5 Benzonatate (Tessalon) Interactions to Be Aware Of

Benzonatate (Tessalon) is a prescription cough medication. It works by numbing your airways to suppress the urge to cough. Benzonatate is an older medication — it was FDA-approved in 1958. At that time, medications didn’t require the same in-depth studies as they do now. So although there aren’t any benzonatate interactions listed on its official labeling, there are some medications and substances you should avoid when you’re taking it.

Here, we’ll cover five potential benzonatate interactions in detail. Note that this isn’t a complete list, so be sure to share your current medication list with your healthcare team before starting treatment.

1. Some anxiety medications

Benzonatate can make you feel dizzy or drowsy. Certain anxiety medications can also cause these side effects. Combining these medications with benzonatate could make you overly sedated.

Examples include benzodiazepines, such as diazepam (Valium) and lorazepam (Ativan). Other anxiety medications that can cause increased drowsiness if you take them with benzonatate include buspirone (Buspar) and hydroxyzine (Vistaril).

To be safe, it’s best to avoid taking these medications with benzonatate. If your prescriber recommends benzonatate for your cough, make sure they know if you’re taking medication for anxiety. They may suggest a different cough medication.

2. Opioids

Opioids, such as oxycodone and hydrocodone / acetaminophen (Norco), are commonly prescribed to manage severe pain. Opioids are central nervous system (CNS) depressants, which means they slow brain activity. As a result, they can make you sleepy or confused. Since benzonatate side effects may also include drowsiness and confusion, the combination isn’t recommended.

Another opioid to be aware of is codeine. Codeine is a common ingredient in prescription cough syrups, such as codeine / guaifenesin (Robitussin AC). You shouldn’t take benzonatate and codeine at the same time. If one cough medication isn’t working on its own, talk to your healthcare team for further guidance.

3. Other medications that make you sleepy

Since benzonatate can make you drowsy, it’s best not to combine it with other medications that cause drowsiness. Opioids and anxiety medications carry the greatest risk, but other medications you should avoid taking with benzonatate include:

• “Z-drugs” (prescription sleep aids), such as zolpidem (Ambien)

• Older antihistamines, such as diphenhydramine (Benadryl, ZzzQuil)

• Muscle relaxers, such as cyclobenzaprine and carisoprodol (Soma)

EXPERT PICKS: WHAT TO READ NEXT

• Benzonatate side effects: Learn about common and rare side effects that can occur while you’re taking benzonatate and how to manage them.

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• Is your cough serious? Here’s when to see a healthcare professional for a cough.

Taking one of these medications with benzonatate can raise your risk of excessive sleepiness. It could also make you unsteady on your feet and raise your risk of falls or accidental injuries. Talk to your prescriber if you’re taking any other medications that may make you sleepy. They may prefer that you take a different cough medication. Or they may provide guidance on separating the two medications to keep you safe. 

4. Alcohol

A “hot toddy” is a common home cough remedy that combines alcohol with a soothing hot drink, such as tea with honey. It may sound like a good idea if you’re sick, but combining alcohol and benzonatate isn’t worth the risk. Alcohol may raise your risk of dizziness or excessive sedation. 

Too much alcohol can also impair your coordination, and it may make it harder for you to take benzonatate correctly. This is especially important, because if you hold benzonatate capsules in your mouth, they can dissolve in the wrong place, which can numb your throat and make it harder for you to breathe and swallow normally.

Talk to your prescriber if you have concerns about avoiding alcohol. They can suggest a different cough medication or provide resources to help you quit drinking, if needed.

5. Antipsychotic medications

Antipsychotic medications treat mental health conditions such as schizophrenia and bipolar disorder. These conditions may cause symptoms such as confusion and hallucinations (hearing or seeing things that aren’t there). In rare cases, benzonatate may cause similar side effects. So while it doesn’t interact directly with antipsychotic medications, combining the two may worsen symptoms of your underlying mental health condition.

This risk is rare, but it’s still best to discuss the risks and benefits of taking benzonatate with your prescriber if you’re taking an antipsychotic medication. They can determine if benzonatate is OK for you based on your personal history.

Can you take benzonatate with Tylenol or Advil?

Yes. It’s generally safe to take benzonatate with acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Keep in mind that ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) can be hard on your stomach. Benzonatate can also cause nausea. So you may want to separate the two medications or make sure to eat before taking them.

Can you take benzonatate with OTC cough and cold medication?

It’s best to talk with a healthcare professional before combining benzonatate with over-the-counter (OTC) medications. Taking it with combination cough and cold products isn’t a good idea. But certain OTC options might be OK.

Antihistamines are often included in OTC cough and cold products to dry up a runny nose and help you sleep. But as explained above, it’s a good idea to avoid medications that cause drowsiness while you’re taking benzonatate. The most common antihistamines in OTC cough and cold products that cause drowsiness are:

• Brompheniramine

• Chlorpheniramine

• Diphenhydramine

• Doxylamine

If an OTC cough and cold product is labeled as “nighttime” or “PM,” it likely contains one of these antihistamines. You should avoid taking it with benzonatate.

It’s also not a good idea to take benzonatate along with dextromethorphan, a common OTC cough medication. They work differently to manage cough, but they can cause similar side effects. So it’s best to only take one cough medication at a time, unless your prescriber tells you otherwise.

Medications in OTC cough and cold products that are likely safe to take with benzonatate include:

• Pain relievers/fever reducers, such as acetaminophen or ibuprofen

• Decongestants, such as pseudoephedrine (Sudafed)

• Expectorants, such as guaifenesin (Mucinex)

Ask your pharmacist for guidance if you’re unsure if an OTC cough or cold medication is safe for you.  

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Written by:

Patricia Weiser, PharmD

Patricia has 16 years of pharmacist experience. She previously held positions as a community pharmacist, pharmacy manager, and hospital pharmacist.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Tegan Smedley, PharmD, APh

Tegan Smedley, PharmD, APh, has 10 years of experience as a pharmacist. She has worked in a variety of settings, including retail, hospital, and ambulatory care.

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