Effects of Medications on Your Voice

Questions About Voice Changes? Contact our Atlanta And Alpharetta ENT Experts.


Many people would be surprised to learn that certain medications can affect the function of your voice. These include prescription medications, over-the-counter medications and herbal supplements. If your doctor prescribes a medication that adversely affects your voice, make sure to weigh the advantages and disadvantages.

How Medications Can Affect Your Voice

Most medications affect your voice by drying out the protective mucosal layer that covers your vocal cords. Vocal cords must be well-lubricated to work properly. When the mucosal layer is dry, the vibration that occurs in your vocal cords when you speak can cause irritation or injury.

Medications can also affect your voice by thinning your blood. This makes bruising or hemorrhaging of your vocal cords more likely if trauma occurs. It can also cause fluid retention, sometimes referred to as edema, which enlarges your vocal cords.

Types of Medications That Can Alter Your Voice

If you are taking any of the following medications and you notice a change in your voice, consider speaking with your doctor about the side effects. A medical professional can help you decide if the benefits of the medication are worth its side effects. You may also be able to explore alternative treatment options.

The following groups of medications may adversely affect your voice*:

  • Antidepressants
  • Muscle relaxants
  • Diuretics
  • Antihypertensives (blood pressure medication)
  • Antihistamines (allergy medications)
  • Anticholinergics (asthma medications)
  • High-doses of Vitamin C (greater than 5 grams per day)
  • Angiotensin-converting-enzyme (ACE) inhibitors (blood pressure medication)
  • Oral contraceptives
  • Estrogen replacement therapy post-menopause
  • An inadequate level of thyroid replacement medication in patients with hypothyroidism
  • Anticoagulants (blood thinners)
  • Herbal medications or supplements


If you take any of the above medications and you suspect that it may be affecting your vocal health, do not stop taking your medication. Suddenly stopping a medication can have severe side effects. Consult with a medical professional about your concerns.

Most vocal problems are highly treatable. Call us today at 404.257.1589 (Atlanta) or 770.777.1100 (Alpharetta), or book an appointment with us online now to discuss your voice concerns.

* NOTE: Contents of this fact sheet are based on information provided by The Center for Voice at Northwestern University.

Medications have side effects ranging from mild to severe. Side effects can affect pretty much any part of the body, including the throat and the voice. It may be surprising to take medication and find that your voice is changing in some way. These include prescription medications, over-the-counter medications, and herbal supplements.

In many cases, this isn't something to be too worried about, but it is important to know everything you can about the effects of medication on your voice. If your doctor prescribes a medication that adversely affects your voice, make sure to weigh the advantages and disadvantages.

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The Vocal Effects of Medication

One of the most common effects that many medications have on the voice is that they cause hoarseness. Hoarseness can be quite frustrating as it is easily noticeable by other people. In some cases, hoarseness is accompanied by pain when speaking. It also requires a person to strain to be audible to others. This stress can be detrimental to the condition that the medication is trying to treat in the first place.

Some medications may have adverse effects that result in slurred speech or inaudible words when trying to communicate. It may also affect the vocal quality by making a person's voice sound tremulous.

When using very specific types of medication, like hormones, there can be a decrease in the pitch of the voice.


Mechanisms Medications Use to Affect Voice

There are different mechanisms that medications use to achieve their effect. In some instances, this main effect or a side effect will affect a person's voice.

For instance, some medications can cause dryness in the throat. When the airway is dry, it causes irritation and pain which affect the functioning of the vocal cords, resulting in hoarseness.

Other medications can have minor effects on the nervous system, in turn affecting the muscles that control speech. These people will find it difficult to speak clearly, as their words may come out slurred or unclear.

Hormones like androgens can result in an increase in the bulk of the vocal cords, which makes them less able to hit high notes that might have previously been easily achievable.

Finally, anticoagulants, known as blood thinners, may increase the risk of hematomas and bruising. Strain to the vocal cords can induce bruising, which predisposes to edema. This may result in hoarseness or deepening of the voice due to the enlargement of the vocal cords.


Which Medications Can Affect the Voice?

The list of medications that can potentially affect the voice is longer than one might think. Several commonly used medicines can alter vocal quality as one of their side effects. Most drugs that affect the voice do so by drying the throat.

If you are taking any of the following medications and you notice a change in your voice, consider speaking with your doctor about the side effects. A medical professional such as Dr. Andrews can help you decide if the benefits of the medication are worth its side effects. You may also be able to explore alternative treatment options.

These include the following classes and medications:

  • Antidepressants

  • Muscle relaxants may predispose to acid reflux, due to muscles around the esophageal junction that relax. This reflux can directly irritate the throat and vocal cords.

  • Decongestants, e.g. pseudoephedrine

  • Diuretics

  • Antihypertensives

  • Antihistamines, used to treat allergies

  • Anticholinergics, such as those used to treat asthma

  • Vitamin C, in doses above 5 grams daily

  • ACE inhibitors, a class of antihypertensives, e.g. ramipril, lisinopril. These drugs may also cause the sensation of a lump in the throat.

  • Oral contraceptive pills may cause fluid to build in the vocal cords, also known as edema, which can really affect vocal quality.

  • Inhaled steroids, such as for asthma, e.g. fluticasone, beclomethasone. These drugs cause hoarseness.

  • Estrogen replacement therapy following menopause

  • Androgen hormones e.g. testosterone

  • Low levels of thyroid replacement medication in hypothyroid patients

  • Anticoagulants, commonly known as blood thinners. This can result in hemorrhage of the vocal cord as well as increasing the chance for polyps to form.

  • Oral retinoids, in rare instances, can cause a dry throat.

  • Herbal supplements

While it might seem like a medication that affects the voice can only do so in a negative manner, there are some that have actually been shown to have a beneficial effect by helping to lubricate the throat. Two great examples of this are guaifenesin and glyceryl.


What Can Be Done About Changes in Voice?

For anyone who might be experiencing changes in their vocal quality after using any medication, the first thing that should be done is to contact the prescribing physician or consult an ENT specialist. Stopping medication suddenly may have serious side effects, so it should not be done without professional consultation.

The vocal changes that medications cause are very likely to resolve when the medication is stopped, but that choice should not be made without a doctor's approval. After all, the benefits of using it may outweigh the effects it has on the voice.

In a few instances, more advanced techniques may be required, if the medication has caused some kind of semi-permanent changes to the vocal cords. This is unlikely to occur with most medications of this kind, however.


Dr. Andrews - Vocal Specialist

For an assessment of any changes in your voice that you believe may have been induced by a medication that you are using, it is important to ascertain the cause. Consulting a professional ENT doctor such as Dr. Andrews is the right move to make.

Not only is Dr. Andrews a board-certified otolaryngologist, but he is a specialist in voice and the things which may affect it. This makes him the perfect fit if you're dealing with medication-induced changes in the voice, as most of these issues can easily be treated.

Contact the Atlanta Institute for ENT for a professional evaluation of your voice and any changes that may have been noticed. Call us today at 404.257.1589 (Atlanta) or 770.777.1100 (Alpharetta), or book an appointment with us online now to discuss your voice concerns.

FAQs:


Are Vocal Changes Permanent

As with many side effects caused by medication use, changes in the voice are typically not permanent and are likely to resolve once an individual stops using a particular substance.

Most medications that induce dryness of the throat are unlikely to cause a permanent change when they are used precisely as prescribed by a professional. However, if they are used for a prolonged period or at an increased dosage, it is possible for the side effects to cause more damage than usual.

Anticoagulants increase the risk of polyps forming, and in such cases, vocal changes may not resolve without intervention such as a surgical procedure.

Should I Stop My Medication if my Voice Changes

An individual should never stop using medication in the event of vocal changes, without the express permission of a physician. We recommend anyone experiencing such side effects to contact our team at the Atlanta Institute for ENT in order to book an appointment with Dr. Andrews.

Most vocal changes are not anything to worry about in the long run. A consultation with a professional is sufficient to provide the appropriate information on how to proceed.
Which Drugs Cause Voice Changes Most Commonly

The medications that most frequently cause dryness of the mouth and throat are those that are the most likely to affect the voice and induce changes. The drugs that commonly do this include the following:

  • Antihistamines e.g. chlorpheniramine, diphenhydramine, loratadine

  • Antidepressants e.g. fluoxetine, sertraline, duloxetine, venlafaxine

  • Diuretics e.g. furosemide, bumetanide, hydrochlorothiazide, spironolactone

  • Decongestants e.g. pseudoephedrine, phenylephrine, oxymetazoline

  • Anticholinergics e.g. atropine, fesoterodine

  • Muscle relaxants e.g. cyclobenzaprine, carisoprodol, metaxalone

How to Prevent Medication-Induced Voice Changes

While it is difficult to entirely prevent side effects from medication in many cases, it is possible to reduce the risk of such side effects occurring by taking certain measures.

In the case of vocal changes that may be caused by the medications listed in this article, observing the following can help keep the risk to a minimum:

  • Staying well hydrated by drinking plenty of water

  • Using the medication at the dosage prescribed

  • Using the medication only for as long as it has been prescribed

  • Not using any additional medications in combination unless approved by a doctor

  • Avoid alcohol for the duration that one is using the medication. Alcohol has a diuretic effect which can dry out the throat even more

  • Making use of a humidifier in low-humidity environments


Sources:

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  2. Kerr, H. D., & Kwaselow, A. (1984). Vocal cord hematomas complicating anticoagulant therapy. Annals of emergency medicine, 13(7), 552-553. https://doi.org/10.1016/s0196-0644(84)80530-2

  3. Beckford, N. S., Rood, S. R., Schaid, D., & Schanbacher, B. (1985). Androgen stimulation and laryngeal development. The Annals of otology, rhinology, and laryngology, 94(6 Pt 1), 634-640. https://doi.org/10.1177/000348948509400622

  4. Daly C. (2016). Oral and dental effects of antidepressants. Australian prescriber, 39(3), 84. https://doi.org/10.18773/austprescr.2016.035

  5. Ihre, E., Zetterström, O., Ihre, E., & Hammarberg, B. (2004). Voice problems as side effects of inhaled corticosteroids in asthma patients--a prevalence study. Journal of Voice: Official Journal of the Voice Foundation, 18(3), 403-414. https://doi.org/10.1016/j.jvoice.2003.05.003

  6. Schreiber, J. U., Lysakowski, C., Fuchs-Buder, T., & Tramèr, M. R. (2005). Prevention of succinylcholine-induced fasciculation and myalgia: a meta-analysis of randomized trials. Anesthesiology, 103(4), 877-884. https://doi.org/10.1097/00000542-200510000-00027

  7. Liu A., Fang S., Kapoor K., Babar-Craig H. (2020). Haemorrhagic nasal polyp mimicking melanoma in an 83-year-old on rivaroxaban, BMJ Case Reports, http://doi.org/10.1136/bcr-2020-236309

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