Benzonatate inhibition of voltage-gated sodium currents

• The popular antitussive benzonatate is a mixture of compounds.
• Benzonatate inhibits voltage-gated sodium channels.
• Inhibition is reversible, concentration-dependent, state-dependent and occurs at concentrations found in humans.
• The Nav1.7 sodium channel is known to be important in cough.
• Benzonatate strongly inhibits Nav1.7, but is not selective for it.

Benzonatate was FDA-approved in 1958 as an antitussive. Its mechanism of action is thought to be anesthesia of vagal sensory nerve fibers that mediate cough. Vagal sensory neurons highly express the Nav1.7 subtype of voltage-gated sodium channels, and inhibition of this channel inhibits the cough reflex. Local anesthetics inhibit voltage-gated sodium channels, but there are no reports of whether benzonatate affects these channels. Our hypothesis is that benzonatate inhibits Nav1.7 voltage-gated sodium channels.We used whole cell voltage clamp recording to test the effects of benzonatate on voltage-gated sodium (Na+) currents in two murine cell lines, catecholamine A differentiated (CAD) cells, which express primarily Nav1.7, and N1E-115, which express primarily Nav1.3.We found that, like local anesthetics, benzonatate strongly and reversibly inhibits voltage-gated Na+ channels. Benzonatate causes both tonic and phasic inhibition. It has greater effects on channel inactivation than on activation, and its potency is much greater at depolarized potentials, indicating inactivated-state-specific effects. Na+ currents in CAD cells and N1E-115 cells are similarly affected, indicating that benzonatate is not Na+ channel subtype-specific. Benzonatate is a mixture of polyethoxy esters of 4-(butylamino) benzoic acid having varying degrees of hydrophobicity. We found that Na+ currents are inhibited most potently by a benzonatate fraction containing the 9-ethoxy component. Detectable effects of benzonatate occur at concentrations as low as 0.3 μM, which has been reported in humans.We conclude that benzonatate has local anesthetic-like effects on voltage-gated sodium channels, including Nav1.7, which is a possible mechanism for cough suppression by the drug.