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These additives are compounded directly into the medication vial

Pro-inflammatory cytokines increase neuronal vulnerability to apoptosis and oxidative stress by activating enzymes such as JNK, ERK, dsRNA-dependent protein kinase (PKR), and IB kinase (IKK) that reduce insulin sensitivity by serine phosphorylation of IRS1 [144, 145]

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A method for preventing drug-induced ototoxicity in an individual in need thereof comprising intratympanic administration of a pharmaceutical composition comprising a therapeutic agent, wherein the therapeutic agent is an antioxidant or anti-apoptotic agent, wherein the pharmaceutical composition is administered prior to onset of therapy with the drug, and wherein the composition provides sustained release of the therapeutic agent into the ear for a period of at least 5 days after a single administration

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