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Key takeaways
Benzonatate alternatives include OTC and prescription options, including Delsym, Mucinex, codeine, Hycodan, and Neurontin.
Benzonatate carries risks such as potential overdose in children and adverse effects like confusion, hallucinations, and dizziness, prompting the search for substitutes.
Natural remedies like honey and throat lozenges offer a non-pharmaceutical option for cough suppression, potentially as effective as some over-the-counter medications.
Consulting a healthcare provider is crucial before switching to an alternative cough suppressant to ensure the new option is appropriate for the individual’s health condition and to discuss potential interactions with other medications.
A cough can definitely be a nuisance at school or work and be disruptive overnight, but since the COVID-19 pandemic, a cough can earn some sideways looks in public too. More than ever, it would be nice if a medication could quiet or resolve a cough. Benzonatate has been an option for many years. Better known by its brand name, Tessalon Pearles, benzonatate stands apart from liquid cough suppressants by being a capsule, a feature that has won it fans. However, the drug has some serious potential for harm, particularly if it falls into the wrong hands. It is best to know about this potential and understand what alternatives exist for benzonatate.
What can I take in place of benzonatate?
Benzonatate is thought to reduce cough by anesthetizing stretch receptors in the chest wall and pleura (lung lining). Adults must be cautious about swallowing the capsules whole. Chewing the capsule could lead to numbness of the throat, which can put one at risk of aspiration. Children could obviously be at risk of this adverse effect, but they are also at higher risk of other adverse effects of benzonatate, like confusion, hallucinations, and dizziness.
Fatal cases of overdose leading to convulsions and cardiac arrest from accidental ingestion in children have been reported. Signs of overdose can occur within 15 minutes and with as little as one or two capsules in very young children. Accordingly, the Food and Drug Administration (FDA) has only approved benzonatate for those over 10 years of age and explicitly warns about the need to store this drug in a child-resistant container out of reach of children.
If these concerns have created hesitations about benzonatate, other mechanisms and options for cough suppression exist. Dextromethorphan is an N-methyl-D-aspartate (NMDA) receptor antagonist that can reduce the sensitivity of cough receptors. Opioids, like morphine and codeine, may reduce coughing by inhibiting the cough center in the brain.
An unexpected option is the gamma aminobutyric acid (GABA) analogs gabapentin and pregabalin, both of which have limited evidence of effectiveness for cough, possibly due to an effect on the central nervous system. Nebulizing an anesthetic drug, such as lidocaine or tetracaine, can provide an inhaled option for cough suppression. More commonly, the expectorant guaifenesin is used for colds to loosen up a cough. Attempts at treating cough with antihistamines like diphenhydramine or decongestants like pseudoephedrine are seen in the setting of allergies or colds, and while they may be effective against the underlying cause, they are truly not antitussives or cough suppressants. The following table provides antitussive alternatives to benzonatate.
Compare Tessalon Perles (benzonatate) alternatives |
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|---|---|---|---|
| Drug name | Uses | Dosage | Savings options |
| Benzonatate | Cough | 100 to 200 mg three times daily as needed | Benzonatate coupons |
| Delsym Cough and Sore throat (acetaminophen-dextromethorphan) | Cough | 650 mg-20 mg/20 mL with 20 mL every 4 hours as needed | Delsym Cough and Sore Throat coupons |
| Mucinex DM (guaifenesin-dextromethorphan) | Cough | 1 to 2 tablets every 12 hours as needed | Mucinex DM coupons |
| Guaifenesin AC (guaifenesin-codeine) | Cough | 100 mg-10 mg/5 mL with 10 mL every 4-6 hours as needed | Guaifenesin AC coupons |
| Hycodan (hydrocodone-homatropine) | Cough | 5 mg-1.5 mg/5 mL with 5 mL every 4-6 hours as needed | Hycodan coupons |
| Neurontin (gabapentin) | Cough (off-label), partial seizures, post-herpetic neuralgia | 300 mg once daily and adjusted as directed | Neurontin coupons |
Top 5 benzonatate alternatives
The following are some of the most common alternatives to benzonatate.
1. Delsym
Delsym is one of the brand name versions of dextromethorphan, and it is available over-the-counter (OTC), unlike benzonatate. Like many OTC cough and cold remedies, it is available in numerous variations, each with a different combination of ingredients aimed at the worst common cold symptoms. The cough suppressant in Delsym products is dextromethorphan, a drug with modest support from clinical trials. While modest, the experimental proof is more robust than with benzonatate, and unlike benzonatate, dextromethorphan has dosing guidelines for children when needed.
Dextromethorphan has its own obstacles, including drug interactions that can lead to serotonin syndrome. Caution with or avoidance of concurrent serotonergic medications is advisable, including certain antidepressants, nausea drugs, and migraine relievers. Be advised that dextromethorphan can also be habit-forming and have abuse potential.
2. Mucinex
If the drug interaction potential of dextromethorphan and the adverse effect potential of benzonatate have you looking for other options, Mucinex may meet your needs. Mucinex is one of the brand name forms of guaifenesin, a safe OTC drug that is thought to thin bronchial mucus, making it easier to cough out or expectorate. As such, guaifenesin is a cough medicine but not a cough suppressant. Under the Mucinex brand umbrella, though, is an assortment of products. Each combines a different set of cough and cold symptom relievers. For example, Mucinex DM includes the cough suppressant dextromethorphan with the expectorant guaifenesin.
3. Codeine
Suppressing a cough is not easy, and many times, treatment attempts fail. Sometimes, it is not advisable, so consult a healthcare provider about using cough suppressants. A prescription is needed for some of these drugs, including benzonatate and opiates. Codeine, like other opiates, is on the controlled substance list of the Drug Enforcement Administration (DEA) based on its habit-forming potential. Be aware of other common side effects of codeine, such as drowsiness and constipation. Evidence supporting codeine’s effectiveness for cough is limited, but it has been used traditionally, often in combination with guaifenesin (Guaifenesin AC).
4. Hycodan
Hycodan is another opiate combination drug with a history of use for coughing. That use is dwindling. Hycodan combines hydrocodone, an opiate, with the typical narcotic adverse effects, and homatropine, an anticholinergic, with all the side effect concerns surrounding that drug class. Put them together, and Hycodan’s possible side effects include sedation, constipation, dizziness, urinary retention, and dry mouth.
5. Neurontin
As a medication typically used for seizures or neuropathic pain, Neurontin (gabapentin) is certainly an unexpected member of this list. Its presence is based on guidelines for the treatment of chronic cough. Those guidelines mention gabapentin because clinical trials have found it helpful. This recommendation is only for chronic, unexplained coughs and not for the typical cough related to colds.
Natural alternatives to benzonatate
By now, there may be an interest in steering clear of benzonatate and a few other antitussives. If that’s the case, natural remedies could be an option. Throat lozenges or topical ointments with menthol or aromatic essential oils could help. Honey is another reasonable choice for a natural solution. A systematic review found evidence that honey is probably as effective as dextromethorphan in children. Adding honey to tea may create a soothing solution for a cough.
How to switch to a benzonatate alternative
There may be some ideas that one could consider trying instead of benzonatate. However, before settling on any one option, seek medical advice from a healthcare provider. Make sure to know what is causing the cough and whether suppressing the cough is advisable. If so, talk with the professional about the pros and cons of the different antitussives, particularly how each might affect any underlying health conditions or interactions with prescription drugs, OTC medications, and supplements. Finally, discuss the cost differences with a local pharmacist and show them a SingleCare discount card for help getting the lowest price. Putting a healthcare team into action will help lead to feeling better as quickly as possible.