What is the recommended dose of Benzonatate (benzonatate) for symptomatic relief of cough in adults and children over 10 years of age?

Benzonatate Dosage Recommendations

For adults and children over 10 years of age, the recommended dose of benzonatate is one 100 mg or 200 mg capsule three times a day as needed for cough, with a maximum daily dose of 600 mg divided into three doses. 1

Dosing Guidelines

• Standard dosing: 100-200 mg three times daily
• Maximum daily dose: 600 mg (divided into three doses)
• Administration: Capsules must be swallowed whole, never chewed, crushed, dissolved, or broken 1
• Age restriction: Contraindicated in children under 10 years of age due to risk of accidental ingestion and death 2

Clinical Considerations

Patient Selection

• Benzonatate is typically used as a fourth-line therapy in cough management after:
  1. First-line: Demulcents
  2. Second-line: Opiate derivatives
  3. Third-line: Peripherally acting antitussives 2

Special Populations

• Children: Only approved for ages 10 years and older
• Elderly patients: Standard adult dosing applies, though patients with cardiovascular or renal comorbidities may be safer using menthol-based products 2

Duration of Treatment

• If symptoms do not improve after a short course of treatment, discontinue benzonatate and try another approach 2

Efficacy and Safety

Benzonatate has shown efficacy in controlling cough, particularly in challenging cases:

• Effective for cancer-related cough unresponsive to opioids 3, 4
• Shows efficacy in acute viral cough, especially when combined with guaifenesin 5

Safety Warnings

• Serious risks: Cardiac arrest has been reported with overdose 6
• Administration: Patient education about proper dosing and administration is critical to avoid serious adverse effects 2
• Mechanism: As a local anesthetic structurally similar to tetracaine and procaine, benzonatate works peripherally by anesthetizing stretch receptors in the lungs 3

Clinical Application

When prescribing benzonatate:

1. Start with 100 mg three times daily for most patients
2. Increase to 200 mg three times daily if needed for adequate cough control
3. Monitor response within the first few days of treatment
4. Discontinue if no improvement is observed after a short trial
5. Emphasize to patients that capsules must be swallowed whole

Benzonatate remains one of the few non-opioid antitussives with demonstrated efficacy in both acute and chronic cough settings, making it a valuable option when other treatments have failed.