UMEM Educational Pearls

Category: Pediatrics

Title: Pearl on Tessalon Perles: One pill can kill

Posted: 2/29/2024 by To-Lam Nguyen, MD (Emailed: 3/1/2024) (Updated: 3/1/2024)
Click here to contact To-Lam Nguyen, MD

You've heard of one kill pills such as calcium channel blockers, beta blockers, sulfonylureas, anti-malarials, but less commonly known is benzonatate, or tessalon perles.

Tessalon perles are not recommended for children under the age of 10. 1-2 capsules of benzonatate in children <2 years old have been reported to cause serious side effects including restlessness, tremors, convulsions, coma and even cardiac arrest rapidly after ingestion (within 15-20 minutes and death within a couple of hours). It is attractive to young children as it somewhat resembles a jelly bean. 

Pearls on Tessalon Perles:

  • Always ask your patients about children in their household and strongly consider alternative to tessalon perles if children <10 years in home
  • If you do decide to prescribe, prescribe only the amount of tessalon perles that a patient needs for cough relief
  • Inform your patients about this high risk of accidental ingestion by children
  • Keep tessalon perles in child-resistant container and keep it out of reach of children AT ALL TIMES
  • Call the poison center (800-222-1222) immediately if accidental ingestion by child


Thimann DA, Huang CJ, Goto CS, Feng SY. Benzonatate toxicity in a teenager resulting in coma, seizures, and severe metabolic acidosis. J Pediatr Pharmacol Ther. 2012 Jul;17(3):270-3. doi: 10.5863/1551-6776-17.3.270. PMID: 23258970; PMCID: PMC3526931.