Benzonatate for Opioid-Resistant Cough

Clinical Context and Recommendations

• The American College of Chest Physicians recommends benzonatate as a local anesthetic option for opioid-resistant cough that does not respond to peripheral antitussives 1
• The CHEST guidelines suggest benzonatate as a trial option alongside nebulized lidocaine/bupivacaine for difficult-to-control cough 1, 2
• Benzonatate is positioned as a later-line therapy, not first-line treatment for acute cough 1, 2

Cough Management with Benzonatate

Treatment Duration and Monitoring

• The American College of Chest Physicians recommends reassessing the need for continued benzonatate therapy regularly, as prolonged cough suggests an underlying condition requiring specific treatment, with a guideline to use benzonatate for short-term symptomatic relief and to reassess if cough persists beyond 3 weeks despite treatment 3, 4