Last month I posted about benzonatate, a cough suppressant also marketed under the brand Tessalon. (See the link below for the original post.) In that post I detailed an FDA warning about the serious potential side effects of benzonatate, especially in accidental overdoses in children. I also passed along the conclusion of the Medical Letter that safer cough suppressants were available.

My colleague Dr. Roy Artal, a pulmonologist, wrote to me a very thoughtful defense of benzonatate, which he let me share with you.

The thrust of the advisory is that the medication bears a potential resemblance to a candy drop, and that patients need to be cautioned to keep the medication in child resistant containers, etc. In terms of the medication’s safety profile, the FDA article indicates that in the period 1958 through 2010 only 31 cases of benzonatate overdose were reported to the FDA.

As a pulmonologist, chronic cough is one of the most common indications for an office visit with me, and in that setting I’ve found benzonatate to be very well tolerated, effective, and to have an excellent side effect profile. I have had a handful of patients (<2%) come back and tell me it made them slightly woozy, and those patients have simply exercised common sense and discontinued the medication on their own.

I have no qualms about continuing to prescribe benzonatate, although the advisory likely will prompt me to reinforce to my patients who may have small children around the house to exercise appropriate precautions. I would also point out that this is no different from any of thousands of other medications that might be potentially toxic to a small child.

Learn more:

My original post about benzonatate: Benzonatate: A Cough Suppressant So Dangerous, You’d Rather Just Cough

Tangential Miscellany

About a month ago, the Daily Journal had a front page article about the growing popularity of direct primary care practices, practices in which physicians are paid directly by patients – New Direct Primary Care Plans Bypass Insurers and Regulators. The article describes why I and other doctors moved to a direct practice, and features a snazzy photo of yours truly. This practice model has been tagged with several different names: concierge medicine, boutique practice, direct primary care, retainer-based care. I don’t think any of the names have stuck yet, and I suspect that patients will pick the name that persists. I’d love to hear from you what name you think is best. What should I call what I do?