Benzonatate is a prescription medication primarily used as a cough suppressant. Approved by the U.S. Food and Drug Administration (FDA), it has been available in the United States since the 1950s. In recent years, its usage has significantly increased, becoming a more common treatment for coughs in outpatient and emergency department settings between 2003 and 2018. This rise in prescriptions highlights its importance as a readily available option for cough relief.
How Benzonatate Works to Suppress Coughs
Benzonatate is available in liquid-filled capsules, often recognized under brand names like Tessalon® and Zonatuss®. These capsules are sometimes referred to as “perles” due to their small, pearl-like shape. Upon swallowing a benzonatate capsule, the liquid inside is absorbed by the gastrointestinal system. From there, it enters the bloodstream and travels to the lungs. Its mechanism of action is at a cellular level where it works to reduce the cough reflex. Essentially, benzonatate acts as a local anesthetic or numbing agent that reduces the activity of cough receptors in the airways and lungs, thus lessening the urge to cough.
Proper Benzonatate Usage: Dosage and Administration
Benzonatate is prescribed in capsule form and it is crucial to swallow these capsules whole. They should never be chewed, crushed, or dissolved. Accidentally breaking open a benzonatate capsule in the mouth can release the liquid contents, leading to rapid numbing of the mouth and throat. This numbing effect can be severe enough to cause choking and breathing difficulties. Similarly, exposure of the eyes to the liquid from these capsules can result in painful eye irritation, blurred vision, and potential ocular damage.
Benzonatate Availability: Prescription Status
In the United States, benzonatate is not available over the counter (OTC). It requires a prescription from a licensed healthcare provider. Benzonatate capsules are available in different strengths, including 100 mg, 150 mg, and 200 mg. The typical adult dosage is usually between 100-200 mg, taken up to three times a day, or as needed to manage coughing symptoms. The specific dosage and frequency will always be determined by a doctor based on individual patient needs and the severity of the cough.
Benzonatate Classification: Anesthetic, Not Steroid or Narcotic
Benzonatate is classified as an anesthetic drug. It is important to understand that benzonatate is neither a steroid nor a narcotic. It shares structural similarities with other local anesthetics like tetracaine, procaine, and even cocaine, although it does not have the addictive properties of cocaine. Due to its anesthetic properties, benzonatate can cause a temporary numbing sensation if it comes into direct contact with skin or mucous membranes. This numbing effect is part of how it works to reduce the cough reflex.
Potential Side Effects of Benzonatate
Like all medications, benzonatate can cause side effects. Common side effects include nausea, headache, confusion, and drowsiness (somnolence). Although less frequent, some individuals may experience psychiatric symptoms such as hallucinations. It is critical to be aware that benzonatate is particularly dangerous in overdose situations. Symptoms of benzonatate overdose can appear very quickly after taking too much of the drug and may include seizures, irregular heart rhythms, and cardiac arrest. In severe overdose cases, death can occur.
Benzonatate Use in Children: Age Restrictions
Benzonatate is not approved for use in children under 10 years of age. It is contraindicated for younger children due to safety concerns. Infants and young children are at risk of choking on the capsules themselves, and they are also more susceptible to serious adverse reactions if they ingest the medication. Even ingesting just one or two benzonatate capsules can cause significant poisoning or be fatal in infants and toddlers. Therefore, it is essential to keep benzonatate and all medications out of reach of young children.
Drug Interactions to Avoid with Benzonatate
Because drowsiness is a potential side effect of benzonatate, it should not be taken in combination with certain other types of medications that also cause sedation. These include sedatives, opioid analgesics (pain relievers), other cough and cold products (especially those containing antihistamines or other sedating ingredients), and any other medications that can cause drowsiness or central nervous system depression. Combining these medications can increase the risk of excessive sedation and other adverse effects.
Contraindications: Who Should Not Take Benzonatate
As previously mentioned, children under 10 years of age should not take benzonatate. Additionally, benzonatate capsules may contain parabens as preservatives. Individuals with known paraben allergies should avoid using benzonatate due to the risk of an allergic reaction. Furthermore, because benzonatate can rarely cause confusion, hallucinations, and other mind-altering effects, individuals who are taking psychotropic medications (medications for mental health conditions) should exercise caution and consult their doctor before taking benzonatate.
What to Do in Case of Benzonatate Overdose
In the event that you or someone you know experiences unwanted or unexpected symptoms after taking benzonatate, or if an overdose is suspected, it is crucial to seek immediate guidance from Poison Control. Poison Control services are readily available to provide expert advice and assistance in poisoning situations. You can access help from Poison Control online at www.poison.org or by calling their 24/7 hotline at 1-800-222-1222. Both options are free, confidential, and provide immediate support.
Prevention Tips for Safe Medication Use
To ensure the safe use of benzonatate and other medications, it is important to follow these prevention tips:
- Take medications as prescribed: Always take medications exactly as prescribed by your doctor. Carefully read and understand the package insert and prescription label to ensure correct dosing instructions.
- Understand side effects: Discuss potential side effects with your doctor or pharmacist when you are prescribed or purchase any medication, whether prescription or over-the-counter. Be aware of what to watch for and what actions to take if side effects occur.
- Keep medications out of reach of children: Store benzonatate and all other medications, both prescription and over-the-counter, in a secure location that is inaccessible to children. Child-resistant containers can also provide an extra layer of safety.
Real-Life Benzonatate Cases: Learning from Experience
Understanding the potential risks of benzonatate is further highlighted by real-life cases:
Case 1: Eye Exposure Misuse: A 46-year-old woman, acting on advice, applied the liquid from a benzonatate capsule into her eye to treat irritation. Initially, she felt relief and continued this for a few days. However, her condition worsened, leading to blurred vision and increasing eye pain. Upon visiting the Emergency Department, she was diagnosed with a corneal abrasion. She was advised to immediately stop using benzonatate in her eye and was treated with antibiotics and eye drops to aid healing. Her symptoms gradually improved over several days. This case underscores the danger of using prescription medications in unintended ways, even with well-meaning advice.
Case 2: Teen Overdose: A 17-year-old girl intentionally ingested at least 10 benzonatate capsules following an argument. Within a couple of hours, she collapsed at home. Her family called emergency services, and upon arrival, first responders found her in cardiac arrest. They initiated CPR and intubation, and she was transported to the hospital’s Intensive Care Unit. She required hospitalization for several weeks due to severe brain damage resulting from the overdose, including blindness and memory problems. This tragic case illustrates the severe toxicity of benzonatate in overdose and the potential for devastating consequences.
Further Resources for Benzonatate Information
For more detailed information about benzonatate, you can consult these reliable resources:
- Benzonatate (Oral Route) (Mayo Clinic): https://www.mayoclinic.org/drugs-supplements/benzonatate-oral-route/precautions/drg-20062223?p=1
- FDA Drug Safety Communication: Death resulting from overdose after accidental ingestion of Tessalon (benzonatate) by children under 10 years of age (U.S. Food & Drug Administration): https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-death-resulting-overdose-after-accidental-ingestion-tessalon
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