Benzonatate vs Dextromethorphan

Coughing can disrupt your sleep and interfere with your quality of life. This bothersome symptom may lead you to seek relief from over-the-counter (OTC) options or prescription medications. Benzonatate vs dextromethophan are two common medications that treat cough. While both medications can reduce coughing, when choosing between benzonatate vs dextromethorphan, you should consider the side effects, safety, and how they work.

What Is Dextromethorphan?

Dextromethorphan is an OTC medication commonly found in cough and cold products. Dextromethorphan is a cough suppressant (antitussive) medication. It primarily works by decreasing the urge to cough. Dextromethorphan can be used in syrup, tablet, or lozenge form. Dextromethorphan also treats a condition called pseudobulbar affect, which is a neurologic disease that causes unusual mood outbursts such as crying or laughing inappropriately. It has also been approved in combination with the antidepressant bupropion for the treatment of major depressive disorder. It is also used off-label for several other conditions. Dextromethorphan is often the active ingredient in cough medications such as Robitussin and Delsym. Dextromethorphan is chemically similar to codeine, which is a narcotic medicine used for pain. Dextromethorphan, however, is not a narcotic. Its structure is different enough that it has no narcotic or pain-relieving properties and is not a controlled substance. Dextromethorphan works by acting on the cough center in the brain. Acting on this medullary cough center raises the cough threshold. Dextromethorphan does not affect the amount or consistency of mucus produced and typically blocks a dry, unproductive cough. Dextromethorphan is very safe at recommended doses. Side effects at normal doses include:

• Stomach upset
• Nausea
• Dizziness
• Sleepiness

At higher, toxic doses, dextromethorphan can cause effects similar to ketamine or phencyclidine (PCP). This can result in symptoms that range from agitation to seizures. Other potential effects include:

• Psychosis
• Euphoria
• Feelings of being disconnected from reality
• Elevated temperature
• Diaphoresis
• Abnormal eye movements (nystagmus)
• Dilated pupils
• Rapid heart rate
• High blood pressure
• Decreased respirations
• Hallucinations
• Confusion
• Rigid muscles
• Altered gait
• Coma

Because of these effects, dextromethorphan is of growing concern as a drug of abuse. While the medication is available OTC in the United States, some individual states and other countries have placed age restrictions on the drug.

What Is Benzonatate?

Benzonatate, often marketed under the name Tessalon Perles, is a prescription-only cough suppressant. Benzonatate works by numbing stretch receptors in the lungs and the tissues that line the lungs. By numbing these receptors, it can reduce the cough reflex in the lungs. Benzonatate is usually prescribed for the relief of cough symptoms due to multiple causes, such as colds, bronchitis, pneumonia, or other respiratory infections. Since Benzonatate acts on the lungs rather than the brain, it does not cause some of the side effects that are sometimes seen with other cough medications, such as those that are opioid based, like codeine. This makes it a good option for people who shouldn’t use narcotics, such as people with a history of substance use disorder. Benzonatate is not a controlled substance, but is available by prescription only. Benzonatate is typically prescribed in gel capsules at 100mg or 200mg. It can be taken up to three times per day. It is typically very safe, but the capsules should not be chewed or dissolved. Side effects include:

• Tingling in the tongue, mouth, or throat
• Dizziness
• Drowsiness

More serious side effects may result from allergic reactions or taking too much medication. These include:

• Rash, hives, or itching of the skin
• Swelling of the face, tongue, or throat
• Confusion
• Hallucinations

Benzonatate is approved only for people over 10 years old. Use in people younger than 10 may cause serious side effects and can potentially cause death. It is very important to store benzonatate away from children because accidental ingestion is the most common reason for toxicity in children. Symptoms of toxicity in children usually start within 10-15 minutes of ingestion. Symptoms include:

• Restlessness
• Tremors
• Seizures or convulsions
• Cardiac arrest

Overall, benzonatate is usually very safe and effective if taken as directed by a healthcare provider.

Why Use Benzonatate vs. Dextromethorphan for Treating a Cough?

When choosing between Benzonatate vs Robitussin or Benzonatate vs Delsym, several factors should be considered. Both medications can treat cough, but they differ in several ways. Dextromethorphan is available over the counter and acts on the cough centers in the brain to raise the cough threshold. It is widely available, though some states may have age limits on purchase. It is first choice for cough because it can be obtained without a prescription. Benzonatate is only available by prescription and works by numbing the stretch receptors in the lungs and airways. Since it does not act on the brain, it may be a good option for people who can’t tolerate medications that act more centrally. It also carries a lower risk for abuse. Benzonatate may not be used in people under age 10 due to the risk of serious adverse effects. Ultimately, the decision on which medication to use depends on several factors. Your healthcare provider can help you determine whether Tessalon Perles or dextromethorphan is best for you.

What Is the Difference Between Benzonatate and Dextromethorphan?

Here is a comparison of benzonatate vs dextromethorphan:

	Benzonatate	Dextromethorphan
Mechanism of action	Numbs receptors in airways and lungs suppressing cough reflex	Acts on brain cough center to raise cough threshold
Available	Prescription only	Over-the-counter
Formulation	Capsules 100mg or 200mg	Syrup, lozenges, tablets, capsules
Side Effects	Drowsiness, dizziness, numbness in the mouth	Drowsiness, dizziness, nausea
Age restrictions	Age 10 or older	Age 4 and older for extended release Age 12 and older for immediate release
Precautions	Swallow whole, do not use in people under age 10	Risk of misuse
Approved for	Persistent nonproductive cough not relieved by over-the-counter medications	Dry, nonproductive cough Pseudobulbar affect Major depressive disorder (combined with bupropion)

Is Benzonatate the Same as Dextromethorphan?

Benzonatate is not the same as dextromethorphan. Tessalon Perles and dextromethorphan have different mechanisms of action and different availability. Benzonatate is available only by prescription and works by numbing stretch receptors in the lungs and airways. This peripheral action decreases cough reflexes at their source. Benzonatate has no abuse potential, but can be dangerous in children under 10. Dextromethorphan, on the other hand, is widely available in various OTC formulations. It acts centrally on cough centers in the brain, raising the cough threshold and reducing the urge to cough. Dextromethorphan is causing increasing concern as a potential drug of abuse.

Is Dextromethorphan as Good as Benzonatate?

Both dextromethorphan and benzonatate are effective cough suppressants. Whether one is “as good as” another really depends on your specific needs and the type of cough. Neither medication affects mucus production, so they are typically used for a dry, nonproductive cough. Dextromethorphan is readily available. It does not require a prescription and is available over the counter at most pharmacies and grocery stores. It also comes in a variety of forms, giving you more options for how to take it. For most people, it’s safe and has a low risk of side effects. The medication works on the cough centers in the brain to decrease the urge to cough. Benzonatate is a prescription-only medication that numbs the stretch receptors in the lungs and airways. It suppresses cough at the source. Benzonatate is often used for coughs that don’t respond to OTC counter options, but it may be used for any dry, persistent cough in people over age 10. Benzonatate has a lower abuse potential because it doesn’t act on the central nervous system.

What Side Effects Are Common Between Dextromethorphan and Benzonatate?

Although Tessalon Perles and dextromethorphan have different mechanisms of action, they share some side effects. Both medications may potentially cause dizziness or sleepiness. They may both affect your ability to drive or operate machinery. These medications may also potentially affect your stomach, causing nausea or mild stomach upset.

What Side Effects Are Not Common Between Benzonatate and Dextromethorphan?

While benzonatate and dextromethorphan have many side effects in common, they also have some side effects that are different. Benzonatate is more likely to cause side effects such as:

• Numbness in the mouth, tongue, or throat (especially if the capsules are dissolved or chewed)
• Difficulty swallowing or choking (from the numbness in the throat)
• Allergic reactions, such as hives or itching of the skin
• Confusion
• Hallucinations
• Restlessness, seizures, and cardiac arrest (more common in overdose or accidental use by children)

Side effects that are more likely with dextromethorphan include:

• Feelings of being dissociated from reality
• Euphoria (at high doses), or feeling high
• Nervousness
• Agitation
• Can potentially cause serotonin syndrome if used with antidepressants

Both medications are generally safe when taken as prescribed, but if you experience side effects, talk to your healthcare provider.

How Successful Is Dextromethorphan in Treating Cough Symptoms?

Dextromethorphan is generally safe and effective for decreasing dry, nonproductive cough, especially when it occurs with mild respiratory infections such as the common cold. Its effectiveness has made it a very common OTC cough suppressant. Some clinical studies have shown mixed results on effectiveness. A 2007 study in the Journal of the American Medical Association Pediatrics compared dextromethorphan to honey or no treatment, and found that dextromethorphan was similar to no treatment for nighttime cough and sleep difficulty. Overall, dextromethorphan is safe and effective for treating cough in adults and children over age four. You should use it only for the short term. It may not be effective for everyone, and if you have a persistent cough, it is important to seek the guidance of a healthcare professional. Dextromethorphan does have the potential for abuse, so adult supervision is recommended, especially for adolescents.

How Successful Is Benzonatate in Treating Cough?

Benzonatate is typically effective for treating a persistent, nonproductive cough, especially when OTC options are ineffective. It works by numbing stretch receptors in the lungs and airways. While typically considered effective, a 2023 review in the Annals of Pharmacology raised concerns about the lack of evidence on benzonatate's safety and efficacy, and the need for larger studies. Clinical practice suggests that it is an effective option for adults with cough, though it should not be used in children under age 10 to avoid potentially serious or fatal side effects.

Is Benzonatate Better Than Dextromethorphan for Cough?

Benzonatate and dextromethorphan are both generally effective for cough. Benzonatate is not necessarily better for cough, but it may be a better option for people who cannot take central-acting cough suppressants such as dextromethorphan. Benzonatate is often used for people who haven’t responded to OTC options. Benzonatate may also be a better option for people who have a history of substance use disorders because it has no potential for abuse. Ultimately, the decision about which medication is better comes down to several factors, including how each individual responds to the medications.

Related FAQs

 

Is benzonatate better than cough syrups?

Benzonatate is not necessarily better than cough syrups. The best option for each individual depends on several factors. Benzonatate works by numbing stretch receptors in the airways and is only available by prescription. It is often used when OTC options are not effective. Over-the-counter cough syrups often contain multiple ingredients that can help with symptoms beyond cough.

From what age can children use benzonatate and dextromethorphan?

Dextromethorphan can be used for individuals aged four and older in extended-release formulations. The immediate-release forms are recommended for children aged 12 and older. Benzonatate, on the other hand, is only approved for people over age 10. It may result in dangerous overdoses in younger children.

Are benzonatate and dextromethorphan right for people with high blood pressure?

Yes, benzonatate and dextromethorphan are typically safe for people with high blood pressure because they don’t raise the blood pressure. If you have an underlying health condition such as high blood pressure, you should consult your healthcare provider before taking any OTC medications to ensure that they are safe for you. It is also important to understand that many OTC formulations of dextromethorphan also contain decongestant medications that can increase blood pressure, which may make them less safe for people who have high blood pressure.

Can you take dextromethorphan and benzonatate together?

In some cases, dextromethorphan and benzonatate can be used together. This is usually reserved for cases of severe cough. The medications should not be taken together without a healthcare provider's supervision and recommendation to avoid side effects and interactions. Benzonatate is only available by prescription, so if your healthcare provider is giving you a prescription for this medication, you should talk to your healthcare provider about whether it is safe to take dextromethorphan with benzonatate.

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