Can You Take Cough Syrup and Tessalon Perles Together?
Yes, you can take benzonatate (Tessalon Perles) together with certain over-the-counter cough syrups, and this combination may actually provide enhanced cough suppression compared to either agent alone.
The Evidence for Combination Therapy
The most compelling data comes from a controlled study showing that benzonatate combined with guaifenesin (a common OTC cough syrup ingredient) suppressed cough significantly better than either medication alone 1. Specifically, the combination suppressed capsaicin-induced cough more effectively than benzonatate alone (p<0.001) or guaifenesin alone (p=0.008) in patients with acute upper respiratory infections 1.
Understanding the Mechanism
This combination makes pharmacologic sense because:
- Benzonatate works peripherally by anesthetizing stretch receptors in the respiratory passages, lungs, and pleura, reducing the cough reflex at its source 2
- Most OTC cough syrups contain either dextromethorphan (a central cough suppressant) or guaifenesin (an expectorant), which work through different mechanisms
- The two agents target different parts of the cough pathway without overlapping toxicity
Important Caveats About Efficacy
However, you should know that the evidence for cough suppressants in general is surprisingly weak:
- For acute cough from upper respiratory infections (the common cold), central cough suppressants like dextromethorphan have limited efficacy and are not recommended by ACCP guidelines 3, 4
- Peripheral cough suppressants (including benzonatate) also have limited efficacy for URI-related cough 3, 4
- These medications show better evidence only for chronic bronchitis, not the common cold
Safety Considerations
Benzonatate carries significant safety risks, particularly in children and with overdose:
- Unintentional exposures in children 0-5 years are rising, with most cases involving children finding and ingesting the liquid-filled capsules 5
- Intentional overdoses can cause seizures, cardiac dysrhythmias, and death 6
- The capsules must be swallowed whole—never chewed, crushed, or sucked, as this releases the medication locally in the mouth and can cause severe reactions
- Most serious adverse events occur with intentional exposures; unintentional exposures rarely cause significant toxicity 6
Practical Recommendation Algorithm
If you have acute cough from a cold:
- The combination is safe but likely provides minimal benefit based on guideline evidence 3, 4
- Consider an older antihistamine-decongestant combination instead, which has better evidence 4
If you have chronic bronchitis:
- The combination is both safe and potentially beneficial
- Benzonatate is FDA-approved for symptomatic cough relief 2
- Use for short-term relief only
Storage warning:
- Keep benzonatate in a locked location away from children—the soft gelcaps are attractive to young children and can be fatal
Bottom Line
There is no pharmacologic contraindication to combining benzonatate with OTC cough syrups, and research suggests potential synergistic benefit 1. However, the overall evidence for either medication treating common cold-related cough is poor 3, 4, so realistic expectations about efficacy are important. The combination is most reasonable for chronic bronchitis rather than acute viral upper respiratory infections.