Benzonatate and Alcohol: Is It Safe to Mix Them?

Find Out if You Are Covered by Insurance

VERIFY INSURANCE

What you will learn

• Benzonatate is a prescription cough medicine that quiets the cough reflex.
• Caution should be exercised when taking benzonatate with alcohol, as both can impair alertness, coordination, and judgment.
• Side effects of combining benzonatate and alcohol may include sedation, dizziness, nausea, confusion, drowsiness, and/or slowed reaction time.
• Risk may be higher if you are also taking opioids, benzodiazepines, antihistamines, muscle relaxants, antidepressants, or other central nervous system (CNS) depressant drugs.
• If you find it difficult to avoid alcohol while on a short-term prescription for your cough symptoms, you may want to discuss this issue with a health care professional concerning your alcohol use.

Most people assume low risk with anything they take for a cold or cough. Benzonatate is not an opiate cough syrup such as codeine, nor does it contain alcohol, so many people ask a practical question: can I drink on benzonatate?

The safest way to approach this is to be cautious and consult with your prescribing physician before drinking alcohol with benzonatate.

There are not always visible interactions between benzonatate and alcohol in the same way some drugs have been known to interact with alcohol. The major worry is that benzonatate will cause neurologic side effects such as sedation, dizziness, foggy thinking, and confusion, which may be enhanced by alcohol.

What Is Benzonatate?

Benzonatate is a prescription medication used to help relieve cough symptoms caused by the common cold, bronchitis, and/or acute respiratory tract infection. It is an antitussive medication which helps reduce coughing. It works by numbing certain receptors in the airways and lungs that induce the cough reflex [1].

In addition to its brand-name product, Tessalon Perles, benzonatate has several generic versions available. It is usually taken up to three times daily. Take it exactly as prescribed and swallow the capsule whole. To prevent choking or other serious adverse events, do not chew, suck, or dissolve the capsule in your mouth [2].

Because benzonatate is not controlled and is not an opiate, some people believe that it must not pose a significant threat to their health. However, benzonatate, like all medications, used correctly, can provide relief from cough symptoms. Used incorrectly, at high doses, or in combination with other central nervous system active substances, it may represent real risks.

Can I Drink Alcohol With Benzonatate?

You should not assume that alcohol will be safe with benzonatate. If you are taking benzonatate and plan on drinking, contact your pharmacist or prescriber first.

As stated earlier, benzonatate has central nervous system side effects including sedation, headache, dizziness, confusion, and visual hallucinations [3]. Similarly, alcohol also has side effects such as drowsiness, dizziness, impaired coordination, and poor judgment. When these two types of side effects occur together, a person may feel more impaired than expected after drinking.

For example, a person who usually does well after one drink may feel extremely tired, lightheaded, unsteady, or mentally fuzzy while on benzonatate. These effects may matter if you need to drive, walk through a crowded area, use public transportation, watch children, or take other medication.

The bottom line is simple: alcohol may make benzonatate side effects harder to predict.

Side Effects of Using Benzonatate and Alcohol

How much of the benzonatate and alcohol side effects we experience will vary depending on our own unique characteristics. These characteristics will include how much we take of each drug, when we take it relative to when we drink alcohol, our age, our health conditions, other medications we are taking, and how much we drink.

Possible side effects of combined benzonatate and alcohol use include:

• Drowsiness
• Dizziness
• Impaired coordination
• Slowed reaction time
• Nausea
• Headache
• Restlessness
• Poorer judgment
• Greater risk of falls and accidents.

Some of these side effects are very uncomfortable. Others can turn into serious problems based upon the particular situation. If you are already sick with a respiratory condition, drinking alcohol may also lead to less successful recovery and possibly even make it harder for you to rest, hydrate, and know whether your symptoms are getting worse.

As noted by the National Institute on Alcohol Abuse and Alcoholism, there are many potential interactions between alcohol and other medications that may result in drowsiness, dizziness, fainting, nausea, vomiting, headaches, or loss of coordination [4]. While benzonatate is not listed everywhere in these guides, its side effect profile makes caution reasonable.

Who Has a Higher Risk From Benzonatate With Alcohol

While some people are more likely to experience problems with benzonatate and alcohol, this group includes:

• People taking other central nervous system depressant medications
• People taking opioids
• People taking benzodiazepines
• People taking antihistamines such as diphenhydramine
• People taking muscle relaxants or sleep medication
• People taking antidepressants or other psychiatric medication
• People with asthma or other breathing disorders such as obstructive sleep apnea
• Older adults or people more susceptible to side effects of medication
• People who drink heavily or binge drink regularly
• People with a history of alcohol use disorder or substance use disorder

Overdose Risk With Combined Use of Benzonatate & Alcohol

While the primary worries about misuse of benzonatate involve taking too much of the medication, the worries about overdose involve seriously undermining the body’s ability to respond to life-sustaining functions such as breathing. The United States Food and Drug Administration (FDA) has warned that serious case reports of benzonatate overdose include restlessness, trembling, seizures, coma, and cardiac arrest, and these symptoms can occur within 15 to 20 minutes of dosage [5].

Alcohol does not need to be part of the mixture for overdose to happen. However, alcohol may make it more difficult to determine when a person has become impaired enough to take extra risks by taking more of the medication than they need to or ignoring warning signs.

Emergency help should be called immediately if you observe any of the following symptoms in someone who has taken benzonatate: severe confusion, hallucinations, excessive drowsiness, fainting, seizures, trouble breathing, shallow breathing, chest pain, loss of consciousness, or signs of an allergic reaction such as swelling, itching, rash, or trouble swallowing.

Chemically related to local anesthetics such as procaine and tetracaine, benzonatate has been responsible for reported hypersensitivity reactions in patients sensitive to these types of medication [6]. If you have a history of hypersensitivity reactions to numbing agents and have been diagnosed with an allergy to these types of products, you should advise your prescriber of this.

How Long After Taking Benzonatate Can You Drink Alcohol?

There is no “safe wait” period that applies to everybody. Benzonatate can be taken up to three times per day, meaning that it can still be active in your system much of the day. Your level of risk will depend on your dose, frequency, response to the medication, your age, liver and kidney function, and other medication(s).

If your presumption was that your provider did not want you to drink while taking benzonatate, then follow his or her orders. If you were not specifically advised against drinking, call your pharmacist or prescriber prior to drinking, especially if you are currently feeling drowsy, dizzy, unsteady, or confused while on benzonatate, or if you are taking other medication(s) that have sedating action.

One practical rule is this: if a medication makes you feel sleepy, dizzy, confused, or imbalanced, then alcohol will probably make those risks worse.

When Drinking While Taking Benzonatate Points to a Bigger Concern

Benzonatate is generally ordered for short-term cough relief for most people. For most people, stopping drinking for only a few days while taking benzonatate will not be difficult. But for other people, the idea of not drinking may feel stressful, frustrating, or unrealistic.

If you find yourself wondering if you can drink alcohol with benzonatate because stopping feels so hard, then that may be a good time to look more closely at your relationship with alcohol.

Signs That Alcohol Use Disorder Help Is Needed

Signs that may indicate that you need help with alcohol use disorder include:

• You have been drinking more than you intended to.
• You have tried cutting back on your drinking but have been unable to do so.
• You feel anxious when you don’t have access to alcohol.
• You need to drink alcohol in order to feel relaxed, sleep well, or feel normal.
• You have been drinking despite warnings from your physician, lab results, or medical problems.
• You continue to mix alcohol with prescription medication despite the development of side effects.
• Loved ones have expressed concern about your drinking.
• Your work, health, parental responsibility, job, or economic status is affected by your drinking.

Alcohol use disorder is a medical condition, not a failure. There are evidence-based methods for treatment of alcohol use disorder, including behavioral therapies, medications, mutual support, and professionally guided care [7].