What is the recommended dosing for Tessalon Perles (Benzonatate)?

Benzonatate (Tessalon Perles) Dosing Guidelines

The recommended dosing for Tessalon Perles (benzonatate) is 100 mg or 200 mg three times daily as needed for cough, with a maximum daily dose not exceeding 600 mg divided into three doses. 1

Standard Dosing Regimen

• Adults and children over 10 years of age:
  • 100 mg or 200 mg capsule three times daily as needed
  • Maximum daily dose: 600 mg (divided into three doses)
  • Capsules must be swallowed whole

Important Administration Instructions

• Benzonatate capsules must NEVER be broken, chewed, dissolved, cut, or crushed
• Swallow capsules whole with water
• If a dose is missed, skip that dose and take the next dose at the scheduled time
• Do not take two doses at once to make up for a missed dose

Safety Considerations

Mechanism of Action

Benzonatate is chemically related to para-amino-benzoic acid class anesthetic agents (like procaine and tetracaine). It works by anesthetizing stretch receptors in the lungs, thereby reducing the cough reflex.

Warnings and Precautions

• Serious risks if not taken properly:

  • Release of benzonatate in the mouth can cause temporary local anesthesia of oral mucosa
  • Choking can occur if the capsule is chewed or broken
  • If numbness or tingling of the tongue, mouth, throat, or face occurs, patients should refrain from oral intake until numbness resolves
  • If symptoms worsen or persist, medical attention should be sought

• Overdose risk:

  • Overdose can be fatal in both children and adults 2, 3
  • Signs of overdose may appear within 15-20 minutes of ingestion
  • Symptoms include restlessness, tremors, convulsions, coma, and cardiac arrest
  • Death has been reported within one hour of ingestion

Special Population Considerations

• Pediatric use:

  • Safety and effectiveness not established in children under 10 years of age
  • Keep out of reach of children due to reports of fatal accidental ingestion 2

• Pregnancy:

  • Pregnancy Category C
  • Animal reproduction studies have not been conducted
  • Use only if clearly needed during pregnancy

• Nursing mothers:

  • Unknown if excreted in human milk
  • Exercise caution when administering to nursing women

Clinical Efficacy

Research has shown that benzonatate can effectively inhibit cough reflex sensitivity, particularly when combined with other agents like guaifenesin 4. However, its rapid onset of action must be balanced against its potential for serious adverse effects if misused.

Common Pitfalls to Avoid

1. Exceeding recommended dosage: Never exceed a single dose of 200 mg or total daily dose of 600 mg
2. Improper administration: Ensure patients understand never to break, chew, or crush capsules
3. Inadequate patient education: Patients must be warned about potential numbness and what to do if it occurs
4. Accessibility to children: Must be stored safely away from children due to risk of fatal ingestion
5. Monitoring for adverse effects: Be alert for signs of CNS effects possibly related to sensitivity to related agents

Remember that benzonatate is not a narcotic cough suppressant but should still be used with appropriate caution due to its potential for serious adverse effects if misused or in overdose situations.