While it is unknown exactly how many pills the patient in this case ingested, the outcome resulted in the rapid development of life-threatening side effects. Generally, management of toxicity is limited to supportive care and continuous monitoring, as well as airway management in anticipation of seizures and cardiac arrhythmias.
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Benzonatate Toxicity: Nothing to Cough At. Bishop-Freeman , Sandra C. Email: sandra. Oxford Academic. Erin M. Laura W. Michael C. Ruth E. Cite Cite Sandra C. Select Format Select format. Permissions Icon Permissions. Benzonatate is analytically problematic and will be underestimated in forensic laboratory reports because of the chemical and pharmacological make-up of this prescription product. Details obtained through investigation by the medical examiner helped to support the possibility of benzonatate over-ingestion in some of our in-house cases.
Benzonatate is rapidly hydrolyzed by plasma butyrylcholinesterase BChE to the major metabolite 4- butylamino benzoic acid BABA along with the corresponding polyethylene glycol monomethyl ethers Figure 1 7 , 9 , The series of polyethoxy metabolites e.
OCME discovered three benzonatate-related cases over the past year and a total of six potential cases since It is possible that past benzonatate-related cases were not identified based on our previous lack of knowledge.
Figure 1. Open in new tab Download slide. Google Scholar Crossref. Search ADS. Inhibition of cough-reflex sensitivity by benzonatate and guaifenesin in acute viral cough. Analysis of benzonatate overdoses among adults and children from — by the United States Food and Drug Administration.
Google Scholar PubMed. Benzonatate toxicity in a teenager resulting in coma, seizures and severe metabolic acidosis. IgE-mediated allergy to local anaesthetics: separating fact from perception: a UK perspective.
Published by Oxford University Press. All rights reserved. For Permissions, please email: journals. Benzonatate is a polyglycol derivative structurally related to procaine and tetracaine.
It acts peripherally on stretch receptors in the lower respiratory tract to suppress the cough reflex. If the patient chews or sucks the liquid-filled capsules or "softgels", the drug can cause laryngospasm, bronchospasm and circulatory collapse. Adverse effects that can occur after swallowing an intact capsule include a feeling of numbness in the chest, mental confusion, a sensation of burning in the eyes, and visual hallucinations.
Taken in overdose, benzonatate can rapidly cause seizures, cardiac arrhythmias and death. If you miss a dose of benzonatate, skip that dose and take the next dose at the next scheduled time.
Do not take more than mg of benzonatate at one time. Patients and caregivers should dispose of any leftover benzonatate in their household trash see Federal Drug Disposal Guidelines : Take the medication out of its original container and mix it with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets, and unrecognizable to people who may intentionally go through your trash.
Put the medication in a sealable bag, empty can with a tight lid, or other container to prevent it from breaking out of a garbage bag. Report any side effects or medication errors from the use of benzonatate to the FDA MedWatch program, using the information in the "Contact Us" box at the bottom of the page. Additional Information for Healthcare Professionals Advise patients to keep benzonatate in a child-resistant container and to store it out of reach of children.
Counsel patients about how to properly dispose of leftover benzonatate after they have stopped taking the medication see Federal Drug Disposal Guidelines.
Advise parents and caretakers to call the Poison Control Center and to seek medical attention immediately if a child accidentally ingests benzonatate. Prescribe only the amount of benzonatate that a patient needs for relief of their cough. Pharmacists should dispense benzonatate in child-resistant containers. Recognize the signs and symptoms of benzonatate overdose, which may include restlessness, tremors, convulsions, coma, and cardiac arrest.
Be aware that the signs and symptoms of benzonatate overdose have been reported within minutes and death has been reported within hours of ingestion. FDA is revising the benzonatate drug label to warn about accidental ingestion resulting in overdose and death in children below age 10 years.
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