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What is Benzonatate?

Benzonatate belongs to a drug class called antitussives or cough suppressants. It is a prescription non-narcotic cough suppressant. 

There is a lower-cost generic version available (active ingredient benzonatate) as well as under brand names such as Tessalon Perles, Tessalon, and Zonatuss. 

Benzonatate can be used for cough relief by adults and children 10 years of age and older. This medication can be extremely harmful for children younger than 10 years old; accidental ingestion can potentially lead to death. 

It comes in the following dosage forms: 100 milligrams (mg), 150 mg, and 200 mg capsules.

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Common Drug Interactions with Benzonatate

Certain medicines and benzonatate interact and this can increase your risk of serious adverse reactions. For example, certain other medications can affect benzonatate and lead to severe drowsiness, dizziness, impaired cognitive function, and an increased risk of respiratory depression (slowed or shallow breathing).

Your healthcare professional may change the dose of your medications, recommend a different medicine to relieve cough, and/or monitor you carefully for side effects if there are possible interactions between benzonatate and your other medicines. 

Some of the medications that can interact with benzonatate include:

• Other cough and cold medications that can cause drowsiness

• Sedatives and tranquilizers (drugs that cause sleepiness)

• Opioid analgesics (pain medications)

• Antihistamines

• Muscle relaxants

• Mental health medication such as antipsychotics and antidepressants, especially the older generation antidepressants such as monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs)

• Alcohol

You should not take benzonatate if you are allergic to topical anesthetics (numbing agents) such as tetracaine and procaine. 

Potential Side Effects of Benzonatate

Common Side Effects

Call your healthcare provider if the following side effects of benzonatate worsen or do not go away after a few days:

• Drowsiness

• Dizziness

• Headache

• Nausea

• Constipation

• Stuffy nose 

• Itching

• Feeling cold

• Burning in the eyes

Other Serious Side Effects 

Seek emergency medical care if you develop the following symptoms:

• Signs of severe allergic reactions: hives, itchiness, swelling of the tongue, lips, or throat, shortness of breath

• Bronchospasm (this is caused by sucking or chewing on a benzonatate capsule): numbness in the chest area, persistent numbness/tingling of mouth and throat, choking feeling

• Confusion or hallucinations (seeing, hearing, or feeling things that aren’t really there)

Use in Pregnancy and Lactation

Benzonatate is a pregnancy Category C drug. This means we don’t know for sure if benzonatate can cause harm to an unborn baby when it is taken by a pregnant woman. We also don’t know if benzonatate affects fertility and reproduction. Tell your doctor you are pregnant before starting treatment with benzonatate. Your healthcare provider will prescribe this medication only if the benefits outweigh the risks.

There isn’t enough research to say whether benzonatate is secreted in breast milk. Talk to your gynecologist or primary care provider about the potential risks and benefits if you are breastfeeding or planning to. 

Understanding Benzonatate: Uses and Effects

Approved Uses

Benzonatate (the common brand Tessalon) is approved to relieve cough caused by acute upper respiratory tract infections, such as bronchitis, which can occur with the common cold and influenza (flu).

Healthcare providers do not recommend taking benzonatate to treat persistent coughing or chronic cough symptoms that develop as a result of smoking or chronic lung conditions like asthma, COPD, or emphysema.

This medication is also not meant for relief from a cough that produces large amounts of phlegm or mucus. 

Off-Label Uses

Benzonatate is a local anesthetic. Off-label uses include opening a pearl of benzonatate (Tessalon Perles) and using the contents to soak a small pledget of cotton which can be placed in a dental cavity for pain relief. 

Note: Do not use benzonatate for topical anesthesia unless advised to do so by your dentist or healthcare provider. Benzonatate reduces sensation in the mouth and tongue and carries potential risks of choking if used in this way. Do not give benzonatate to children younger than 10 years old. A benzonatate overdose can be fatal to a child.

Check out our blog to learn about safe cough medicine for babies.

How Benzonatate Works to Suppress the Cough Reflex

Benzonatate acts as a numbing agent on the stretch receptors in the airways and lungs. By numbing the throat and lungs, benzonatate reduces the urge to cough. 

Questions and Concerns About Benzonatate

Is There Anything You Can't Take With Benzonatate?

It’s best not to take other drugs that can make you sleepy with benzonatate. This includes opioid pain medications, sleeping pills, muscle relaxers, anti-anxiety pills, and antiseizure drugs. It’s also a good idea to avoid drinking alcohol while on benzonatate. Alcohol is a central nervous system (CNS) depressant and can worsen drowsiness and dizziness. Alcohol also affects your immune system. If you have a cough from an infection, your body needs a healthy immune system to fight it off. 

Why do you need to be cautious when taking benzonatate?

While benzonatate is generally well-tolerated by most people when used as instructed, you should exercise caution when taking this medication. Benzonatate is an older medication approved by the U.S. Food and Drug Administration (FDA) in 1958. Due to less rigorous requirements to be FDA-approved, there are no interactions listed on the benzonatate package insert. However, there are medications and substances that you should be aware of while taking benzonatate. Therefore, it is important to inform your doctor of all your current medications to avoid drug interactions leading to harmful side effects.

Who Should Not Take Benzonatate?

Benzonatate is not safe for children younger than 10 years of age. Keep benzonatate capsules safely out of reach of children. 

People who have had an allergic reaction to benzonatate in the past should not take this medication again. Those with hypersensitivity (allergy) to procaine and tetracaine may also be allergic to benzonatate; it is vital to let your doctor know about this allergy and discuss potential alternative treatments. 

Is Benzonatate Over-the-Counter?

No, benzonatate is a prescription drug and you cannot purchase it over-the-counter.

Can I Take Benzonatate for a Wet Cough?

Doctors don’t recommend taking benzonatate for a wet cough (a cough that brings up a lot of mucus or phlegm). This is because benzonatate prevents coughing by blocking the cough reflux. It can therefore prevent the body from getting rid of mucus in the lungs and airways. 

An expectorant such as guaifenesin is the better choice for a wet cough. Guaifenesin can help to loosen phlegm in the airways and make it easier to cough up.

How Long Does It Take For Benzonatate To Get Rid of a Cough?

Benzonatate begins to act within 15-20 minutes and can control cough symptoms for 3-8 hours. 

Can You Take Benzonatate Every Day?

You can take benzonatate every day for cough relief provided you do not exceed the prescribed dosage. The typical adult dose is 100 mg or 200 mg in a single dose and a total daily dose of 600 mg in three divided doses. Benzonatate is not for chronic (long-lasting) cough. Tell your doctor if you have persistent coughing that continues after 7 days of taking benzonatate.

Should I Take More Than The Recommended Dose of Benzonatate For Quicker Relief? 

No. An overdose of this drug can result in seizures, coma, and cardiac arrest, potentially resulting in death.

Safety Precautions and Guidelines

Consultation with Healthcare Providers

Benzonatate is used to provide symptomatic relief from dry cough caused by respiratory tract infections such as the common cold and flu. Consult your healthcare provider if you have a chronic cough that lasts more than a week. It’s important to identify the cause of the cough and treat the underlying condition.

Tips for Safe Usage

• Medical conditions and medications: Give your doctor a complete list of your medical conditions and medications before starting treatment with benzonatate. Your doctor or pharmacist can tell you if any of your medications interact with benzonatate. Drug interactions can increase your risk of serious side effects.

• Dosage: Read the prescription label carefully and take benzonatate exactly as prescribed. Do not take more than the recommended dose of benzonatate. The typical adult dose is a 100 mg or 200 mg capsule of benzonatate up to three times a day (total daily dose of 600 mg in three divided doses). 

• Administration: Swallow benzonatate capsules whole. Do not open, break, cut, chew, crush, or dissolve the capsule. Release of the medicine from the capsule in the mouth can numb the local tissues, which can increase the risk of choking. Chewing or sucking a benzonatate capsule can increase the risk of hypersensitivity reactions, including bronchospasm (narrowing of the airways), laryngospasm (spasm of the vocal cords), and cardiovascular collapse.

• Oral numbness: If numbness or tingling of your mouth, throat, or face occurs after taking benzonatate, wait before eating or drinking anything until the numbness resolves. Seek medical help if the symptoms worsen or you develop a choking feeling.

• Missed dose: You should take benzonatate as needed to manage cough. If you are taking it on schedule and miss a dose, take it as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not take two doses or extra medicine to make up for a missed dose.

Warning Signs to Watch Out For

Serious side effects of too much benzonatate in the body include restlessness, tremors, seizures, coma, and cardiac arrest. Signs and symptoms of a benzonatate overdose can appear within 15-20 minutes. Seek emergency medical attention in case a child accidentally ingests benzonatate or an adult takes an overdose. Call the National Poison Control Center at 1-800-222-1222 or seek emergency medical attention in case of an overdose.

Note: This drug information is for educational purposes only. It is not a substitute for professional medical advice from a healthcare provider. Talk to your doctor or pharmacist if you have further questions about what drugs can interact with benzonatate.