Question: Tox

B) It is a “one pill can kill” toxicologic drug for young children
Benzonatate (Tessalon Perles, other brand names) is an antitussive that acts similarly to local anesthetics by anesthetizing pulmonary stretch receptors. It comes in 100, 150, and 200 mg liquid-filled capsules, and the maximum daily dose is 600 mg. It has an onset of effect of 15-20 minutes, duration of 3-8 hours, and is recommended to be dosed q 8 hours prn. It has a narrow therapeutic index, and a small child can overdose on just one capsule. Overdose symptoms include seizures, cardiac arrhythmias, and CNS depression. Chewing or sucking on the capsule can result in bronchospasm, laryngospasm, seizures, and cardiovascular collapse. Intralipid may be useful in treatment, much like for local anesthetic toxicity. It is contraindicated in < 10 year olds, and carries an FDA black box warning https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-death-resulting-overdose-after-accidental-ingestion-tessalon after the FDA adverse event reporting system documented 5 of 7 reported accidental ingestions in children < 2yo resulted in death.