Is benzonatate safe during pregnancy?

What does the evidence say about benzonatate during pregnancy?

1. Animal reproduction studies have not been conducted with benzonatate, and the label states it is not known whether the drug can cause fetal harm when given to a pregnant woman. 1
2. Benzonatate works peripherally by numbing the stretch receptors in the airways, lungs, and pleura, beginning to act within 15 to 20 minutes with effects lasting three to eight hours. 1
3. Capsules must be swallowed whole, since releasing benzonatate in the mouth produces temporary local anesthesia of the oral lining and choking could occur, and accidental swallowing has resulted in death in children below age 10. 1
4. Dextromethorphan, the over-the-counter cough suppressant your provider is more likely to raise first, is not expected to increase the chance of birth defects when used as directed. 2
5. Guaifenesin, which loosens mucus rather than quieting the cough reflex, is not expected to greatly raise the chance of birth defects, and its fact sheet adds one specific pregnancy instruction: pick an alcohol-free product. 3

Is benzonatate safe in each trimester?

• First trimester. There is no first-trimester safety data on benzonatate to lean on, because reproduction studies have not been conducted at all. Most obstetric teams start with fluids, honey, a humidifier, and better-documented options this early. If a cough is severe enough that your clinician raises benzonatate anyway, that is a conversation about your specific situation rather than a general rule.
• Second trimester. The evidence gap does not narrow in the second trimester. What does shift is the value of asking why the cough is there at all, since reflux, postnasal drip, and asthma all become more common in pregnancy and each is handled a different way. A cough that has outlasted a week deserves that look.
• Third trimester. One warning applies at every stage and is worth repeating late: benzonatate capsules have to be swallowed whole. Breaking or chewing one releases the drug in your mouth, numbs the throat, and can cause choking. Keep the bottle well out of reach of children too, since accidental swallowing has been fatal in kids under 10.