What is the role of Tessalon Perles (Benzonatate) in relieving coughs?

Role of Tessalon Perles (Benzonatate) in Relieving Coughs

Benzonatate (Tessalon Perles) acts peripherally by anesthetizing stretch receptors in the respiratory passages, lungs, and pleura to reduce cough reflex at its source, providing symptomatic relief of cough without central respiratory depression when used at recommended doses. 1

Mechanism of Action

Benzonatate works differently from many other cough suppressants:

• Acts as a peripheral agent rather than centrally acting (unlike opioids)
• Begins working within 15-20 minutes
• Effects last for 3-8 hours
• Does not inhibit the respiratory center at recommended dosages 1
• Anesthetizes stretch receptors in the respiratory tract, dampening their activity 1

Clinical Applications

Indications

• Symptomatic relief of cough from various causes 1
• Particularly useful for:
  • Patients with opioid-resistant cough in advanced cancer 2
  • Acute viral cough when combined with guaifenesin 3
  • Cough associated with lung cancer 4

Efficacy

• Effectively controlled cough in 80% of patients with malignant pulmonary involvement 4
• Has shown effectiveness in cases where opioids failed to provide relief 2
• When combined with guaifenesin, provides enhanced antitussive effect compared to either agent alone 3

Comparison to Other Antitussives

Advantages over centrally acting agents:

• No sedation or respiratory depression at recommended doses 1
• Lower abuse potential than opioid antitussives
• Can be effective in cases where opioids fail 2

Limitations:

• Effect is transient (3-8 hours) 1
• Not as extensively studied as some other antitussives in chronic cough conditions 4
• Risk of serious adverse events with overdose 5

Safety Considerations

Important precautions:

• Risk of cardiac arrest with overdose (particularly when combined with alcohol) 5
• Should be used with caution due to structural similarity to local anesthetics 5
• Proper patient education about dosing is essential

Clinical Decision Algorithm

1. First-line for non-productive cough requiring symptomatic relief:

   • Benzonatate 100-200mg three times daily

2. For enhanced effect in acute viral cough:

   • Consider combination with guaifenesin 600mg 3

3. For opioid-resistant cough in advanced disease:

   • Benzonatate has shown effectiveness when opioid antitussives fail 2

4. For cough due to lung cancer:

   • Consider benzonatate as an alternative when centrally acting suppressants like dihydrocodeine and hydrocodone are contraindicated or ineffective 4

Conclusion

Benzonatate occupies an important niche in cough management as a peripherally acting agent that provides symptomatic relief without central effects. It is particularly valuable in situations where opioid antitussives are contraindicated, ineffective, or undesirable due to their side effect profile.