for hearing loss, or ethambutol with a ratio above 12 for tinnitus.⁹ When a drug does not generate a disproportionality signal, it means that the rate of ear-related reports is about what you would expect from the background population rate. Losartan and other ARBs fall into that unremarkable category.

Sorting Out What Is Happening If You Have Ringing

If you are taking losartan and have developed tinnitus, the practical question is what to investigate. A few considerations are worth walking through with your prescriber:

Timing: If the ringing started within days of beginning losartan or a dose increase, a transient blood pressure drop is a reasonable explanation. This tends to resolve as you adjust to the medication.
Other medications: Review everything you take, including over-the-counter pain relievers, supplements, and any recently added prescriptions. Diuretics, NSAIDs, and certain antibiotics are more established causes of tinnitus than ARBs.
Hearing evaluation: Since the link between hypertension and tinnitus appears to run through hearing loss, a hearing test can clarify whether there is an underlying auditory issue. Tinnitus in the presence of measurable hearing loss points toward inner ear damage from hypertension, aging, noise exposure, or a combination of these.
Blood pressure patterns: If your blood pressure is swinging widely between high and low readings, those fluctuations can affect cochlear blood flow. Stable blood pressure control is better for the inner ear than dramatic ups and downs.

Stopping losartan without medical guidance is generally a poor idea, both because uncontrolled hypertension carries serious cardiovascular risks and because, based on the available evidence, losing the ARB’s potential protective effect on the inner ear could be counterproductive. If tinnitus is genuinely interfering with your quality of life, your doctor may want to investigate other causes rather than reflexively blaming the ARB.

The Bigger Research Picture on ARBs and the Ear

The research interest in losartan and hearing is growing, particularly around vestibular schwannomas. These tumors, which arise on the nerve that carries hearing and balance signals from the ear to the brain, affect a small but significant number of people. The standard management approaches include surgery, radiation, and watchful waiting, all of which carry a risk of hearing loss. The finding that ARBs appear to halt tumor-related hearing decline has generated enough excitement that clinical trials are being designed to test losartan specifically as a hearing-preservation strategy in vestibular schwannoma patients.⁷

The mechanism behind this effect appears to involve losartan’s ability to reduce inflammatory signaling in the tumor microenvironment. Specifically, losartan reduced a signaling pathway involving interleukin-6 and STAT3, which the research team found was inversely associated with hearing function in human tumor samples. When tumor-derived interleukin-6 was applied to cochlear tissue in the lab, it reduced the survival of sensory cells and neurons in the inner ear.⁷ Losartan’s anti-inflammatory properties in the ear extend beyond this specific tumor context. The diabetes rat model showed structural preservation of the stria vascularis, which is responsible for maintaining the chemical environment the cochlea needs to convert sound into nerve signals.⁵

Whether these findings will eventually lead to losartan being used specifically to protect hearing in high-risk populations remains an open question. The vestibular schwannoma data are the furthest along, but even there, the human evidence comes from retrospective analyses rather than randomized controlled trials. The zero-progression finding across 36 patient-years of ARB use is striking, but the numbers are small.⁸ What can be said with reasonable confidence is that the evidence base does not support losartan as a cause of tinnitus, and it increasingly suggests the drug may be doing the opposite of what people who Google this question are worried about.

1
PubMed Central. Prevalence of tinnitus in patients with hypertension and the impact of different anti hypertensive drugs on the incidence of tinnitus: A prospective, single-blind, observational study
2
PubMed Central. A Systematic Review and Meta-Analysis on the Association between Hypertension and Tinnitus
3
PubMed. Tinnitus and arterial hypertension: a systematic review
4
PubMed Central. Positive Association between Tinnitus and Arterial Hypertension
5
Cell and Tissue Research. Zucker diabetic fatty rats, a model for type 2 diabetes, develop an inner ear dysfunction that can be attenuated by losartan treatment
6
Hearing Research. Changes in cochlear blood flow due to intra-arterial infusions of angiotensin II (3–8) (angiotensin IV) in guinea pigs
7
Science Translational Medicine. Losartan prevents tumor-induced hearing loss and augments radiation efficacy in NF2 schwannoma rodent models
8
PubMed Central. Angiotensin-Receptor Blockers Prevent Vestibular Schwannoma–Associated Hearing Loss
9
Frontiers in Pharmacology. Ototoxic Adverse Drug Reactions: A Disproportionality Analysis Using the Italian Spontaneous Reporting Database