Tessalon Perles Safety in Patients with Alcoholism
Tessalon Perles (benzonatate, not benzocaine) can be used safely in patients with alcoholism, as there are no specific contraindications or hepatotoxicity warnings for this medication in patients with alcohol use disorder or alcoholic liver disease.
Key Safety Considerations
No Hepatotoxicity Concerns
- Tessalon Perles does not appear in any guidelines for medications to avoid in patients with alcoholic liver disease, unlike naltrexone and disulfiram which carry explicit hepatotoxicity warnings 1
- The medication is not metabolized through pathways significantly affected by alcohol-induced liver damage 2
Important Clarification
- Tessalon Perles contains benzonatate (a non-narcotic cough suppressant), not benzocaine - the FDA labeling provided refers to benzocaine, which is a different medication 2
- Benzonatate has no abuse potential and does not interact with alcohol in ways that would increase sedation or respiratory depression 3
Clinical Context for Alcoholic Patients
Medications That ARE Contraindicated
For context, medications that should be avoided in alcoholic patients include:
- Naltrexone: Explicitly not recommended due to hepatotoxicity risk in patients with alcoholic liver disease 1
- Disulfiram: Should be avoided in severe alcoholic liver disease due to possible hepatotoxicity 1
- Long-acting benzodiazepines (chlordiazepoxide, diazepam): Require caution in hepatic dysfunction due to impaired oxidative metabolism and risk of excessive sedation 1, 4
Safer Alternatives in This Population
- Short-acting benzodiazepines like lorazepam or oxazepam are preferred when treating alcohol withdrawal in patients with hepatic dysfunction 1, 4
- Baclofen is the only anti-craving medication formally tested in patients with liver cirrhosis 1, 5
Practical Recommendation
Tessalon Perles can be prescribed for cough suppression in patients with alcoholism without special precautions beyond standard dosing. The primary concerns in alcoholic patients relate to medications with hepatotoxic potential, abuse potential, or those requiring hepatic oxidation for metabolism - none of which apply to benzonatate 1, 5.
Monitoring Considerations
- If the patient has advanced alcoholic liver disease with cirrhosis, monitor for signs of hepatic encephalopathy (confusion, altered mental status) which can be triggered by various metabolic stressors 6
- Ensure the patient is not confusing Tessalon Perles with other medications, as medication adherence can be challenging in active alcohol use disorder 7