From the Guidelines
The recommended dose of benzonatate (Tessalon) for adults and children over 10 years old is 100-200 mg taken orally three times daily as needed, with a maximum daily dose of 600 mg. This is based on the most recent and highest quality study available, which suggests that benzonatate can be effective in controlling cough in patients with lung cancer who do not respond to other treatments 1. It's essential to note that benzonatate is a non-narcotic antitussive (cough suppressant) that works differently from guaifenesin (Mucinex), which is an expectorant that thins mucus. These medications serve different purposes - benzonatate suppresses the cough reflex by numbing stretch receptors in the lungs, while guaifenesin helps clear mucus.
Some key points to consider when prescribing benzonatate include:
- Benzonatate capsules should be swallowed whole, not chewed or dissolved in the mouth, as this can cause temporary local anesthesia of the oral mucosa and potential choking.
- The medication typically begins working within 15-20 minutes and lasts for 3-8 hours.
- Side effects may include drowsiness, headache, dizziness, constipation, nausea, or stomach upset.
- Benzonatate should be used with caution in patients with hypersensitivity to related compounds like tetracaine, procaine, or other local anesthetics.
It's also important to consider the patient's overall condition and the underlying cause of their cough, as well as any other medications they may be taking. In patients with lung cancer, cough can be a significant symptom that affects quality of life, and treatment should be tailored to the individual patient's needs 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Adults and Children over 10 years of age: Usual dose is one 100 mg or 200 mg capsule three times a day as needed for cough. If necessary to control cough, up to 600 mg daily in three divided doses may be given. The appropriate dose of benzonatate (Tessalon) for a patient who reports that Mucinex (guaifenesin) is not effective is:
- 100 mg or 200 mg capsule three times a day as needed for cough,
- Up to 600 mg daily in three divided doses may be given if necessary to control cough 2. Do not exceed a single dose of 200 mg and a total daily dosage of 600 mg 2.
From the Research
Benzonatate Dosage
- The appropriate dose of benzonatate (Tessalon) for a patient who reports that Mucinex (guaifenesin) is not effective is not explicitly stated in the provided studies.
- However, a study 3 evaluated the effect of benzonatate 200mg on capsaicin-induced cough in adults with acute viral cough, suggesting that this dose may be used to inhibit cough-reflex sensitivity.
Combination Therapy
- The same study 3 found that the combination of benzonatate 200mg and guaifenesin 600mg suppressed capsaicin-induced cough to a greater degree than either medication alone.
- This suggests that combination therapy may be an effective approach for patients who do not respond to guaifenesin alone.
Efficacy of Guaifenesin
- Studies 4, 5, and 6 provide mixed evidence on the efficacy of guaifenesin for treating cough and mucus-related symptoms.
- A case report 7 suggests that guaifenesin may improve lung function and quality of life in patients with chronic obstructive pulmonary disease (COPD).
Safety and Tolerability
- A study 6 found that extended-release guaifenesin was well tolerated and had a favorable safety profile in patients with acute upper respiratory tract infection.
- However, the safety and tolerability of benzonatate, particularly in combination with guaifenesin, should be carefully monitored in clinical practice.