Tessalon Perles Dosage
For adults and children over 10 years of age, the standard dose is 100-200 mg three times daily as needed for cough, with a maximum daily dose of 600 mg divided into three doses 1.
Adult Dosing
- Standard dose: 100-200 mg three times daily (TID)
- Maximum daily dose: 600 mg in three divided doses
- Frequency: Every 8 hours as needed for cough control 1
The FDA-approved labeling clearly establishes that benzonatate should be administered up to 600 mg daily when necessary to control cough 1. This dosing is also supported by clinical guidelines for cough management, which list benzonatate at 100-200 mg four times daily (QID) as an option for opioid-resistant cough 2.
Pediatric Dosing
- Children ≥10 years: Same as adult dosing (100-200 mg TID, maximum 600 mg/day) 1
- Children <10 years: Contraindicated - safety and effectiveness have not been established 1
Critical Safety Warnings
Capsules must be swallowed whole - never broken, chewed, dissolved, cut, or crushed 1. Release of benzonatate in the mouth produces temporary local anesthesia of oral mucosa and can cause choking. If numbness or tingling of the tongue, mouth, throat, or face occurs, patients must refrain from eating or drinking until numbness resolves 1.
Pediatric Toxicity Risk
Accidental ingestion in children has resulted in death, with signs of overdose appearing within 15-20 minutes and death reported within one hour 1. Even in unintentional pediatric exposures, hospitalization may be required, though serious adverse effects are rare in this population 3. The medication must be kept out of reach of children at all times 1.
Overdose Considerations
Serious outcomes occur in approximately 5% of all exposures, with intentional overdoses carrying significantly higher risk (22% serious adverse effects) compared to unintentional exposures (0.7%) 3. Life-threatening effects include:
- Seizures (including status epilepticus)
- Cardiac dysrhythmias and arrest
- CNS depression and coma
- Death (primarily from dysrhythmias, not seizures) 4, 5
Notably, QRS prolongation may occur acutely but can resolve rapidly, so a normal QRS interval does not exclude benzonatate toxicity 5.