How do I use Tessalon Pearls (Benzonatate) for sore throat and mouth pain?

Tessalon Pearls (Benzonatate) for Sore Throat and Mouth Pain

Tessalon Pearls (benzonatate) are not recommended for the treatment of sore throat or mouth pain as they are not indicated for these conditions and may pose serious safety risks including fatalities.

Appropriate Treatment Options for Sore Throat

First-Line Treatments

• Either ibuprofen or paracetamol (acetaminophen) are recommended as first-line treatments for relief of acute sore throat symptoms 1
• These medications have demonstrated effectiveness in reducing acute sore throat symptoms in both adults and children 1
• Systematic reviews have shown no significant difference between ibuprofen and paracetamol in analgesic efficacy or safety for short-term treatment 1

Local Anesthetic Options

• Benzocaine lozenges have demonstrated superiority over placebo for reducing painful pharyngeal discomfort 2
  • In clinical trials, benzocaine lozenges showed significant pain reduction with median time to worthwhile pain relief of 20 minutes 2
• Ambroxol lozenges (20 mg) have shown efficacy in randomized controlled trials for treating acute uncomplicated sore throat 3
  • These provide pain relief with early onset lasting up to at least 3 hours after a single lozenge 3
• Benzydamine hydrochloride is recognized by healthcare professionals as suitable for topical treatment of sore throat and various inflammatory/irritative conditions of the oral cavity 4

Safety Concerns with Benzonatate (Tessalon Pearls)

• Benzonatate (Tessalon Pearls) has been associated with fatalities, including cases involving children 5
• There are documented cases of death occurring within 1 hour of ingestion 5
• Blood, brain, and kidney concentrations of benzonatate have been reported in fatal cases 5

Treatment Algorithm for Sore Throat and Mouth Pain

1. First step: Oral analgesics

   • Start with either ibuprofen or paracetamol for pain relief 1
   • Follow recommended dosing guidelines for these medications

2. Second step: Topical treatments

   • Add topical treatments such as benzocaine lozenges 2, ambroxol lozenges 3, or benzydamine hydrochloride preparations 4
   • These provide direct local anesthetic and anti-inflammatory effects at the site of pain

3. For severe cases in adults

   • In adult patients with severe presentations (3-4 Centor criteria), corticosteroids may be considered in conjunction with antibiotic therapy 1
   • Note: No evidence of significant benefit has been found for corticosteroids in children 1

Important Cautions

• Zinc gluconate is not recommended for the treatment of sore throat despite some use in common cold symptoms 1
• Complementary treatments such as herbal remedies and acupuncture have inconsistent evidence and are not recommended as primary treatment 1
• When treating children, be particularly cautious with medication selection and dosing 1
• Avoid using Tessalon Pearls (benzonatate) for sore throat or mouth pain due to safety concerns and lack of indication for this use 5