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Medically reviewed by, Russell Braun RPH
Tessalon Perles are a medication that is used to treat cough. Tessalon is available generically by the chemical name benzonatate. Many people think that Tessalon Perles or benzonatate can be bought over the counter with other cough and cold products.
#1 You need a prescription
Unfortunately, benzonatate is only available with a prescription from your doctor. Even though benzonatate is a non-narcotic, it is not available over the counter.
#2 Perles are just soft capsules!
Both brand and generic products come in a 100mg and 200mg dosage form. The name perle also confuses come people. It was first marketed as a brand name product in the perle form which is just a soft gel form of a capsule. This makes it easier for the drug to dissolve quickly.
You should not chew or suck on the perles!
The best thing to do is swallow them whole with plenty of water. The capsules are soft to help as most people who have cough symptoms will have sore or irritated throats and the soft capsule is easier to swallow.
If you feel numbness in your mouth it is due to the benzonatate and it means you are not swallowing it quickly enough. Some other side effects from chewing or sucking on the perles:
#3 Do you really need a cough suppressant?
This is the number one question I receive from people who know that I am a pharmacist. “What should I take for my cough” Most of the time patents are looking to self treat with over the counter options.
Not surprisingly cough sends more people to pharmacies, doctors offices and emergency rooms than any other medical problem. Patients spend (and often waste) billions of dollars a year on products that are not the right thing for the symptom, they didn’t need in the first place or are not effective.
When you DO NOT need a cough suppressant
Coughing can be annoying, I understand why patients want to suppress it. What most people don’t realize is that coughing is a protective mechanism for the body. It is a way of getting phlegm and other drainage out of the lungs to prevent respiratory tract infections like pneumonia from happening.
If your cough is one that is “productive” then it should not be suppressed. A productive cough is one that is resulting in mucous and phlegm coming up into your mouth where it is either spit out or swallowed. When this is happening the body’s defense mechanism is working as designed.
Most coughs are caused by viruses and fewer doctors will give you an antibiotic for a virus due to resistance concerns. With no natural defense and no antibiotic you are setting yourself up to get a secondary bacterial infection from the virus if you suppress the cough.
If you want to shorten the time you are sick, and not spend extra money on urgent care, doctors office visit or an emergency room trips then stop using cough suppressants on productive coughs!
When you do need a cough suppressant
There are three cases where you should suppress your cough.
- Dry coughs that do not produce any mucous or phlegm are called unproductive coughs. They are typically a result of inflammation of the airways and should be suppressed to let the airway heal. Typical causes of unproductive cough include:
- Heartburn or acid reflux
2. The cough is keeping you up at night. Regardless of if it is productive or non productive. Sleep is the best thing you can do to help your body heal. Make sure you get plenty of rest when you have a cough.
3. You experience moderate to severe pain when coughing. For milder pain you can use pain relievers such as ibuprofen or acetaminophen to help with this. When the pain becomes more severe, then it is time to start suppressing the cough, speak to your doctor at this point you will probably need a prescription cough suppressant.
#4 Do cough suppressants really work?
Evidence is mixed to support the efficacy of the hundreds of over the counter products that are marketed today for treating cough and cold symptoms. Many will have ingredients that don’t do anything to help with cough but are marketed under a brand name that makes you think it would because it sounds like a cough product.
Most consumers are desperate for some relief when shopping for these products. Typically, people don’t buy these products with they are feeling healthy. The combination of marketing tricks and desperation usually end up in consumers buying a product that doesn’t really do much to make them feel better.
There is also a strong placebo effect associated with cough and cold medications. Placebo are pills with no active ingredients that are used as a control group in clinical studies. The drug in question is tested against the placebo. Many times a placebo pill will have a positive effect, simply because the person thinks that the pill is helping them.
There are few studies where over the counter cough and cold drugs outperform placebo.
Don’t waste your money on random over the counter cough and cold medicines, ask your doctor or pharmacist for help!
#4 How does Benzonatate work?
Benzonatate works by numbing the vocal cords, larger airways and smaller air sacs in the lungs called alveoli. This is how it helps to stop your bodies natural reflex to cough when it senses something in these areas.
- Benzonatate starts working in your body within 15-30 minutes
- It does not cause drowsiness and almost all other cough medicines do
- Benzonatate should be taken every eight hours to keep cough at bay
- This drug is not safe for use in children, do not share your prescription with a child.
One important note, benzonatate is is not a narcotic. Almost all the other prescription cough suppressants are narcotics. This is important because opioids are used as cough suppressants and they have been in the national spotlight over the addiction potential that has lead to the opioid epidemic. If you have concerns about opioids then benzonatate might be an option to ask your doctor about.
#5 Does benzonatate stop cough?
Benzonatate appears to be similar to placebo in stopping cough. This article goes more in depth on using benzonatate for sore throat
However, when taken together with guaifenesin also known as the brand name Mucinex 600mg the combination were found to be more effective than placebo at stopping cough. This is according to a study that looked at the inhibition of viral cough published in respiratory medicine.
Guaifenesin can be purchased over the counter or obtained via prescription from your doctor.
#6 What does Benzonatate cost?
As discussed most of the time you will not want to suppress cough. Since Benzonatate is prescription only, you have to take that into account when thinking about the cost.
What does an office visit or urgent care visit cost you?
Most insurance plans will cover benzonatate, since it is the generic of Tessalon Perles. There is no reason to take the brand name product as it costs nearly 10 times more!
Cost comparison per GoodRx:
Benzonatate 100mg, 30 caplets = 10 day supply
- Cost $6.00
Tessalon Perles 100mg, 30 perles = 10 day supply
- Cost $60.00
If you fill this via your insurance, make sure to see if the cash price is cheaper than your copay.
Don’t forget to add on guaifenesin
Guaifenesin ER 600mg, 40 tablets = 20 day supply
- Cost ~ $13.00
Mucinex 600mg, 40 tablets = 20 day supply
- Cost ~ $15.00
If you find yourself using guaifenesin often then higher quantities come at better prices.
Mucinex 600mg, 100 tablets = 50 day supply
- Cost ~ $ 34.00
Most coughs will clear up on their own. If yours persists or falls into a category that needs to be treated you can look to spend around $14.00 out of pocket using benzonatate and guaifenesin.
#7 Prescription cough suppressants
Prescription cough suppressants contain combinations of opioids and antihistamines. Opioids have been proven to be effective, but are a major risk for causing addiction and abuse. Antihistamines make you sleepy, but can actually cause respiratory infections to get worse.
That being said these should be reserved for short term use when severe coughing is keeping you up or causing pain.
If you cough is this severe you should be seeing a doctor and you can weigh the pros and cons of these types of medications.
#8 Over the counter cough suppressants
The only over the counter cough suppressants that has been shown in some studies to be effective are dextromethorphan and guaifenesin. A database review of studies on PubMed (which is like google for the medical professionals) done by the Cochrane group stated the following:
“There is no good evidence for or against the effectiveness of OTC medicines in acute cough”
Why do people spend so many millions of dollars a year on cough medicines then? The answer probably lies in the placebo effect.
Another study from PubMed concluded that “placebo treatment has significant anti cough activity.”
Essentially your mind wants it to work because you feel so bad, and it does by making protective neurotransmitters according to the research.
The bottom line, many combination drugs are out there that will not help stop your cough.
Don’t waster your money! Look for dextromethorphan, guaifenesin or nothing.
#9 Non drug options
The number one non drug option is honey. One teaspoonful three times a day has been shown to be more effective than placebo and dextromethorphan.
Using a vaporizer in your bedroom when you sleep is also a good way to prevent your throat from becoming dry. Many types and brands are available.
Finally, drink plenty of water. Staying hydrated when you are sick is key to keeping your body in a state where it can defend itself against viral and bacterial attackers.
Have to go to doctor, so now what?
There are 7 Essential Steps to prepare a doctors appointment.
- Prepare questions to ask the doctor and write them down so you don’t forget.
- Make sure you have a complete medication list.
To get the full checklist for how to get the most value out of a short office visit, click here.
Get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, FREE Click here!
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