What is the appropriate dosage and administration of Tessalon (benzonatate) Perles for cough relief?

Benzonatate (Tessalon Perles) Dosage and Administration

The recommended dosage of benzonatate (Tessalon Perles) is 100-200 mg three times daily as needed for cough, with a maximum daily dose of 600 mg in three divided doses. 1

Dosage Guidelines

• Standard adult dosage: 100-200 mg three times daily
• Maximum daily dose: 600 mg (divided into three doses)
• Age restriction: Only for adults and children over 10 years of age
• Administration: Capsules must be swallowed whole and should never be broken, chewed, dissolved, cut, or crushed

Mechanism of Action

Benzonatate is a peripherally acting non-opioid antitussive that works by anesthetizing stretch receptors in the lungs, thereby reducing the cough reflex at its source. It is structurally related to tetracaine and other local anesthetics.

Clinical Applications

Benzonatate is indicated for symptomatic relief of cough in various conditions:

• Acute bronchitis: Can be offered for short-term symptomatic relief of coughing 2
• Lung cancer: Suggested as a treatment option for opioid-resistant cough 2
• Advanced cancer: Effective for opioid-resistant cough when other treatments fail 3

Special Considerations

Efficacy

• Benzonatate has shown effectiveness in both acute and chronic cough settings 4
• When combined with guaifenesin, it demonstrates enhanced antitussive effects compared to either agent alone 5

Safety Precautions

• Overdose risk: Benzonatate overdose can lead to serious adverse events including cardiac arrest 6
• Administration warning: Patients must be instructed to swallow capsules whole, as chewing or breaking the capsules releases the medication too quickly and can cause local anesthesia of the mouth and throat
• Monitoring: Patients should be monitored for adverse effects, particularly when starting therapy

Alternative Treatments When Benzonatate Is Ineffective

If benzonatate does not provide adequate relief:

1. Opioid derivatives may be considered (codeine, hydrocodone) 2
2. Dextromethorphan for non-productive cough 7
3. Nebulized local anesthetics such as lidocaine 2% (2-5 ml) or bupivacaine 0.25% (2-5 ml) for palliative care 2
4. Diazepam has been reported effective in cases of intractable cough unresponsive to standard treatments 8

Common Pitfalls to Avoid

1. Improper administration: Ensure patients understand that capsules must be swallowed whole
2. Inadequate dosing: Starting with too low a dose may not provide sufficient relief
3. Failure to address underlying cause: Benzonatate provides symptomatic relief but does not treat the underlying condition
4. Overdose risk: Prescribe appropriate quantities and educate patients about maximum daily dose
5. Inappropriate use in children under 10: Not approved for younger children

Benzonatate provides an effective non-opioid option for cough management, particularly valuable when opioid-based antitussives are contraindicated or ineffective. Its proper use according to FDA guidelines can significantly improve quality of life for patients suffering from persistent cough.