Late dosing with ethacrynic acid can reduce gentamicin concentration in perilymph and protect cochlear hair cells

Hear Res. 2003 Nov;185(1-2):90-6. doi: 10.1016/s0378-5955(03)00258-2.


A key factor in the well-known interaction between ethacrynic acid (EA) and aminoglycoside antibiotics (AABs) is disruption of the blood-labyrinth barrier (BLB), leading to rapid entry of EA and AABs into the cochlear fluids. The idea that the blood-labyrinthine fluid concentration gradient might be utilized in a protective manner was tested in the current experiment. We hypothesized that administering EA when gentamicin (GM) levels are higher in the cochlea than in the blood might actually reduce cochlear damage by permitting efflux of GM from the cochlear fluids into the bloodstream, down a concentration gradient and across a temporarily disrupted BLB. Guinea pigs received 1, 11, 14 or 20 injections of GM (125 mg/kg i.m.). Approximately half of the animals also received a single injection of EA (40 mg/kg i.v.) either concurrently or 12-18 h after the last GM injection. Concurrent injection of EA significantly increased GM concentration in serum and perilymph at all time points sampled (2.5, 5-8, and 12 h post injection). Compared to animals that received GM only, animals that received a delayed injection of EA had a significantly lower GM concentration in perilymph, lower thresholds of the compound action potential, and less outer hair cell loss. Collectively, the evidence suggests that EA can reduce GM ototoxicity if it is administered 12-18 h after GM, but the mechanism remains to be elucidated. The results may have implications for the clinical management of aminoglycoside ototoxicity in humans, as well as for understanding the mechanisms underlying AAB/EA interactions.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Action Potentials / drug effects
  • Aminoglycosides / antagonists & inhibitors*
  • Aminoglycosides / blood
  • Aminoglycosides / pharmacokinetics
  • Aminoglycosides / poisoning
  • Animals
  • Anti-Bacterial Agents / antagonists & inhibitors*
  • Anti-Bacterial Agents / blood
  • Anti-Bacterial Agents / pharmacokinetics
  • Anti-Bacterial Agents / poisoning
  • Cell Survival / drug effects
  • Cochlea / drug effects
  • Cochlea / physiology
  • Differential Threshold / drug effects
  • Drug Administration Schedule
  • Ethacrynic Acid / administration & dosage*
  • Gentamicins / antagonists & inhibitors*
  • Gentamicins / blood
  • Gentamicins / pharmacokinetics
  • Gentamicins / poisoning
  • Guinea Pigs
  • Hair Cells, Auditory / drug effects*
  • Hair Cells, Auditory / physiology
  • Injections, Intravenous
  • Neuroprotective Agents / administration & dosage*
  • Osmolar Concentration
  • Perilymph / metabolism*


  • Aminoglycosides
  • Anti-Bacterial Agents
  • Gentamicins
  • Neuroprotective Agents
  • Ethacrynic Acid