© 2019, South African Medical Association. All rights reserved. Ototoxicity is a common side-effect during treatment of a a number of life-threatening health conditions. Often, when treating such conditions, the focus tends to be on saving the patient’s life rather than preserving their hearing or vestibular function. However, advances in clinical management of these conditions, availability of less ototoxic alternative medicines and developments in interventions to prevent ototoxicity now give clinicians a better opportunity to save the patient’s life and preserve their hearing and vestibular function. Effective communication between audiologists, clinical pharmacists and physicians is critical in preventing drug-induced ototoxicity. Clinicians need to stay up to date regarding scientific and clinical developments related to the prevention of treatment-induced ototoxicity. This article reviews common ototoxic medicinal agents and strategies to prevent ototoxicity, and discusses recent developments towards preventing drug-induced ototoxicity.