What is Benzonatate?
Benzonatate is a prescription-only, non-narcotic cough suppressant (antitussive) that has been on the market in the U.S. since 1958. It is most commonly known by the brand names Tessalon Perles or Zonatuss and is used to relieve symptoms of cough in people 10 years of age and older. Structurally, benzonatate is related to ester-type local anesthetics like procaine and tetracaine. Instead of working on the central nervous system like opioid cough suppressants (e.g., codeine), it acts peripherally by numbing the stretch receptors in the lungs and air passages, thereby reducing the cough reflex. This peripheral mechanism of action is why it does not produce the same euphoria or dependency associated with narcotic drugs.
Potential for Misuse and Abuse
While benzonatate is not categorized as a controlled substance and does not typically lead to classic drug addiction, it is not without a potential for abuse, especially among adolescents. Research has highlighted a worrying trend of increased intentional ingestions among teenagers (ages 10-16), sometimes involving multiple substances. This rise in misuse has been observed as healthcare providers shift away from prescribing opioid-based cough medicines, making benzonatate a more accessible alternative.
Why is it misused?
Unlike opioids, benzonatate does not produce a pleasurable 'high' when taken correctly. However, a small percentage of users have reported psychiatric side effects, such as confusion, visual hallucinations, and bizarre behavior, particularly when the drug is used improperly or in combination with other medications. These rare mind-altering effects may contribute to its misuse. Furthermore, the perception that a non-narcotic is 'safer' or less risky can lead to reckless behavior among those seeking a recreational effect.
The Critical Dangers of Benzonatate Overdose
Despite its low addictive potential, benzonatate has a very narrow margin of safety, making an overdose extremely dangerous and potentially fatal. The anesthetic-like properties that make it an effective cough suppressant are also responsible for its severe toxicity when too much is ingested. Accidental overdose in young children, who might mistake the shiny, round 'perles' for candy, is a particularly severe risk. The FDA has issued safety communications warning of accidental ingestions leading to death in children under 10. Ingestion of just one or two capsules has proven fatal for toddlers.
Improper administration risks
One of the most immediate and dangerous risks comes from improper administration. The capsules must be swallowed whole. Chewing, crushing, or sucking on the capsules releases the anesthetic into the mouth, throat, and esophagus, leading to rapid numbing. This can result in:
- Choking: Numbness of the throat and tongue can impair the ability to swallow, creating a choking hazard.
- Bronchospasm: Spasms of the muscles in the bronchial tubes, leading to difficulty breathing.
- Circulatory Collapse: A rapid drop in blood pressure and heart function.
Overdose symptoms
Overdose symptoms can appear quickly, often within 15-20 minutes, and include:
- Restlessness and tremors
- Convulsions or seizures
- Coma
- Cardiac arrest
- Altered mental status
- Rapid, irregular, or slow heartbeat
- Difficulty breathing
Benzonatate vs. Opioid Cough Suppressants
The rise in benzonatate prescribing is partially due to efforts to reduce reliance on opioid-based cough medicines. However, it is important to understand the fundamental differences in their abuse profiles and risks. The following table compares benzonatate with opioid antitussives like codeine and hydrocodone:
| Feature | Benzonatate (e.g., Tessalon Perles) | Opioid Cough Suppressants (e.g., Codeine) |
|---|---|---|
| Drug Class | Non-narcotic antitussive | Opioid (controlled substance) |
| Addiction Potential | Very low to none | High risk of dependence and addiction |
| Controlled Substance Status | No | Yes |
| Mechanism of Action | Peripherally numbs stretch receptors in the lungs | Acts on the central nervous system to suppress cough |
| Overdose Risk | Severe and rapid toxicity, potential for fatal cardiac events | Severe, potential for respiratory depression and fatal overdose |
| Overdose Onset | Rapid, within 15-20 minutes of ingestion | Varies, but can cause dangerously slow breathing |
| Recreational Effects | Not typically euphoric; some rare, undesirable psychiatric effects | Produces euphoria and sedation, highly sought after for misuse |
| Targeted User for Misuse | Adolescents seeking unconventional psychoactive effects, often involving multiple substances | Individuals with pre-existing substance use disorders, broad misuse potential |
Conclusion: Responsible Use and Prevention
While benzonatate is not an abused drug in the classic sense of being highly addictive or a euphoric narcotic, its potential for misuse and the severe, rapid toxicity associated with overdose pose serious risks. The increase in intentional misuse among adolescents is a significant concern that highlights the need for careful prescribing, patient education, and safe storage. Healthcare providers should educate patients and caregivers on proper administration and the lethal consequences of improper use. Keeping this medication in a child-resistant container and out of reach of both young children and adolescents is critical. Unused medication should be properly disposed of via a take-back program or following FDA guidelines to prevent accidental ingestion and misuse.
For more information on proper medication disposal, visit the FDA's website for guidance on disposing of unused medicines. In summary, the question of 'is benzonatate an abused drug?' is more nuanced than a simple yes or no. The answer lies in recognizing its unique dangers, which stem from high toxicity rather than addictive potential. Safe handling and awareness are the best defenses against the serious harm it can cause when misused.
