What is benzonatate used for?
Benzonatate is a non-opioid, prescription medication primarily used for the symptomatic relief of cough. It is most effective for a non-productive, or dry, cough caused by minor throat or lung irritation. Physicians may prescribe benzonatate for coughs associated with various respiratory illnesses and conditions, including:
- The common cold
- Influenza (the flu)
- Bronchitis
- Pneumonia
- Other respiratory infections
It is important to note that benzonatate does not treat the underlying cause of the cough, but rather provides temporary relief from the symptom itself. It is not recommended for a chronic cough that is a result of smoking, asthma, or emphysema, or when the cough produces a large amount of mucus or phlegm. For these conditions, different treatments are typically required.
Mechanism of action: How does benzonatate work?
Benzonatate's effectiveness stems from its unique mechanism of action, which differs from many over-the-counter cough suppressants. The medication works on the cough reflex in two main ways:
- Peripheral action: Benzonatate is a local anesthetic that acts on the stretch receptors located in the respiratory passages, lungs, and pleura. By anesthetizing these receptors, it decreases their activity and reduces the signals that tell the body to cough. Think of it as a numbing agent for the cough trigger points in the lungs and airways.
- Central action: The drug also has a central effect, suppressing the transmission of the cough reflex at the level of the medulla in the brain. This means it helps to calm the cough center in the nervous system, further reducing the frequency and severity of coughing.
Unlike opioid-based cough medicines, benzonatate does not inhibit the respiratory center at the recommended administration, making it a non-addictive option for cough relief. The onset of action is relatively fast, typically within 15 to 20 minutes, with effects lasting up to 8 hours.
Proper and safe administration of benzonatate
For benzonatate to be safe and effective, it is crucial to follow the prescribed directions and understand the administration warnings. The medication is available as liquid-filled capsules, often referred to as 'perles'.
How to take benzonatate
- Swallow Whole: The most critical instruction is to swallow the capsules whole without chewing, crushing, or dissolving them. Doing so can release the anesthetic medication into the mouth and throat, causing temporary numbness and potentially serious complications, including choking or severe allergic reactions.
- Administration: Follow the specific administration instructions provided by your healthcare provider or pharmacist. The frequency of administration is typically as needed for cough.
- Timing: The medication can be taken with or without food. Spacing administrations evenly throughout the day helps maintain consistent cough relief. If you miss an administration, simply skip it and continue your regular schedule; do not take a double amount.
- Age Restriction: Benzonatate is not approved for use in children under 10 years of age due to the risk of fatal overdose. Accidental ingestion by a child can lead to rapid toxicity and death within a short period.
Important warnings and side effects
While generally safe when taken correctly, benzonatate carries significant risks, especially if misused. It is chemically related to anesthetic agents like procaine and tetracaine, and can cause severe reactions if not handled properly.
Serious Side Effects and Overdose Risks
- Accidental Ingestion in Children: A major warning issued by the FDA highlights the fatal risk of accidental ingestion in children under 10. The pearl-like appearance of the capsules can be attractive to young children. In case of accidental ingestion, seek emergency medical help immediately.
- Chewing or Sucking Capsules: As mentioned, chewing or sucking the capsules can cause serious hypersensitivity reactions, including bronchospasm (constriction of airways), laryngospasm (spasms of the vocal cords), and cardiovascular collapse.
- Overdose: Taking more than the recommended amount can be dangerous, with symptoms appearing within 15-20 minutes, including restlessness, tremors, seizures, and potentially leading to cardiac arrest and death.
- Psychiatric Effects: In rare cases, bizarre behavior, mental confusion, and visual hallucinations have been reported.
Common Side Effects
- Drowsiness
- Dizziness
- Headache
- Constipation
- Nausea
- Nasal congestion
- Mild sensation of burning in the eyes
Benzonatate vs. over-the-counter cough medicines
Understanding the differences between benzonatate and OTC options can help determine which may be more suitable for your specific needs, under a doctor's supervision.
| Feature | Benzonatate (Tessalon Perles) | Dextromethorphan (Delsym, Robitussin DM) | Guaifenesin (Mucinex) |
|---|---|---|---|
| Availability | Prescription only | Over-the-counter (OTC) | Over-the-counter (OTC) |
| Primary Function | Anesthetizes stretch receptors to reduce the urge to cough (antitussive) | Acts on the brain's cough center to suppress the reflex (antitussive) | Thins and loosens mucus, making coughs more productive (expectorant) |
| Best For | Dry, non-productive cough from respiratory infections | Dry cough from minor throat/lung irritation | Wet, chesty cough with mucus or phlegm |
| Age Restriction | 10 years and older | Generally safe for children, but check product label for specific age limits | Children and adults, check product label for specific age limits |
| Mechanism | Numbing agent for lung/airway nerves | Central nervous system suppression | Hydrates and thins mucus secretions |
Benzonatate's targeted, numbing action makes it a powerful option for persistent, dry coughs that are not producing mucus. However, OTC alternatives are suitable for milder coughs and productive coughs.
Conclusion
Benzonatate is a valuable prescription medication for the symptomatic relief of dry cough associated with acute respiratory illnesses such as the flu, colds, and bronchitis. Its unique mechanism of action involves numbing the cough reflex receptors in the lungs and suppressing the cough center in the brain, offering effective and non-addictive relief. For safety, it must always be swallowed whole to prevent a dangerous local anesthetic effect in the mouth and throat. Due to the risk of fatal overdose, it is strictly contraindicated for children under 10 years of age. While effective for dry coughs, it is not the right choice for chronic or productive coughs, for which other treatments like expectorants are more appropriate. Always consult a healthcare provider to determine if benzonatate is the best treatment for your specific type of cough.
For more detailed information on drug interactions and safety, an excellent resource can be found on the Drugs.com website.
