Benzonatate, sold under the brand name Tessalon among others, is a medication that reduces cough and hiccups. It is taken by mouth. Use is not recommended in those under the age of ten. Effects generally begin within 20 minutes and last up to eight hours. Side effects include sleepiness, dizziness, headache, upset stomach, skin rash, hallucinations, and allergic reactions. Excessive doses may cause seizures, irregular heartbeat, and death. Chewing or sucking on the capsule can lead to laryngospasm, bronchospasm, and circulatory collapse. It is unclear if use in pregnancy or breastfeeding is safe. It works by numbing stretch receptors in the lungs and suppressing the cough reflex in the brain. Benzonatate was approved for medical use in the United States in 1958. It is available as a generic medication. Availability worldwide is limited. In 2020, it was the 157th most commonly prescribed medication in the United States, with more than 3million prescriptions. Medical uses Cough Benzonatate is a prescription non-opioid alternative for the symptomatic relief of cough. It has been shown to improve cough associated with a variety of respiratory conditions including asthma, bronchitis, pneumonia, tuberculosis, pneumothorax, opiate-resistant cough in lung cancer, and emphysema. Benzonatate also reduces the consistency and volume of sputum production associated with cough in those with chronic obstructive pulmonary disorder (COPD). Compared to codeine, benzonatate has been shown to be more effective in reducing the frequency of induced cough in experiments. Benzonatate does not treat the underlying cause of the cough. Hiccups Benzonatate has been shown to have use in the suppression of hiccups. Intubation Benzonatate acts as a local anesthetic and the liquid inside the capsule can be applied in the mouth to numb the oropharynx for awake intubation. However, there can be life-threatening adverse effects when the medication is absorbed by the oral mucosa, including choking, hypersensitivity reactions, and circulatory collapse. Contraindications Hypersensitivity to benzonatate or any related compounds is a contraindication to its administration. Side effects Benzonatate is generally well-tolerated if the liquid-capsule is swallowed intact. Potential adverse effects to benzonatate include: Constipation, dizziness, fatigue, stuffy nose, nausea, headache are frequently reported. Sedation, a feeling of numbness in the chest, sensation of burning in the eyes, a vague "chilly" sensation, itchiness, and rashes are also possible. Ingestion of a small handful of capsules has caused seizures, cardiac arrhythmia, and death in adults. Hypersensitivity reactions Benzonatate is structurally related to anesthetic medications of the