What is benzonatate used for?

What Benzonatate Is Used For

Benzonatate is indicated for the symptomatic relief of cough, functioning as a peripherally-acting non-opioid antitussive that anesthetizes stretch receptors in the lungs to reduce the cough reflex. 1

Primary Indication

• Benzonatate is FDA-approved specifically for symptomatic cough relief across various etiologies. 1
• The medication works by anesthetizing pulmonary stretch receptors, thereby suppressing the cough reflex without central nervous system depression. 2

Clinical Applications by Cough Type

Acute Cough

• Benzonatate is effective for acute viral upper respiratory tract infections, where it has been shown to inhibit cough-reflex sensitivity when measured by capsaicin challenge testing. 3
• Treatment duration should be limited to 7-10 days for acute cough, with discontinuation if symptoms persist beyond 1 week. 4

Cancer-Related Cough

• In patients with lung cancer experiencing opioid-resistant cough, benzonatate is recommended as a peripherally-acting antitussive alternative. 5
• The 2017 CHEST guidelines suggest benzonatate specifically for adult lung cancer patients with cough that does not respond to opioid derivatives. 5
• Case studies demonstrate benzonatate's effectiveness in controlling cough in advanced cancer patients when standard opioid therapy fails. 5, 2

Chronic Bronchitis

• Benzonatate is recommended only for short-term symptomatic relief in chronic bronchitis, not for long-term management. 4

Dosing Guidelines

• The recommended dosage is 100-200 mg three to four times daily according to American College of Chest Physicians guidelines. 4
• The medication should be swallowed whole as capsules must not be chewed or dissolved due to risk of local anesthetic effects in the mouth and throat. 1

Position in Treatment Algorithm

For General Cough Management

• Benzonatate serves as a first-line non-opioid option when demulcents (simple linctus) are ineffective or unavailable. 4

For Cancer-Related Cough

• The hierarchical approach places benzonatate after opioid derivatives fail but before trials of nebulized local anesthetics (lidocaine/bupivacaine). 5
• It is specifically positioned for opioid-resistant cough alongside other peripherally-acting agents like levodropropizine, moguisteine, or sodium cromoglycate. 5

Special Populations

Safety in Porphyria

• Benzonatate is safe in patients with porphyria, with no evidence suggesting it triggers acute porphyria attacks. 4

Pediatric Considerations

• While FDA-approved, benzonatate carries significant overdose risk in children, particularly those under 10 years old, where accidental ingestion can cause seizures, cardiac arrest, and death within 15 minutes. 6
• Unintentional exposures are most common in children 0-5 years old (83% of cases), necessitating strict storage precautions. 7

Common Pitfalls to Avoid

• Do not prescribe benzonatate for extended periods without reassessing the underlying cause of persistent cough. 4
• Persistent cough beyond 2 weeks requires diagnostic evaluation rather than continued symptomatic suppression. 4
• Never instruct patients to chew or dissolve the capsules, as this causes oropharyngeal anesthesia and potential choking hazard. 1
• Ensure counseling on safe storage away from children, as fatal overdoses have occurred with ingestion of as few as 1-2 capsules in young children. 6