Benzonatate Contraindications
Benzonatate is contraindicated in patients with hypersensitivity to benzonatate or related compounds. 1
Primary Contraindications
Hypersensitivity: Patients with known hypersensitivity to benzonatate or chemically related compounds (such as tetracaine or other ester-type local anesthetics) should not use this medication 1
Age restriction: Not recommended for children under 10 years of age due to risk of severe toxicity and death from accidental ingestion 2, 3
Special Populations with Precautions
Pregnancy and Lactation
- While not absolutely contraindicated, benzonatate should be used with caution during pregnancy as safety data is limited 2
- Use during breastfeeding requires careful consideration of risks versus benefits 2
Patients with Seizure Disorders
- Benzonatate should be used with extreme caution in patients with seizure disorders as overdose can precipitate seizures 3, 4
Risk of Toxicity
Benzonatate has sodium channel-blocking properties similar to local anesthetics that can lead to serious toxicity in overdose:
- Cardiovascular effects: Can cause cardiac arrhythmias including QT prolongation, torsades de pointes, and cardiac arrest 5, 6
- Neurological effects: May cause seizures, coma, and central nervous system depression 3, 4
- Metabolic effects: Severe overdose can cause metabolic acidosis 3
Important Clinical Considerations
- Symptoms of toxicity can occur rapidly, sometimes within 15 minutes of ingestion 2
- Intentional overdoses have significantly higher risk of serious adverse effects (22%) compared to unintentional exposures (0.7%) 4
- Deaths have been reported, particularly in pediatric accidental ingestions and intentional overdoses 2, 6
Patient Education Points
- Patients should be counseled about: