Tessalon Pearls (Benzonatate) Use During Breastfeeding
There is insufficient evidence to recommend Tessalon Pearls (benzonatate) during breastfeeding, and safer alternatives for cough suppression should be strongly considered first.
Critical Issue: Lack of Safety Data
The provided evidence does not contain any information about benzonatate (the active ingredient in Tessalon Pearls) and breastfeeding. This is a significant concern because:
- No published data exists on benzonatate transfer into breast milk or effects on breastfed infants
- The drug is not mentioned in comprehensive breastfeeding medication guidelines 1
- General principles indicate that drugs without established safety data should be used with extreme caution during lactation 2
Important Clarification
Note: The question mentions "Tessalon Pearls (benzocaine)" but this is incorrect. Tessalon Pearls contain benzonatate, not benzocaine. These are completely different medications with different safety profiles.
Risk Assessment Based on General Principles
When prescribing medications for breastfeeding patients, those with the lowest risk to the infant should be selected 3. For medications without established safety data:
- Most commonly used drugs are relatively safe, but this assumes they have been studied 2
- The dose received via milk is generally small for most medications, but this cannot be confirmed without specific data 2
- Drugs should only be used when benefits clearly outweigh unknown risks 4
Recommended Approach
Consider safer alternatives first:
- Acetaminophen is a preferred analgesic during lactation and may help with associated discomfort 3
- Ibuprofen is also preferred and compatible with breastfeeding 1, 3
- Non-pharmacologic measures for cough suppression should be maximized
- If an antitussive is absolutely necessary, consult current resources like LactMed for the most up-to-date information 3
If Benzonatate Must Be Used
Should clinical circumstances require benzonatate use despite lack of data:
- Use the lowest effective dose for the shortest duration 1
- Monitor the infant closely for unusual drowsiness, poor feeding, or respiratory changes 1
- Time doses before the infant's longest sleep interval to minimize exposure 3
- Consider temporary interruption of breastfeeding if high doses or prolonged use is required
- Document the risk-benefit discussion with the patient
Common Pitfalls to Avoid
- Do not assume all cough medications are safe simply because they are over-the-counter
- Do not confuse benzonatate with benzocaine or other local anesthetics that have different safety profiles
- Avoid relying on package insert information alone, as it often recommends against breastfeeding due to liability concerns rather than actual risk 2