Febrifuge Posted October 11, 2014 Share Posted October 11, 2014 My first rotation in school was Internal Medicine, and my preceptor was this amazing, good-humored, workaholic old dude. Half his patients were over 65, and so was he, I think. It was from Dr. B that I learned the value of a good pair of Chelsea boots (seriously, they go with everything), as well as the virtues of benzonatate for cough. This stuff has apparently been around forever. After decades of use it still has a ridiculously low profile for side-effects and interactions. It has a low potential for abuse (and the only way to really misuse it is to break open the gelcaps and use it to numb your tongue; why anyone would do that is a mystery). I find that I prescribe it a LOT during cough and cold season, and patients tend to be pretty happy with it as far as I can tell. It's a nice way to not prescribe codeine, as far as I'm concerned. But I don't see it used a lot in the notes for patients who have their PCP with my health system. Is this some old-timer med that I have adopted? How common is this? Not that I'm insecure about it, quite the opposite in fact, but I'm curious. Sometimes I feel like whoever makes the stuff should send me on a golf weekend or something. Link to comment Share on other sites More sharing options...
Acebecker Posted October 11, 2014 Share Posted October 11, 2014 My use of benzonatate is about equal to tussionex pennkinetic. Only one of them has been studied in a trial showing efficacy - tussionex. I really like benzonatate for that postnasal drip "tickle" cough that people get - it tends to work remarkably well for that. I find that when the stimulus is reactive airway the benzonatate can help desensitize the stretch receptors, especially in conjunction with good old albuterol. But when the cough is deeper is in bronchitis or pneumonia or influenza, the tussionex seems to work better. This is only my experience, but as mentioned a controlled trial has been performed and tussionex showed a modest benefit. YMMV Link to comment Share on other sites More sharing options...
Febrifuge Posted October 11, 2014 Author Share Posted October 11, 2014 Awesome, thanks, I'll read up on it. Especially now that hydrocodone is Sched II, I feel like the thing I mentioned about plain benzonatate being an alternative to codeine is even more important (and honestly I might be tempted to go to codeine before anything with hydrocodone, just to save the administrative headaches), but you can't argue with results. EDIT TO ADD: I really like benzonatate for that postnasal drip "tickle" cough that people get - it tends to work remarkably well for that. Exactly. Most of the people who think they have "bronchitis" have a chest cold, which is taking forever to clear because of the constant drainage from up top. I explain to them that they should cough sometimes, to avoid blocking up the airways and courting real bronchitis, but benzonatate half an hour before bedtime can be a good way to get some sleep, so you can get up and hawk big glorious disgusting loogies in a steamy shower in the morning. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted October 11, 2014 Moderator Share Posted October 11, 2014 Upvote for Tessalon Link to comment Share on other sites More sharing options...
medic25 Posted October 11, 2014 Share Posted October 11, 2014 I'm a big fan of tessalon perles. I also write for a ton of it during cold and flu season. For the patient with the viral URI who isn't getting antibiotics, they at least feel happy about getting a prescription. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted October 11, 2014 Share Posted October 11, 2014 Love tessalon. I get horrible bronchitis a few times a year (likely secondary to fire exposure years ago)and tessalon works great to stop the chest pain from coughing. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 11, 2014 Moderator Share Posted October 11, 2014 great stuff. have a bottle at home as well. Link to comment Share on other sites More sharing options...
Guest Paula Posted October 11, 2014 Share Posted October 11, 2014 I prescribe it quite a bit too. My patients seem to like it, some better than codeine cough syrup. Link to comment Share on other sites More sharing options...
Febrifuge Posted October 11, 2014 Author Share Posted October 11, 2014 Huh. Seems I'm not such an oddball after all*. * at least in terms of this topic Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 11, 2014 Moderator Share Posted October 11, 2014 Tessalon is the bomb. Just make sure to tell folks not to suck on them as that can cause laryngospasm. we had a peds code at our facility a few years ago when a parent gave tessalon to a 3 yr old thinking they were "cough drops". kid had resp failure, got intubated, etc and ended up doing fine. so, as long as they can swallow pills and understand the concept(say age >12) they are a great option. Link to comment Share on other sites More sharing options...
kaidou1412 Posted October 11, 2014 Share Posted October 11, 2014 In my experience of myself and many other patients around me, Tessalon works extremely well. It dropped my 2 years long cough. Link to comment Share on other sites More sharing options...
Piper Posted October 12, 2014 Share Posted October 12, 2014 My common rx is tussionex 1 hour before bedtime and benzonatate during the daytime. Link to comment Share on other sites More sharing options...
Corpsman2PA Posted October 12, 2014 Share Posted October 12, 2014 We used this stuff a lot in the military and I was pleasantly surprised that it was well used in the real world as well. Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
Joelseff Posted October 12, 2014 Share Posted October 12, 2014 I used it too. Works well. I write in "SWALLOW WHOLE DO NOT CHEW" on the script. Link to comment Share on other sites More sharing options...
jsfelder0417 Posted October 12, 2014 Share Posted October 12, 2014 Second Corpsman2PA, I used it a lot as an Army Medic when everyone got "The Crud," and pts and providers alike loved it. Still use it. Link to comment Share on other sites More sharing options...
Guest Paula Posted October 12, 2014 Share Posted October 12, 2014 I used it too. Works well. I write in "SWALLOW WHOLE DO NOT CHEW" on the script. I'm adding that to my scripts and caution parents to not give to anyone under 12. I've never prescribed it for a peds patient. Link to comment Share on other sites More sharing options...
Joelseff Posted October 12, 2014 Share Posted October 12, 2014 I'm adding that to my scripts and caution parents to not give to anyone under 12. I've never prescribed it for a peds patient.I wanted to edit my post but tapatalk disabled edit for some reason but it should say "DO NOT SUCH OR CHEW SWALLOW WHOLE" Sorry... These fandangled gizmos drive me nuts sometimes :P Link to comment Share on other sites More sharing options...
Joelseff Posted October 12, 2014 Share Posted October 12, 2014 Arrrgh there it goes again lol SUCK not SUCH Stupid auto type Link to comment Share on other sites More sharing options...
LKPAC Posted October 12, 2014 Share Posted October 12, 2014 I use it all the time. Patients like it. I can give people an rx for cough without narcs. Link to comment Share on other sites More sharing options...
Acebecker Posted October 12, 2014 Share Posted October 12, 2014 Epocrates notes that it's not for children less than 14 yo, IIRC. That said, I don't know why. Link to comment Share on other sites More sharing options...
bradtPA Posted October 12, 2014 Share Posted October 12, 2014 It's also on the $4 list for 15 caps of the 100 mg dose.... Link to comment Share on other sites More sharing options...
Joelseff Posted October 13, 2014 Share Posted October 13, 2014 Epocrates notes that it's not for children less than 14 yo, IIRC. That said, I don't know why.Only thing I can think of is it can cause laryngospasm if sucked or chewed. Maybe we can't trust kids <14 to do that? I dunno. Link to comment Share on other sites More sharing options...
Joelseff Posted October 13, 2014 Share Posted October 13, 2014 Only thing is all the "red syzzrp" pts hate it when I RX it lol. Sucks for them. Hahaha Link to comment Share on other sites More sharing options...
cbrsmurf Posted October 13, 2014 Share Posted October 13, 2014 I'm surprised you guys have had success with tessalon, or any class of cough suppressant for that matter. Many trials have shown that most otc and prescription meds are either no better than placebo or show slight effectiveness at best. http://journal.publications.chestnet.org/article.aspx?articleid=1084262#t1 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001831.pub2/abstract;jsessionid=D20DEF464FAEDAA8E41DA902F85CB243.f02t01 Evidence for antitussive use in cough from URI's is not good. Link to comment Share on other sites More sharing options...
JustinPA Posted October 13, 2014 Share Posted October 13, 2014 Do you guys use the 100mg or 200mg TID PRN dosing most commonly? Link to comment Share on other sites More sharing options...
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