Article

Benzonatate (Tessalon, Tessalon Perles, Zonatuss)
January 30, 201901,318

 

What is Benzonatate (Tessalon, Tessalon Perles, Zonatuss)?

Benzonatate (ben-ZOE-na-tate) is an oral drug that is commonly prescribed to treat cough symptoms1,4.  The drug has been used for cough symptoms as far back as 1958, when it was approved by the US Food and Drug Administration (FDA)2,7.  It comes as a generic prescription, but is also available in the following brand names:

  • Tessalon
  • Tessalon Perles
  • Zonatuss

Benzonatate belongs to a class of drugs called antitussives, otherwise known as cough suppressants.4  Cough suppressants treat symptoms, but do not cure the underlying cause of your cough.  Unlike over-the-counter cough pills, benzonatate it is only available through a prescription by your doctor.8

 

 

What is Benzonatate used for?

Benzonatate (Tessalon Perles) is normally taken as needed to help control cough symptoms.  The medication can be used in adults and children older than 10 years of age.4  It works by directly numbing the breathing passages and lungs.  When the air passages and lungs lose sensation, they are less likely to become irritated and create an urge to cough.1

Cough can be caused by a variety of factors, including infection, allergies, heart disease, lung disease, or drug side effect.9  Benzonatate does not treat the underlying cause of your cough.  All it does is relieve your symptoms.  Benzonatate is most often prescribed for short term (acute) cough, such as when you have a common cold or flu infection.8

It is generally not recommended for long term treatment of cough caused by conditions such as asthma, smoking, or COPD.8  Occasionally, your doctor will prescribe benzonatate it if you have a long term (chronic) cough that has not responded to other treatments.  The medication can even be useful if you have advanced cancer and a persistent cough.2

 

Benzonatate Dosage

Benzonatate Adult Dosage

Benzonatate is available in 100mg, 150mg, and 200mg oral capsules.  It is most commonly prescribed in 100mg or 200 mg capsules.  The brand name Tessalon Perles is only available in 100mg capsules.4

Benzonatate comes in gelatin capsules that are yellow, soft, and oval-shaped.4,7 This allows you to easily and clearly identify the medication.

It is important to read and follow the prescription instructions very closely.  Your doctor will normally recommend taking one capsule, three times daily, as needed for cough symptoms.2,3,4,7  You can take the medication with or without food.

Make sure to swallow the capsule whole.  You should never crush, chew, or cut the capsule.  You should also avoid dissolving the capsule in your mouth.  Crushing or dissolving the capsule can lead to mouth numbness and choking. 4

Benzonatate takes about 15 to 20 minutes to start working.  The effect of the medication lasts about 3 to 8 hours.  You should avoid taking two or more doses at the same time – a single dose should not exceed 200 mg.  You should also refrain from taking more than the daily maximum dose of 600 mg/day.2,3,4,7

Benzonatate is taken as needed for cough.  If you are taking this medication regularly and you miss a dose, skip the missed dose and continue taking the medication on your normal schedule.4,8  Check with your doctor before you begin, stop, or change the dose of the medication.

You should avoid driving or operating heavy machinery until you are familiar with the effects of the medication.  Avoid performing tasks that require you to be alert until you know how the medication makes you feel.

Benzonatate Child Dosage

Benzonatate is not prescribed in children younger than 10 years of age.  Accidental ingestion and fatal overdoses have been reported in this age group.3,4,5,6,7 Benzonatate gelatin capsules can look like candy to children.5  Make sure to keep the medication in a childproof container away from young children.4

 

 

Benzonatate Side Effects

More Common Side Effects of Benzonatate

Benzonatate (Tessalon Perles) is generally well tolerated.  You may occasionally experience side effects when taking this medication.  Some of the more common and less serious side effects of benzonatate include3,4,7:

  • Upset stomach
  • Nausea
  • Constipation
  • Headache
  • Dizziness
  • Drowsiness
  • Stuffy nose

Stop taking the medication and call your doctor if you experience these side effects.

Serious Side Effects of Benzonatate

Benzonatate is rarely associated with serious side effects when taken properly at prescribed doses.  However, a small percentage of patients may experience potentially deadly side effects.  Serious side effects usually occur if you overdose on the medication.  The most serious side effects of benzonatate include3,4,7:

  • Chest numbness
  • Burning of the eyes
  • Confusion
  • Hallucinations
  • Restlessness
  • Shaking
  • Seizure & convulsions3
  • Heart attack (cardiac arrest)

If any of these side effects occur, call your doctor or get medical assistance immediately.  Symptoms of overdose can happen within 15 to 20 minutes after taking the medication.  Death can occur within one hour of ingesting the medication4.

 

 

Benzonatate Warnings

Benzonatate General Warnings

Benzonatate (Tessalon Perles) is generally safe to use, but there are special precautions you should take when ingesting this medication.  You should avoid breaking, chewing, dissolving, or crushing the capsules.  Capsules that are chewed or dissolved in the mouth can lead to numbness of the face, mouth, tongue, and throat.  Loss of feeling in the face or throat can increase the risk of choking.  It is also associated with a higher risk of developing severe allergic reactions.4

You should not take this medication if you have a history of allergies to benzonatate or related compounds.  Tell your doctor if you have a history of allergies to certain anesthetic agents, such as procaine or tetracaine.  If you have mouth numbness or tingling, avoid eating or drinking until the numbness goes away.  Contact your doctor as soon as possible if the numbness does not go away or gets worse.4

If you develop symptoms of an allergic reaction, you should contact your doctor or get immediate medical attention.  Symptoms of an allergic reaction may include8:

  • Rash
  • Fever
  • Wheezing
  • Chest tightness
  • Difficulty breathing
  • Swelling of the mouth, face, or lips
  • Swelling of the tongue or throat

The allergic rash is often red, itchy, and swollen.4 .  Chest tightness, wheezing, and difficulty breathing may occur due to constriction of the air passages in your lungs (bronchospasm)4.

Mental side effects are a lot less common with benzonatate compared to other prescription cough suppressants.4,6  Nonetheless, it is important for you to recognize these adverse effects in case they occur.  You may begin acting differently, behaving abnormally, or feeling confused.  There are reports that the medication can also cause hallucinations.4  Hallucinations are characterized as seeing or hearing things that do not actually exist.

Confusion and hallucinations most often occur if benzonatate is combined with other medications.4  If you experience these side effects, contact your doctor right away or have someone take you to the nearest emergency department.

 

Benzonatate Warnings for Special Groups

Benzonatate and Children

Benzonatate should not be given to children younger than 10 years of age.3,4,5  Accidental overdoses have occurred in this age group because the gelatin capsules can look like candy to children.5  There are reports that accidental ingestion by children can lead to seizure, coma, cardiac arrest, and death.3,5  

In 2010, the US Food and Drug Administration (FDA) issued a warning to keep the drug away from young children.  They recommend that parents keep the pills in childproof containers, out of sight or reach.10

Benzonatate and the Elderly

There are no specific dosing recommendations for benzonatate use in older individuals.  Medication dose and frequency follows the adult recommendations.4  If you are of older age, use this medication cautiously.

Side effects such as dizziness and drowsiness can potentially increase your risk for falls.  If you have dementia, your confusion may become worse with this medication.  Constipation can also be a significant problem in elderly individuals taking benzonatate.4,8

Benzonatate and Pregnancy

If you are a woman of childbearing age, you should tell your doctor if you are pregnant or plan on becoming pregnant.  Benzonatate is designated as pregnancy risk category C by the FDA.4  This means that risk to the baby cannot be excluded based on research studies in animals or humans.8  You should only take the medication during pregnancy after speaking to your doctor about the potential benefits and risks of treatment.

Benzonatate and Breastfeeding

You should also let your doctor know if you are breastfeeding.  It is not known whether Benzonatate gets passed into the breast milk.4  Nursing mothers should first speak to their doctor about the possible risks and benefits before starting treatment.

 

 

Benzonatate Drug Interactions

Drug interactions occur when one drug changes the way another drug works.  Drug interactions can be harmful because they may alter the effectiveness of a medication.  Sometimes, drug interactions cause a drug to be less effective.  On the other hand, drug interactions can even make a drug even more potent.

Benzonatate (Tessalon Perles) is usually well tolerated and has no significant interactions with most other medications.  Benzonatate and alcohol should generally not be combined as this can lead to excessive drowsiness.8  If alcohol is consumed, it should be significantly limited.

You should also tell your doctor if you are on other medications that can cause drowsiness.  These medications can potentially worsen the sedative effects of benzonatate.

Some of the most commonly prescribed medications associated with drowsiness include11:

  • Antihistamines – Diphenhydramine (Benadryl)
  • Muscle relaxers & anxiety pills – Lorazepam (Ativan), Diazepam (Valium)
  • Sleep medications – Zolpidem (Ambien), Eszopiclone (Lunesta)
  • Antidepressants – Trazadone, Amitriptyline (Elavil)
  • Narcotics pain killers – Codeine, Hydrocodone, Oxycodone

Make sure to check your over-the-counter cold and cough medications as these sometimes contain ingredients that can make you drowsy.  For example, Nyquil contains an antihistamine called doxylamine, which can cause sedation and drowsiness.

This is an abbreviated list that does not contain all the potential drug interactions of benzonatate.  If you are worried about benzonatate interactions, talk to your doctor or pharmacist.  You should tell them about all the medications you are taking, including over-the-counter drugs, vitamins, herbal products, and supplements.  You should also update your doctor or pharmacist before starting a new medication while taking Benzonatate.

 

 

Benzonatate Abuse

Benzonatate (Tessalon Perles) is a non-narcotic cough suppressant that works by numbing the breathing passages and lungs.  Its actions are different than prescription cough suppressants that contain narcotics, such as codeine.  Benzonatate is not a controlled substance under the Controlled Substance Act.12  It is much less likely to cause addiction or abuse compared to prescription cough suppressants containing narcotics.6

Benzonatate may produce mild sedative effects.  In addition, the medication can occasionally lead to confusion and hallucinations.4    The sedative effects of benzonatate are mild in comparison to narcotic cough suppressants.8

Benzonatate overdose

Drug overdose most often occurs in children due to accidental ingestion.  It may also occur in individuals that intentionally overdose in a suicide attempt.7 Individuals who overdose on benzonatate may develop seizure, coma, and heart attack (cardiac arrest).  Death is the most worrisome complication of benzonatate overdose.

If you suspect an overdose, contact the American Association of Poison Control Centers (1-800-222-1222) or go to the nearest emergency room.10

 

 

Other Important Information about Benzonatate

How should I store Benzonatate?

When storing Benzonatate, make sure to protect it from light.  You should also store your medication at room temperature (between 68 and 77 degrees F).4  Choose a dry area.  Avoid storage in moist of wet environments such as the bathroom.  Remember to always keep your drugs in a safe location that is out of reach of children and pets.

How should I throw out Benzonatate?

According to the FDA Disposal Guidelines, any leftover benzonatate should be disposed in your household trash by taking the medication out of its packaging and mixing it with an undesirable substance, such as the remains of your coffee grounds or cat litter. This will make the medication less appealing to anyone that is exposed to your trash.You can also put the medication in a sealable bag or an empty can with a tight lid, so as to prevent it from breaking out of your garbage can.10.  You should not share Benzonatate with others or take anybody else’s medications.  Call your doctor if your cough does not improve or worsens despite taking the medication.4,8

 

 

References

  1. Dicpinigaitis PV, Gayle YE, Solomon G, et al. Inhibition of cough-reflex sensitivity by benzonatate and guaifenesin in acute viral cough. Respir Med. 2009 Jun;103(6):902-6.
  2. Doona M, Walsh D. Benzonatate for opioid-resistant cough in advanced cancer. Palliat Med 1998; 12:55.
  3. Crouch BI, Knick KA, Crouch DJ, Matsumura KS, Rollins DE. Benzonatate overdose associated with seizures and arrhythmias. J Toxicol Clin Toxicol. 1998;36(7):713–718.
  4. Pfizer. Physician prescribing information 2017. http://www.pfizer.com/files/products/uspi_tessalon.pdf. Accessed June 5, 2017.
  5. Cohan JA, Manning TJ, Lukash L, Long C, Ziminski KR, Conradi SE. Two fatalities resulting from Tessalon (benzonatate) Vet Hum Toxicol. 1986;28(6):543–544.
  6. Burns J, Boyer E.  Antitussives and substance abuse. Subst Abuse Rehabil. 2013; 4: 75–82.
  7. Cohen V, Jellinek SP, Stansfield L, et al. Cardiac arrest with residual blindness after overdose of Tessalon® (benzonatate) perles. J Emerg Med. 2011 Aug;41(2):166-71.
  8. Benzonatate (By mouth) – National Library of Medicine – PubMed Health. (2017). PubMed Health. Retrieved 13 August 2017, from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0009242/?report=details
  9. Cough – National Library of Medicine – PubMed Health. (2017). PubMed Health. Retrieved 13 August 2017, from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022714/
  10. FDA Drug Safety Communication: Death resulting from overdose after accidental ingestion of Tessalon (benzonatate) by children under 10 years of age. (2017). Fda.gov. Retrieved 14 August 2017, from https://www.fda.gov/drugs/drugsafety/ucm236651.htm
  11. Publications, H. (2017). What to do when medication makes you sleepy – Harvard Health. Harvard Health. Retrieved 15 August 2017, from https://www.health.harvard.edu/drugs-and-medications/what-to-do-when-medication-makes-you-sleepy
  12. Controlled Substances. (2017). DEA Diversion Control Division. Retrieved 15 August 2017, from https://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf

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