What is the recommended use of Tessalon Perles (Benzonatate) for cough treatment?

Recommended Use of Tessalon Perles (Benzonatate) for Cough Treatment

Benzonatate (Tessalon Perles) is recommended as a non-opioid peripheral antitussive agent for short-term symptomatic relief of cough, particularly when opioid antitussives are contraindicated or ineffective. 1

Mechanism and Indications

• Benzonatate is a peripherally acting non-opioid antitussive that works by anesthetizing stretch receptors in the lungs, thereby reducing the cough reflex sensitivity 2
• It is particularly useful for non-productive cough that persists despite treatment of underlying causes 3
• Benzonatate has shown efficacy in both acute viral cough and chronic cough associated with advanced conditions like cancer 1, 3

Dosing and Administration

• Standard dosing is 200mg three times daily for symptomatic relief of cough 2
• The medication should be swallowed whole (not chewed) as the local anesthetic effect can cause temporary numbness of the mouth and throat if the capsule is broken 4
• Treatment duration should be limited to short-term symptomatic relief, as long-term safety data is limited 1

Efficacy Profile

• Benzonatate has demonstrated effectiveness in suppressing cough in clinical studies, particularly when combined with other agents like guaifenesin 2
• The combination of benzonatate with guaifenesin has shown superior cough suppression compared to either agent alone 2
• It has proven effective in cases of opioid-resistant cough in advanced cancer patients, offering an alternative when first-line treatments fail 3, 5

Safety Considerations

• Benzonatate carries a risk of serious adverse events, particularly in overdose situations, which can lead to cardiac arrhythmias and arrest 4
• It should be used with caution in patients with known cardiac conditions 4
• Patients should be advised to keep the medication out of reach of children due to rapid onset of toxicity in overdose 4
• The medication should not be crushed or chewed as this can lead to local anesthesia of the oropharynx and potential aspiration 4

Comparative Efficacy

• Benzonatate offers an alternative to opioid antitussives like codeine and dextromethorphan, which have significant adverse effect profiles 6
• Unlike codeine or pholcodine, benzonatate does not have the same adverse side effect profile and may be preferred when opioids are contraindicated 6
• For acute viral cough, benzonatate may be more effective when combined with guaifenesin than when used alone 2

Clinical Decision Algorithm

1. Assess cough characteristics (productive vs. non-productive) and duration (acute vs. chronic)
2. Rule out serious underlying causes requiring specific treatment 6
3. For symptomatic relief of non-productive cough:
   • Consider benzonatate 200mg three times daily if opioid antitussives are contraindicated or ineffective 1, 3
   • Consider combination therapy with guaifenesin for enhanced effect in acute viral cough 2
4. Monitor for response within 3-5 days and reassess if inadequate relief 3
5. Discontinue if adverse effects occur or after resolution of symptoms 4

Special Populations

• Benzonatate has shown particular benefit in patients with advanced cancer who have opioid-resistant cough 3, 5
• It should be used with extreme caution in patients with a history of substance abuse, as overdose can be life-threatening 4
• Patient education regarding proper administration (swallowing whole, not crushing) is essential to prevent complications 4