What is Tessalon Pearl?
Tessalon Pearl is the brand name for benzonatate, a non-narcotic oral antitussive (cough suppressant) medication—NOT benzocaine as incorrectly stated in the expanded question. This is a critical distinction because benzonatate and benzocaine are completely different medications with different mechanisms, uses, and safety profiles.
Medication Classification and Mechanism
Benzonatate is structurally similar to local anesthetics like tetracaine and procaine, working as a peripherally-acting antitussive that anesthetizes stretch receptors in the respiratory passages and lungs 1, 2.
The medication comes in liquid-filled gelatin capsules (perles) containing 100-200 mg of benzonatate 1, 2.
It provides cough suppression through local anesthetic action on the respiratory tract, not through central nervous system depression like narcotic cough suppressants 3.
Clinical Uses
Benzonatate is prescribed as an antitussive for symptomatic relief of cough 1, 2.
In specialized settings, it has been used off-label for rapid oropharyngeal anesthesia before awake intubations, achieving loss of gag response in approximately 55 seconds 3.
Critical Safety Concerns
Benzonatate carries significant toxicity risks that are not fully appreciated by prescribers, despite being one of the most widely prescribed antitussives available 2.
Life-Threatening Toxicity Profile
Overdose can cause rapid cardiac arrest, seizures, and death within 1-2 hours of ingestion 1, 2.
Fatal cases have been documented in both pediatric accidental ingestions and intentional overdoses, with death occurring as quickly as within 1 hour 1, 2.
A 17-year-old who ingested at least 10 capsules (≥2000 mg) experienced cardiac arrest and developed permanent blindness despite aggressive resuscitation including hypothermia protocol 2.
The capsules must be swallowed whole—chewing or sucking can cause rapid local anesthesia of the oral mucosa and potentially life-threatening systemic absorption 3.
Limited Treatment Options
Management of benzonatate overdose is primarily supportive, with emergent gastric lavage if presenting early, prophylactic magnesium for dysrhythmias, and advanced cardiac life support as needed 2.
There is no specific antidote for benzonatate toxicity 2.
Common Prescribing Pitfall
The major clinical pitfall is that benzonatate appears to be a "seemingly innocuous" over-the-counter-type medication, leading to inadequate patient education about its serious toxicity potential, particularly in households with children 2. Rational prescribing requires explicit warnings about keeping the medication away from children and the absolute necessity of swallowing capsules whole without chewing 2, 3.
Note: The expanded question incorrectly identified Tessalon Pearl as benzocaine. Benzocaine is a different topical anesthetic used in lozenges and sprays for sore throat, with its own distinct safety profile including methemoglobinemia risk 4, 5.