Understanding Delsym (Dextromethorphan)
Delsym is a popular brand-name over-the-counter (OTC) medication whose active ingredient is dextromethorphan (DXM). It is widely used to temporarily relieve coughs caused by the common cold, flu, and other respiratory conditions. As an OTC option, it is easily accessible to consumers without a doctor's prescription.
How Delsym Works
Unlike medications that target the respiratory tract directly, Delsym works centrally within the brain. It suppresses the cough reflex by decreasing the activity in the part of the brain responsible for causing the urge to cough. By disrupting the communication between the brain's cough center and the nerves in the respiratory tract, Delsym effectively raises the threshold needed to trigger a cough. This mechanism makes it particularly effective for dry, non-productive coughs.
What to Know About Delsym
Delsym is available in various forms, including liquids and caplets, with different dosing frequencies. The extended-release (ER) liquid formulation is designed to provide up to 12 hours of relief, while immediate-release products may require more frequent dosing, such as every 6 to 8 hours.
Common side effects of Delsym include:
- Nausea and stomach upset
- Dizziness and drowsiness
- Diarrhea
- Feeling nervous or restless
Delsym carries a significant drug interaction risk, most notably with monoamine oxidase inhibitors (MAOIs). This combination can lead to a potentially dangerous condition called serotonin syndrome. It is also important to note its potential for recreational abuse, though this is primarily a concern at very high, non-therapeutic doses. Delsym is generally considered safe for adults and children aged 4 and older, though age-specific formulations and dosing instructions must be followed.
Understanding Benzonatate
Benzonatate, often recognized by the brand name Tessalon Perles, is a prescription-only cough suppressant. It is approved for use in individuals aged 10 and older. Because it is a prescription drug, its use is more tightly controlled and overseen by a healthcare professional.
How Benzonatate Works
Benzonatate acts as a local anesthetic that works peripherally, primarily in the lungs and airways. It works by anesthetizing or numbing the stretch receptors in the respiratory passages, lungs, and pleura. By dampening the activity of these nerves, it reduces the cough reflex at its source. It may also have a mild central effect on the cough center in the brain. The effects of benzonatate are typically felt within 15 to 20 minutes and can last for 3 to 8 hours.
Important Considerations for Benzonatate
A critical safety warning for benzonatate is that the capsules must be swallowed whole. Chewing or sucking on the capsule can release the medication into the mouth and cause rapid numbing of the tongue, mouth, and throat, leading to choking or severe allergic reactions. For this reason, and because of the risk of fatal overdose, it is not recommended for children under 10.
Common side effects of benzonatate include:
- Headache
- Drowsiness
- Dizziness
- Nausea and constipation
Serious side effects, including psychiatric effects like confusion and hallucinations, have been reported in rare cases. Accidental ingestion by young children can be fatal, and a boxed warning from the FDA highlights this risk. Therefore, benzonatate must be stored securely away from children.
Delsym vs. Benzonatate: A Comparison
The choice between Delsym and benzonatate depends heavily on individual circumstances, including cough type, age, and potential drug interactions. One is not inherently better than the other, but they are suited for different patient profiles and needs.
Delsym vs. Benzonatate Comparison Table
| Feature | Delsym (Dextromethorphan) | Benzonatate (Tessalon Perles) |
|---|---|---|
| Availability | Over-the-counter (OTC) | Prescription-only |
| Mechanism of Action | Central: Suppresses the cough reflex in the brain | Peripheral: Anesthetizes stretch receptors in the lungs and airways |
| Duration of Action | Extended-release up to 12 hours, immediate-release 6-8 hours | 3-8 hours per dose |
| Recommended Age | Adults and children 4+ (age-specific formulations) | Adults and children 10+ |
| Safety Concerns | Potential for abuse, drug interactions (especially MAOIs) leading to serotonin syndrome | Fatal overdose risk, especially in children, if chewed or crushed; choking hazard |
| Swallowing | Varies by formulation (liquid, caplet) | Must be swallowed whole |
| Common Side Effects | Nausea, stomach upset, dizziness, restlessness | Headache, drowsiness, dizziness, constipation |
Which Should You Choose?
Making the right choice depends on your specific needs, so always consult a healthcare provider for the best recommendation.
Consider Delsym if:
- You need a readily available, OTC option for temporary relief of a dry cough.
- You are an adult or have a child over age 4 (using the correct children's formulation) with a cough from a common cold.
- You are not taking MAOIs or other drugs that interact with dextromethorphan.
Consider Benzonatate if:
- Your doctor prescribes it for more severe or persistent coughs, such as those related to lung conditions like bronchitis or pneumonia.
- You are an adult or child over 10 and can safely swallow capsules whole without chewing.
- You require a centrally-acting suppressant like dextromethorphan and cannot take it due to drug interactions or other contraindications.
Remember that some coughs are productive, meaning they help clear mucus from the airways. In these cases, a suppressant like Delsym or benzonatate may not be the best choice, and an expectorant like guaifenesin may be more suitable.
Conclusion: Making the Right Choice for Your Cough
In summary, Delsym (dextromethorphan) and benzonatate are both effective cough suppressants, but they are not interchangeable. Delsym offers a convenient, OTC option that works in the brain to suppress the cough reflex. Benzonatate, a prescription-only medication, works by numbing receptors in the lungs and carries more significant safety risks, particularly if mishandled. The best choice ultimately depends on factors such as age, specific symptoms, and any existing medical conditions or other medications. Always consult a healthcare professional to determine the most appropriate treatment and ensure proper, safe usage. For more in-depth information regarding drug safety, it is always wise to consult trusted sources like the FDA drug safety resources.
