For a 72-year-old female with acute nasopharyngitis prescribed benzonatate (Tessalon) 100 mg three times daily, how many capsules should be ordered?

Benzonatate (Tessalon) Prescription Quantity

For a 72-year-old female prescribed benzonatate 100 mg three times daily, order 90 capsules for a 30-day supply (3 capsules per day × 30 days = 90 capsules).

Dosing and Duration

The FDA-approved dosing for benzonatate is straightforward 1:

• Standard dose: 100 mg or 200 mg three times daily as needed for cough
• Maximum daily dose: 600 mg in three divided doses
• For this patient: 100 mg TID = 300 mg total daily dose

Quantity Calculation

For standard outpatient prescribing:

• 30-day supply: 90 capsules (100 mg each)
• Alternative: Some providers prescribe 60-90 capsules initially to reassess efficacy and need for continuation

Critical Safety Considerations for This Patient

Age-related concerns: While benzonatate dosing does not require adjustment based on age alone 1, this 72-year-old patient warrants specific counseling:

Essential Patient Instructions (Must Emphasize)

Swallowing instructions are critical 1:

• Capsules MUST be swallowed whole
• Never break, chew, dissolve, cut, or crush capsules
• Release in the mouth causes local anesthesia of oral mucosa and choking risk
• If numbness/tingling of tongue, mouth, throat, or face occurs, avoid eating or drinking until resolved

Storage Warning

Keep completely out of reach of others 1: Accidental ingestion has resulted in death within 15-20 minutes to 1 hour, with serious outcomes including restlessness, tremors, convulsions, coma, and cardiac arrest 2, 3, 4. This is particularly important if grandchildren or others visit the home.

Clinical Context for Acute Nasopharyngitis

Since the diagnosis is acute nasopharyngitis (common cold), benzonatate is being used for symptomatic cough relief only 5. Key points:

• Acute nasopharyngitis is viral and self-limited 6
• Antibiotics are not indicated 5
• Cough typically resolves within 1 week without treatment
• Benzonatate provides symptomatic relief but does not alter disease course

Reassess need for continuation after initial supply is used, as most viral URIs resolve within 7-10 days and prolonged cough may warrant evaluation for other causes.

Prescription Writing

Rx: Benzonatate 100 mg capsules

• Quantity: #90 (ninety)
• Sig: Take 1 capsule by mouth three times daily as needed for cough. Swallow whole. Do not chew or break capsules.
• Refills: 0-1 (reassess if refill needed)