Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new tessalon research articles will be listed here shortly after becoming available to us.
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Medical research on tessalon
The Cough from Hell: Diazepam for Intractable Cough in a Patient with Renal Cell Carcinoma.
J Pain Symptom Manage. 2008 Apr 25;
Estfan B, Walsh D
Cough is a common symptom in cancer. Its underlying cause should be managed when identified; otherwise, empiric treatment is the mainstay of symptom control. Cancer-related cough usually responds to radiation therapy, an opioid, or benzonatate, a peripheral anesthetic. We present the case of a patient with renal cell carcinoma hospitalized for intractable cough that failed to respond adequately to usual treatments, but improved with diazepam.
Management of cough in advanced cancer.
J Support Oncol. 2004 Nov-Dec; 2(6): 523-7
Estfan B, LeGrand S
Cough is a common symptom in cancer, with causes that can be benign or malignant. When severe, it affects patients' quality of life and well being. Treatment begins with a detailed history and careful physical examination, followed by chest imaging. Managing cough is directed at correcting the reversible causes. Empiric treatment of cough is valuable in both reversible and irreversible causes. We prefer hydrocodone as first-line empiric treatment, but when the cough is resistant to this, our second-line therapy would be the addition or substitution of benzonatate. Bronchodilators, as well as corticosteroids, are commonly employed in our practice and can be useful in unsuspected bronchospasm.
Important drugs for cough in advanced cancer.
Support Care Cancer. 2001 Nov; 9(8): 565-74
Homsi J, Walsh D, Nelson KA
Cough is a defense mechanism that prevents the entry of noxious materials into the respiratory system and clears foreign materials and excess secretions from the lungs and respiratory tract. In advanced cancer, it is a common symptom that interferes with the patient's daily activity and quality of life. Empiric treatment with antitussive agents is often needed. Two classes of antitussive drugs are available: (1) centrally acting: (a) opioids and (b) non-opioids; (2) peripherally acting: (a) directly and (b) indirectly. Antitussive availability varies widely around the world. Many antitussives, such as benzonatate, codeine, hydrocodone, and dextromethorphan, were extensively studied in the acute and chronic cough settings and showed relatively high efficacy and safety profiles. Benzonatate, clobutinol, dihydrocodeine, hydrocodone, and levodropropizine were the only antitussives specifically studied in cancer and advanced cancer cough. They all have shown to be effective and safe in recommended daily dose for cough. In advanced cancer the patient's current medications, previous antitussive use, the availability of routes of administration, any history of drug abuse, the presence of other symptoms and other factors, all have a role in the selection of antitussives for prescription. A good knowledge of the pharmacokinetics, dosage, efficacy, and side effects of the available antitussives provides for better management.
Benzonatate overdose associated with seizures and arrhythmias.
J Toxicol Clin Toxicol. 1998; 36(7): 713-8
Crouch BI, Knick KA, Crouch DJ, Matsumura KS, Rollins DE
BACKGROUND: Benzonatate is an antitussive with a unique chemical structure. It can contain as many as 8 structural analogs. Therefore, laboratory analysis of benzonatate is difficult. We report 2 cases of benzonatate poisoning with seizures and cardiac arrest and an analytical method to identify and quantify benzonatate in human plasma. CASE REPORTS: Case 1: A 12-month-old male presented to the emergency department of a rural hospital following ingestion of an unknown amount of benzonatate. Upon arrival, the child was seizing and in full cardiac arrest. Resuscitative measures were unsuccessful and the child died shortly after arriving at the emergency department. Case 2: A 39-year-old male ingested 36 benzonatate capsules in a suicide attempt. Enroute to the health care facility, the patient experienced a seizure, had a cardiac arrest, and was cardioverted. Upon arrival at the emergency department, the patient was acidotic with a pH of 6.8. Gastric lavage was performed followed by the administration of activated charcoal. Six hours after arrival at the emergency department, the patient was alert, oriented, and hemodynamically stable. The patient was observed for 24 hours and subsequently discharged. Laboratory confirmation of benzonatate in the plasma of the patient was performed using high-pressure liquid chromatography with tandem mass spectrometry (MS/MS). The benzonatate concentration was estimated to be 2.5 micrograms/mL. CONCLUSION: Seizures and cardiac arrest are possible following an acute ingestion. Quantitative analysis of benzonatate is possible using high-pressure liquid chromatography with tandem mass spectrometry. Routine analysis for benzonatate is not common.
Benzonatate for opioid-resistant cough in advanced cancer.
Palliat Med. 1998 Jan; 12(1): 55-8
Doona M, Walsh D
Chronic cough is a distressing symptom experienced by approximately 37% of patients with advanced cancer. Palliation of chronic nonproductive cough should always first address the underlying cause but in some patients chronic, nonproductive cough persists and antitussive agents are required. Opioids are the gold standard cough suppressants, of which codeine is the most widely used; patients with an opioid-resistant cough often prove to be a therapeutic challenge. We report three patients with an opioid-resistant cough who achieved symptomatic relief with the peripherally acting nonopioid drug benzonatate.
Displaying electroencephalographic dipole sources on magnetic resonance images.
J Neuroimaging. 1997 Apr; 7(2): 106-10
Rodin E, Rodin M, Boyer R, Thompson J
A simple, inexpensive method of displaying electroencephalographic (EEG) dipole sources on magnetic resonance images (MRIs) is presented. It consists of measuring the head according to the 10-20 system but instead of placing electrodes, benzonatate capsules (Tessalon Perles) (100 mg) are affixed to the patient's scalp. MRI is obtained with the capsules in place. In addition to the routine images, thin-section (1.0-1.3-mm) scans in a three-dimensional volume are obtained and the coordinates for each electrode position ascertained. The capsules are then replaced by electrodes and a waking and sleep recording is performed with a digital EEG instrument. Phenomena of interest are then averaged and interfaced with a source analysis program. The three-dimensional electrode coordinates are placed in a file and used to establish the electrode cloud on the basis of which source analysis proceeds. The three-dimensional source locations are then superimposed on the MRIs. The method is useful in the workup of epilepsy patients, by relating focal epileptogenic activity to definable lesions, and it also allows more precise localization of normal EEG phenomena.
Pain. 1995 Feb; 60(2): 167-74
Jaffe RA, Rowe MA
Systemically administered local anesthetics are known to provide analgesia in a variety of pain states; however, the site of action and the mechanism by which these effects are produced remain in question. In the present study, the effects of low (subblocking for nerve conduction) concentrations of lidocaine on a spinal cord nociceptive potential were studied. Spinal cords were removed from neonatal rats and maintained in vitro. Lumbar dorsal and ipsilateral ventral roots were attached to suction electrodes for stimulation and recording, respectively. Following a stabilization period (60-120 min) with control measurements, each preparation was exposed to a single concentration of lidocaine (30-60 min) then returned to control perfusate for recovery (60-120 min). Data were digitized and integrals computed for both monosynaptic and slow ventral root potentials (VRP). Low concentrations of lidocaine produced a selective reduction in the magnitude of the slow-VRP. At lidocaine concentrations of 1-10 micrograms/ml (3.6-36 microM), the slow-VRP was reduced from 79% to 36% of control. Recovery to pre-exposure control levels was slow and sometimes not complete after 60-120 min in drug-free perfusate. The monosynaptic component of the VRP was unaffected by lidocaine at any concentration, suggesting that the depression of the slow-VRP cannot be attributed to simple conduction block. The addition of naloxone 0.1 microM to the perfusate had minimal effect on lidocaine-induced depression. Although resembling the selective effects of morphine, the antinociceptive effects of lidocaine do not appear to be primarily mediated through opiate receptors.(ABSTRACT TRUNCATED AT 250 WORDS)
Rapid oral anesthesia for awake intubation.
J Clin Anesth. 1992 Mar-Apr; 4(2): 101-5
Mongan PD, Culling RD
STUDY OBJECTIVE: To determine whether sodium benzonatate (Tessalon Perles) can provide rapid, effective topical oral anesthesia in preparation for awake intubations. DESIGN: Randomized, controlled, single-blind study. SETTING: Medical center anesthesia department. PATIENTS: Forty patients counseled for an awake intubation. INTERVENTIONS: The patients were randomized (random permutated block) to receive either benzonatate 200 mg topically for oropharyngeal anesthesia or bilateral superior laryngeal nerve blocks (total 8 ml of 1% lidocaine) in conjunction with 2 ml of 20% benzocaine orally. Both groups were administered 4 ml of 4% lidocaine translaryngeally. If nasal intubation was anticipated, the patients received 6 ml of 2% lidocaine jelly for nasal anesthesia. MEASUREMENTS AND MAIN RESULTS: The time to obtain oropharyngeal anesthesia was measured as the time from obtaining the benzonatate capsules from the bottle or palpation of the neck to locate the hyoid bone to the time when the patient exhibited an absent gag response to an oropharyngeal airway. After completion of airway preparation, the patient's response to intubation was evaluated by an anesthesiologist blinded to the method of preparation. Medications administered for sedation and analgesia were recorded. Noninvasive blood pressure, heart rate (HR), cardiac rhythm, and three-lead ST segments (I, II, V5) were recorded and evaluated for changes from baseline. Postoperatively, the patient was questioned for recall of the intubation. The time required to obtain loss of the gag response was shorter in the benzonatate group (55.1 +/- 5.7 seconds vs 339 +/- 22.4 seconds, p less than 0.005). The patient response to intubation was similar in both groups (90% no response, 10% minimal response). No abnormal cardiac rhythms or ST segment depression occurred, and mean arterial pressure and HR did not increase more than 20%. CONCLUSIONS: The results of this study indicate that benzonatate capsules provide rapid and reliable oropharyngeal anesthesia in preparation for awake intubation. In addition, if excellent airway anesthesia is provided, awake intubations can be accomplished with minimal patient response and discomfort.
Dig Dis Sci. 1990 Jun; 35(6): 774-80
Knauer CM, Castell JA, Dalton CB, Nowak L, Castell DO
Extensive physiological studies of swallowing have been carried out in laboratory animals; however, similar studies in humans have been limited by available technology. In this study we describe the use of a solid-state circumferential sphincter transducer to define manometric characteristics of the human pharynx and upper esophageal sphincter (UES). Effects of pharmacologic agents and thermal stimulation are also described. We studied nine normal volunteers on three separate days. All studies were done in the upright position and consisted of a station pull-through of the UES and six wet swallows with the sphincter transducer in the most proximal segment of the UES and a posteriorly oriented single transducer 5 cm proximal in the pharynx. Baseline studies preceded all drug studies. Effects of bethanechol were studied on day 1, cold stimulation and benzonatate on day 2, edrophonium and atropine on day 3. The UES resting pressure showed large intrasubject day-to-day variations; however, mean values did not differ. There were no effects on UES relaxation or swallow coordination with any of the pharmacologic agents, although benzonatate produced multiple pharyngeal contractions.
Arzneimittelforschung. 1988 Apr; 38(4A): 605-8
Karttunen P, Männistö PT, Lahovaara S, Havas A
Vadocaine hydrochloride (2',4'-dimethyl-6'-methoxy-3-(2-methylpiperidyl) propionanilide hydrochloride, OR K-242-HCl; INN: vadocaine) is a novel antitussive compound which is effective in several animal models at doses of 2.5-6 mg/kg. It has both central and peripheral local anaesthetizing properties. The present studies were aimed at exploring the specificity of the central antitussive activity of vadocaine. Vadocaine administered in doses of 25 and 50 mg/kg was not found to be effective in any of a series of experiments, although some antinociceptive activity was shown in the hotplate test and in the writhing test at a dose of 75 mg/kg. Some deteriorative activity was noted at a dose of 75 mg/kg in tests measuring motor coordination (rotarod) and spontaneous motility. This high dose of vadocaine did not affect pentobarbital sodium-induced sleeping time nor protect the animal from pentetrazole-induced convulsions. As expected, codeine phosphate was found to be a more potent antinociceptive drug than vadocaine, also enhancing spontaneous motility. Both the control anaesthetics benzonatate and lidocaine proved rather ineffective. Benzonatate (50 mg/kg) did not alter any of the results, whereas lidocaine (50 mg/kg) caused a decrease in the number of writhings. In conclusion, vadocaine can be said to initiate minor deterioration of the central nervous system only at doses about 10 times higher than those which show antitussive activity. Acute lethal doses are still 2 to 5 times higher. The central antitussive action of vadocaine can therefore be considered fairly specific.