Key takeaways
Benzonatate is a prescription cough suppressant that is not suitable for everyone because of its potential risks.
Benzonatate alternatives include OTC and prescription cough medicines, such as dextromethorphan, codeine-containing medications, and gabapentin.
Non-medication options, including honey and throat lozenges, also help relieve cough symptoms.
Benzonatate is a generic prescription cough suppressant. The benzonatate brand name, Tessalon Perles, is no longer available. Benzonatate works by numbing stretch receptors in the airways and lungs, reducing the cough reflex. However, because benzonatate carries certain safety risks, it may not be appropriate for everyone. Other cough treatments are available for people who cannot take benzonatate or prefer not to.
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RELATED: What is benzonatate?
What can I take instead of benzonatate?
Benzonatate reduces coughing by anesthetizing stretch receptors in the respiratory passages, lungs, and pleura (lung lining). Benzonatate capsules should always be swallowed whole. Chewing, crushing, or dissolving a capsule can numb the mouth and throat and may cause slurred speech, drooling, and choking.
Benzonatate also poses a serious risk to young children. Fatal overdoses from accidental ingestion have been reported, with symptoms such as convulsions and cardiac arrest occurring within 15 to 20 minutes. The safety and effectiveness of benzonatate have not been established in children younger than 10. The Food and Drug Administration (FDA) warns that benzonatate should be kept in a child-resistant container and out of children’s reach.
Several alternatives work differently from benzonatate. Dextromethorphan is an N-methyl-D-aspartate (NMDA) receptor antagonist commonly found in over-the-counter cough medicines. Other cough suppressants include opioids, such as codeine. Opioids such as morphine can also suppress the cough reflex, but are generally reserved for specific types of severe or chronic cough because of their risks. Codeine-containing cough medicines are rarely prescribed.
For certain chronic or refractory coughs, healthcare providers may consider the gamma-aminobutyric acid (GABA) analogs gabapentin or pregabalin. These medications are not standard treatments for an acute cough, but there is some evidence supporting their use for chronic cough. In some circumstances, inhaled anesthetics such as lidocaine or tetracaine may also be used under medical supervision.
Other medications do not suppress the cough reflex and instead thin mucus or decrease the cause of a cough. The expectorant guaifenesin, for example, helps loosen or thin mucus so it is easier to cough up. Antihistamines such as diphenhydramine and decongestants such as pseudoephedrine help reduce allergy symptoms or congestion, which can cause a cough.
The following table compares alternatives to benzonatate.
Compare Tessalon Perles (benzonatate) alternatives |
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|---|---|---|---|
| Drug name | Price without insurance | SingleCare price | Savings options |
| Benzonatate | $65 for 30, 100 mg capsules | $10 for 30, 100 mg capsules of generic benzonatate at Kroger | See latest prices |
| G Tussin AC (guaifenesin/codeine) | $16 per 120 mL of 100-10 mg/5 mL solution | $13 per 120 mL of 100-10 mg/5 mL solution of generic G Tussin AC at Food Lion | See latest prices |
| Promethazine/codeine | $37 for 120 mL of 6.25-10 mg/5 mL solution | $15 for 120 mL of 6.25-10 mg/5 mL solution of generic promethazine with codeine at Food Lion | See latest prices |
| Promethazine/dextromethorphan | $38 for 120 mL of 6.25-15 mg/5 mL syrup | $5 for 120 mL of 6.25-15 mg/5 mL syrup of generic promethazine DM at Kroger | See latest prices |
| Hydrocodone/homatropine | $53 for 30, 5 mg/1.5 mg tablets | $40 for 30, 5 mg/1.5 mg tablets at Kroger | See latest prices |
| Neurontin (gabapentin) | $802 for 90, 300 mg capsules | $9 for 90, 300 mg capsules of generic Neurontin at Kroger | See latest prices |
Top 5 benzonatate alternatives
The following are some of the most common prescription alternatives to benzonatate.
1. Guaifenesin-codeine
Cough suppression is not always necessary or appropriate, so talk to a healthcare provider before using a prescription cough suppressant. Guaifenesin-codeine requires a prescription, and because codeine is an opioid with misuse and dependence potential, it is a controlled substance. Common side effects of codeine include drowsiness and constipation.
Evidence for opioid cough suppressants, including codeine, is limited, particularly for chronic cough. Guaifenesin-codeine combines codeine, which suppresses the cough reflex, with guaifenesin, an expectorant that helps loosen mucus so it is easier to cough up.
2. Promethazine-codeine
Codeine provides the cough-suppressing action of promethazine-codeine, while promethazine is an antihistamine that can help relieve upper respiratory symptoms associated with allergies or the common cold. Both medications can cause drowsiness, and the combination carries a risk of serious respiratory depression. Promethazine-codeine is not indicated for people younger than 18 and should be used cautiously in people at increased risk of respiratory problems.
3. Promethazine-dextromethorphan
Promethazine-dextromethorphan combines promethazine, an antihistamine, with dextromethorphan, a cough suppressant. Dextromethorphan is also available in many over-the-counter cough medicines, but this combination requires a prescription. According to the prescribing information, it can cause drowsiness and potentially serious respiratory depression. Promethazine-dextromethorphan should not be used in children younger than 2 years, and caution is advised when giving it to older children.
4. Hydrocodone-homatropine
Hydrocodone-homatropine is a prescription cough medicine that combines hydrocodone, an opioid cough suppressant, with homatropine, an anticholinergic. Because hydrocodone carries risks of misuse, opioid use disorder, overdose, and respiratory depression, hydrocodone-homatropine is generally reserved for adults who cannot get adequate relief from other treatments. Common side effects include drowsiness, dizziness, dry mouth, nausea, and constipation.
5. Neurontin
Neurontin (gabapentin) is typically used to treat seizures and neuropathic pain, but it may also be prescribed for certain chronic coughs. Guidelines recommend a trial of gabapentin for adults with unexplained chronic cough after other causes have been evaluated. A clinical trial also found that gabapentin improved cough-related quality of life in adults with refractory chronic cough. This use does not apply to a typical short-term cough caused by a cold. olds.
Over-the-counter cough medications
Benzonatate is available by prescription only and cannot be purchased over the counter. However, several OTC medications are available for cough and related cold symptoms. Many OTC cough suppressants contain dextromethorphan.
Delsym is a brand of OTC cough medicine containing dextromethorphan. Like many OTC cough and cold products, Delsym is available in different formulations for different symptoms. Dextromethorphan suppresses the cough reflex and has been studied more extensively than benzonatate, for which evidence of effectiveness remains limited. Some dextromethorphan products are formulated for children, but age restrictions vary by product and should be followed carefully.
Dextromethorphan can interact with some medications and, in certain combinations, increase the risk of serotonin syndrome. These include certain antidepressants, nausea drugs, and migraine medications. Dextromethorphan also has misuse or abuse potential, particularly when taken in large amounts.
If a cough involves mucus or chest congestion, Mucinex may be another option. Mucinex is the brand name for generic guaifenesin. Guaifenesin is an expectorant that helps loosen mucus and thin bronchial secretions, making coughing more productive. Guaifenesin is not a cough suppressant. Some Mucinex products contain additional ingredients. For example, Mucinex DM combines guaifenesin with the cough suppressant dextromethorphan.
Natural alternatives to benzonatate
People who prefer to avoid benzonatate or other cough medicines may consider natural remedies for symptom relief. Throat lozenges or topical ointments containing menthol or aromatic essential oils may help soothe cough symptoms. Honey may also help relieve an acute cough. A systematic review found low-quality evidence that honey may reduce cough symptoms and improve sleep in children. However, honey should never be given to children younger than 1 year because of the risk of infant botulism and death. Adding honey to tea may also help soothe a cough.
How to switch to a benzonatate alternative
Before switching from benzonatate to another treatment, talk to a healthcare provider about the cause of the cough and whether suppressing it is appropriate. A healthcare provider can help weigh the benefits and risks of different treatments based on underlying health conditions and possible interactions with prescription drugs, OTC medications, and supplements.
A pharmacist can help compare medication costs. A SingleCare discount card can help lower the cost of eligible prescriptions. SingleCare is free to use, and registered members can access additional savings and are free to join.
- FDA to revise labeling for prescription cough medicine following overdose concerns in young children, Pharmacy Times (2022)
- Efficacy and safety of gabapentin in the treatment of chronic cough: a systematic review, Tuberculosis & Respiratory Diseases (2018)
- Efficacy and tolerability of treatments for chronic cough: a systematic review and meta-analysis, Chest (2013)
- Treatment of unexplained chronic cough, Chest (2016)
- Gabapentin for refractory chronic cough: a randomised, double-blind, placebo-controlled trial, Lancet (2012)
- Benzonatate safety and effectiveness: a systematic review of the literature, Annals of Pharmacotherapy (2023)
- Aromatic ointments for the common cold: What does the science say?, Drugs in Context (2022)
- Honey for acute cough in children—a systematic review, European Journal of Pediatrics (2023)
- Promethazine hydrochloride and dextromethorphan hydrobromide solution, DailyMed (2026)
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