Citation

Cohen V, Jellinek SP, Stansfield L, Truong H, Baseluos C, Marshall JP. J. Emerg. Med. 2011; 41(2): 166-171.

Affiliation

Department of Pharmaceutical Services, Residency Training Program, Maimonides Medical Center, Brooklyn, New York.

Copyright

(Copyright © 2011, Elsevier Publishing)

DOI

10.1016/j.jemermed.2009.08.027

PMID

19892505

Abstract

Background: The extent to which benzonatate (Tessalon(R)), a structurally similar agent to other local anesthetics including tetracaine and procaine, poses a risk to the public is not fully appreciated as it is still one of the most widely prescribed antitussives available. Objectives: To report a case of cardiac arrest with residual blindness after Tessalon(R) overdose, review its clinical manifestations, toxicology and management considerations, and describe the need for rational prescribing. Case Report: A 17-year-old woman with no previous medical history presented to the Emergency Department (ED) status post cardiac arrest. One to two hours prior, the patient had ingested at least 10 200-mg Tessalon(R) capsules as part of a suicide attempt. The patient was sedated, intubated, and given magnesium as prophylaxis against recurrent dysrhythmias. Emergent gastric lavage was performed and well tolerated. A 24-h hypothermia protocol with 6-h cooling period was initiated. Toxicological studies, chest radiograph, and a computed tomography scan of the head were all unremarkable. The patient was admitted to the Pediatric Intensive Care Unit for further work-up and supportive care. The patient was extubated and able to follow some commands 1 week post-admission. The patient developed blindness and experienced generalized confabulations, which did not resolve. Conclusion: Ingestion of Tessalon(R), a seemingly innocuous and widely prescribed antitussive, may pose a risk to patients due to its potential for the rapid development of life-threatening adverse events and limited treatment options in the overdose setting. Rational prescribing and patient education is needed.

Language: en