What is Benzonatate?
Tessalon Perles, and their generic counterparts, contain the active ingredient benzonatate [1.2.3]. It is a prescription medication classified as an antitussive, or cough suppressant [1.3.5]. Unlike many other prescription cough medicines, benzonatate is not a narcotic or an opioid [1.10.4]. It is chemically related to local anesthetic agents like procaine and tetracaine, which explains its unique mechanism of action [1.4.5]. It is prescribed for the symptomatic relief of cough caused by conditions like the common cold, flu, bronchitis, or pneumonia [1.2.1, 1.2.2]. It is important to note that benzonatate only helps to control the cough symptom; it does not treat the underlying cause of the cough [1.4.1].
How Benzonatate Works to Suppress Cough
Benzonatate has a distinct peripheral mechanism of action, differentiating it from centrally-acting suppressants like codeine or dextromethorphan. When a capsule is swallowed, it is absorbed and travels to the lungs and breathing passages [1.3.3]. There, it acts as a local anesthetic, numbing the stretch receptors (vagal afferent fibers) in the bronchi, alveoli, and pleura [1.4.4, 1.4.5]. These receptors are responsible for signaling the brain to initiate a cough when they are irritated or stretched. By desensitizing these receptors, benzonatate dampens the cough reflex at its source [1.3.2]. It may also have a secondary, milder effect on the cough center in the brain [1.3.1]. This dual action provides relief that typically begins within 15 to 20 minutes after ingestion and lasts for 3 to 8 hours [1.11.4].
Proper Administration and Critical Safety Warnings
Proper administration is crucial for the safety and efficacy of benzonatate. The capsules, often called 'perles' due to their round, pearl-like appearance, must be swallowed whole [1.5.1, 1.3.3].
DO NOT break, chew, cut, or suck on the capsules. Doing so releases the liquid medication directly into the mouth and throat, causing rapid numbness [1.6.5]. This can lead to a risk of choking and severe, potentially life-threatening hypersensitivity reactions like bronchospasm, laryngospasm, and cardiovascular collapse [1.6.2, 1.6.5].
A boxed warning from the FDA highlights the danger of accidental ingestion by children. Due to their candy-like appearance, accidental ingestion by children under 10 can be fatal [1.6.2, 1.9.2]. Overdose symptoms can appear within 15-20 minutes and include restlessness, seizures, coma, and cardiac arrest [1.9.1, 1.9.2]. It is imperative to store this medication in a child-resistant container and far out of reach of children [1.8.2].
Dosage and Side Effects
The typical dosage for adults and children over 10 years of age is one 100 mg or 200 mg capsule taken three times a day as needed for cough [1.5.2]. The total daily dosage should not exceed 600 mg, and a single dose should not exceed 200 mg [1.5.2, 1.5.4].
Common side effects, when taken correctly, are generally mild but can include [1.8.2, 1.6.1]:
- Drowsiness or sedation
- Dizziness
- Headache
- Constipation
- Nausea
- Stuffy nose
Rare but more serious side effects can occur, such as mental confusion, visual hallucinations, and bizarre behavior, particularly when taken with other medications [1.6.5].
Comparison of Common Cough Suppressants
Understanding how benzonatate differs from other common antitussives can help clarify its role in treating cough.
| Feature | Benzonatate (Tessalon) | Dextromethorphan (OTC) | Codeine (Prescription Opioid) |
|---|---|---|---|
| Mechanism | Peripherally-acting; numbs lung stretch receptors [1.4.4] | Centrally-acting; suppresses cough center in the brain [1.7.1] | Centrally-acting; suppresses cough center in the brain [1.7.2, 1.7.4] |
| Classification | Non-narcotic [1.10.4] | Non-narcotic derivative of morphine [1.7.4] | Narcotic (Opioid) [1.7.2] |
| Availability | Prescription only [1.2.1] | Over-the-counter (OTC) [1.7.1] | Prescription only (Schedule II) [1.7.2] |
| Primary Use | Symptomatic relief of cough [1.2.1] | Symptomatic relief of cough [1.7.1] | Mild-to-moderate pain and cough [1.7.2] |
| Key Side Effect | Drowsiness, dizziness, headache [1.6.1] | Nausea, stomach upset, potential for serotonin syndrome with other drugs [1.7.1] | Constipation, sleepiness, potential for addiction and respiratory depression [1.7.2] |
Conclusion
The medication in Tessalon Perles is benzonatate, a unique, non-narcotic prescription cough suppressant [1.2.3, 1.10.4]. It provides symptomatic relief by anesthetizing nerves within the lungs and airways, effectively reducing the urge to cough [1.3.2]. While it is an effective option for many, its safe use is paramount. The critical importance of swallowing the capsules whole to avoid severe oral and throat reactions cannot be overstated [1.6.5]. Furthermore, extreme caution must be taken to prevent accidental ingestion by children, for whom it can be fatal [1.9.2]. As with any prescription medication, it should only be used as directed by a healthcare provider.
For more detailed safety information, consult the official FDA label information. Link to FDA [1.8.4]
