Can Patients with Heart Issues Take Tessalon (Benzonatate)?
Patients with heart issues can take Tessalon (benzonatate), but extreme caution is warranted due to documented cardiovascular risks including cardiac arrest, cardiovascular collapse, and arrhythmias, particularly in overdose situations. 1, 2
Key Safety Considerations
Cardiovascular Risks
Benzonatate is chemically related to local anesthetic agents (procaine, tetracaine) and has been associated with serious cardiovascular adverse effects including cardiovascular collapse, particularly when capsules are chewed or dissolved in the mouth 1
Cardiac arrest has been documented in both adults and children following benzonatate overdose, with death occurring within 1 hour of ingestion 2, 3
Bradyarrhythmias and other cardiac rhythm disturbances have been reported in overdose cases 2
Mechanism of Cardiac Effects
Benzonatate exerts local anesthetic effects on cardiac tissue, specifically blocking non-myelinated nerve endings in the left ventricle at therapeutic concentrations 4
The drug can attenuate cardiovascular reflex responses and impair normal cardiac receptor function, similar to lidocaine's effects on the heart 4
Clinical Recommendations for Patients with Heart Disease
Safe Use Guidelines
Patients with heart conditions should strictly adhere to prescribed dosing: maximum single dose of 200 mg and total daily dose not exceeding 600 mg 1
Capsules must be swallowed whole—never broken, chewed, dissolved, cut, or crushed—to prevent rapid release and systemic absorption that could precipitate cardiovascular events 1
Keep benzonatate out of reach of children, as accidental ingestion has resulted in death within 15-20 minutes, with cardiac arrest occurring within one hour 1
High-Risk Scenarios to Avoid
Do not use benzonatate in patients taking other medications that affect cardiac conduction or rhythm without careful consideration, as the drug's local anesthetic properties may interact with concomitant cardiac medications 1
Avoid use in patients with a history of sensitivity to para-amino-benzoic acid class anesthetics (procaine, tetracaine) due to potential cross-reactivity 1
Exercise extreme caution in patients with pre-existing arrhythmias, conduction abnormalities, or those on antiarrhythmic therapy 2, 3
Overdose Recognition and Management
Warning Signs
Symptoms of overdose may include restlessness, tremors, convulsions, coma, and cardiac arrest, developing within 15-20 minutes of ingestion 1
If accidental overdose occurs, seek emergency medical attention immediately—death has been reported within one hour 1, 2
Emergency Considerations
Treatment is primarily supportive with advanced cardiac life support (ACLS) protocols, as there are limited specific antidotes available 2, 3
Gastric lavage may be considered in early presentation, along with prophylactic magnesium for dysrhythmia prevention 3
Common Pitfalls
The most critical error is underestimating benzonatate's toxicity potential—it is not a benign cough suppressant and carries significant cardiovascular risks, particularly in overdose 2, 3
Patients and caregivers often lack awareness of the serious consequences of chewing or crushing capsules, which can lead to rapid systemic absorption and cardiovascular collapse 1
Missing doses should be skipped entirely—never double dose, as this increases risk of toxic effects 1