Benzonatate Contraindications
Benzonatate is contraindicated in patients with hypersensitivity to benzonatate or related compounds. 1
Primary Contraindication
- Hypersensitivity to benzonatate or related compounds (including tetracaine and procaine) 1
Special Populations and Risk Considerations
Pediatric Patients
- Not recommended for children under 10 years of age due to risk of fatal overdose 2
- Accidental ingestion in children under 10 years has resulted in fatalities, with 5 reported deaths in children 2 years and younger 2
- Children 0-5 years old represent the majority (83%) of unintentional exposure cases 3
Pregnancy and Breastfeeding
- Use with caution in pregnant or breastfeeding women due to limited safety data 4
Overdose Risk Factors
- History of intentional medication misuse or abuse, particularly in adolescents aged 10-16 years 3
- Concurrent use of alcohol, which may potentiate toxic effects 5
- Access to medication by young children, as rapid onset of toxicity can occur within 15 minutes of ingestion 2
Clinical Considerations for Prescribing
Potential Severe Adverse Effects
- Cardiac arrest and dysrhythmias including torsades de pointes 5, 6
- Seizures, which can occur rapidly after overdose 2, 7
- Coma, respiratory arrest, and anoxic brain injury 2
- Death, which has been reported in both pediatric and adult overdose cases 2, 5
Monitoring Recommendations
- Patients with intentional overdose require close monitoring as they have higher incidence of serious toxicity compared to unintentional exposures 7
- Signs of toxicity can develop within minutes of ingestion, requiring immediate medical attention 2
Patient Education Points
- Store medication securely away from children 2, 3
- Recognize signs of overdose (seizures, cardiac symptoms, rapid loss of consciousness) and seek immediate medical care 2
- Do not exceed prescribed dosage 5
- Avoid concurrent alcohol consumption 5
Clinical Pearls
- Benzonatate has a chemical structure similar to local anesthetics (tetracaine and procaine), which explains its sodium channel blocking properties and potential for serious cardiac effects 5, 7
- While serious outcomes are possible with intentional overdoses, unintentional exposures in adults rarely result in clinically significant adverse effects 7
- The rapid onset of life-threatening symptoms makes benzonatate particularly dangerous in overdose situations 2, 5