Benzonatate

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Benzonatate
Benzonatate.svg
Systematic (IUPAC) name
2-[2-[2-[2-[2-[2-[2-[2- (2-methoxyethoxy) ethoxy] ethoxy] ethoxy] ethoxy] ethoxy] ethoxy] ethoxy] ethyl4-butylaminobenzoate
Clinical data
Trade names Tessalon
AHFS/Drugs.com monograph
MedlinePlus a682640
Pregnancy cat.
Legal status
?
Pharmacokinetic data
Half-life 3-8 hours
Identifiers
CAS number 104-31-4 YesY
ATC code R05DB01
PubChem CID 7699
DrugBank DB00868
ChemSpider 7413 YesY
UNII 5P4DHS6ENR YesY
KEGG D00242 YesY
ChEBI CHEBI:3032 YesY
ChEMBL CHEMBL1374379 N
Chemical data
Formula C30H53NO11 
Mol. mass 603.742 g/mol
 N (what is this?)  (verify)

Benzonatate is a non-narcotic oral cough suppressant, or antitussive, with effects that last from 6 to 8 hours. Its formal name is 2,5,8,11,14,17,20,23,26-nonaoxaoctacosan-28-yl para-butylaminobenzoate. Since it is not an opioid, benzonatate is not prone to abuse like some other cough medications such as codeine. Benzonatate was approved by the U.S. Food and Drug Administration (FDA) in 1958.[1]

Chemical structure[edit]

Benzonatate is a butylamine, chemically related to other ester local anesthetics such as procaine and tetracaine.

Pharmacologic mechanisms of action[edit]

Benzonatate is thought to act as a local anesthetic, decreasing the sensitivity of stretch receptors in the lower airway and lung, thereby reducing the drive to cough after taking a deep breath.[2]

Indications[edit]

An antitussive, benzonatate is employed to reduce coughing in various respiratory conditions such as bronchitis, emphysema, influenza, and pneumonia.[2] It should never be used to suppress a productive cough producing mucus that can be spit out, or in place of treatment of the actual cause of cough, such as asthma treatment.[citation needed]

It has been used in small doses as a topical anesthetic for mouth or pharyngeal pain. This practice is not recommended, because the oropharyngeal anesthesia may result in pulmonary aspiration.[3]

Noted beneficial side-effect is the reduction or quieting of chronic snoring.[citation needed]

Dosage and administration[edit]

100mg generic Benzonatate capsules.
100mg generic Benzonatate capsules.

Benzonatate is sold as yellow or blue 100 mg and 200 mg softgel capsules. Initial dose is one 100 mg perle (gelcap) by mouth, 3 times a day. Dosage may be increased as necessary, up to a maximum of 600 mg per day.[1]

Due to its potency and potential toxicity, the capsules must be swallowed intact in order to allow slower release of the medication.

Adverse reactions[edit]

Reported side effects include drowsiness, dizziness, and dysphagia. There are numerous reports of death related to overdose of benzonatate, mostly in children.

Para-aminobenzoic acid (PABA) is a metabolite of the ester class of local anesthetics, which includes benzonatate, as well as procaine and tetracaine. Severe allergic reactions have been reported in patients who are allergic to PABA. Severe sensitivity reactions to benzonatate have resulted in respiratory side effects such as bronchospasm, laryngospasm and cardiac arrest.[4]

Excessive absorption of benzonatate (a local anesthetic) in the oral mucosa will result in the rapid development of numbness of the mouth and throat. In extreme cases, the mouth and pharynx may become so numb that pulmonary aspiration may occur.

Excessive absorption of benzonatate will occur if the gelcaps are chewed or allowed to dissolve in the mouth. This may lead to an overdose of the drug. Overdose of benzonatate may manifest as central nervous system side effects, such as mental confusion and hallucination, restlessness and tremors,[citation needed] followed in extreme cases by convulsions and death.[5]

Brand names[edit]

It is sold in the USA generically or under the brand name Tessalon Perles (gelcaps), Zonatuss or Tessalon Capsules. It is sold in other countries under various brand names, including Benzonatato, Benzonatatum, Benzononantin, Benzononatine, Exangit, Tesalon, Tessalin, and Ventussin.

References[edit]

  1. ^ a b MedicineNet.com: Benzonatate
  2. ^ a b Medicalook.com: Benzonatate
  3. ^ Medline Plus: Benzonatate
  4. ^ Crouch, B. I.; Knick, K. A.; Crouch, D. J.; Matsumura, K. S.; Rollins, D. E. (1998). "Benzonatate overdose associated with seizures and arrhythmias". Journal of toxicology. Clinical toxicology 36 (7): 713–718. doi:10.3109/15563659809162620. PMID 9865240.  edit
  5. ^ Cohan, J. A.; Manning, T. J.; Lukash, L.; Long, C.; Ziminski, K. R.; Conradi, S. E. (1986). "Two fatalities resulting from Tessalon (benzonatate)". Veterinary and human toxicology 28 (6): 543–544. PMID 3788039.  edit