What is the proper use of Tessalon (benzocaine) pearls for sore throat and mouth pain relief?

Tessalon Pearls (Benzonatate) for Sore Throat and Mouth Pain

Tessalon pearls (benzonatate) are not recommended for sore throat or mouth pain relief as they are not FDA-approved for this indication and pose significant safety risks including potentially fatal outcomes. 1

Correct Understanding of Tessalon Pearls

Tessalon pearls contain benzonatate, which is a non-narcotic antitussive medication primarily used as a cough suppressant. It is important to note that:

• Benzonatate is different from benzocaine, which is a local anesthetic sometimes used for sore throat
• Tessalon pearls are not indicated for sore throat or mouth pain treatment
• Fatal cases have been reported with Tessalon (benzonatate) ingestion 2

Recommended Treatments for Sore Throat

First-Line Treatments

1. Systemic analgesics:

   • Ibuprofen 400mg every 6-8 hours (not exceeding 2400mg/day) - preferred option 3
   • Paracetamol/acetaminophen 1000mg every 6 hours (not exceeding 4000mg/day) 3

2. Non-pharmacological approaches:

   • Rest and humidification of air 3
   • Adequate fluid intake
   • Warm salt water gargles (1/2 teaspoon salt in 8oz warm water)
   • Avoiding irritants (smoking, alcohol, spicy foods) 3

Appropriate Local Anesthetics for Sore Throat

If a local anesthetic is desired for sore throat pain relief, the following options have documented efficacy:

• Benzocaine (8mg) lozenges - can be used up to 4 times daily for adults and children over 2 years 1, 4, 5
• Lidocaine (8mg) lozenges 4
• Ambroxol (20mg) - has the best documented benefit-risk profile among local anesthetics 4

Important Safety Warnings

Benzocaine Warnings

When using benzocaine products for sore throat:

• Methemoglobinemia risk: Can reduce oxygen in blood; stop use immediately if pale/gray/blue skin, headache, rapid heart rate, shortness of breath, dizziness, fatigue occurs 1
• Allergy alert: Do not use with history of allergy to local anesthetics including procaine, butacaine, benzocaine or other "caine" anesthetics 1
• Duration warning: If sore throat is severe, persists >2 days, or is accompanied by fever, headache, rash, swelling, nausea, or vomiting, consult a doctor 1

Usage Guidelines

• Adults and children ≥2 years: Use up to 4 times daily
• Children under 12: Should be supervised
• Children under 2 years: Do not use 1

When to Seek Medical Attention

• Sore throat persisting >2 days
• Severe symptoms
• Accompanying fever, headache, rash, swelling, nausea, or vomiting
• High Centor criteria score (3-4) suggesting bacterial infection 3
• If symptoms do not improve within 7 days 1

Key Takeaways

• Tessalon pearls (benzonatate) should not be confused with benzocaine products
• Ibuprofen or paracetamol are recommended first-line treatments for sore throat pain 6
• Benzocaine lozenges (not Tessalon) can provide temporary relief of sore throat pain 5
• Zinc gluconate is not recommended due to inconsistent evidence and adverse effects 6
• Herbal treatments and acupuncture have inconsistent evidence for sore throat treatment 6

Remember that most sore throats are viral in origin and will resolve without specific treatment within 5-7 days. Symptomatic treatment with appropriate analgesics and local anesthetics (not Tessalon pearls) is the recommended approach.