What is the recommended dosage and usage of Tessalon (benzonatate) for cough relief?

Benzonatate (Tessalon) Dosage and Usage for Cough Relief

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

Dosage Guidelines

• Benzonatate capsules should be swallowed whole and never broken, chewed, dissolved, cut, or crushed 1
• Standard dosing: 100-200 mg three times daily as needed for cough 1
• Maximum daily dose: 600 mg divided into three doses 1
• Approved for use in adults and children over 10 years of age only 1

Mechanism of Action

• Benzonatate is a peripherally acting non-narcotic antitussive agent that is structurally similar to local anesthetics like tetracaine and procaine 2
• It works by anesthetizing stretch receptors in the lungs, thereby reducing the cough reflex at its source 3

Clinical Efficacy

• Benzonatate has been specifically studied in cancer and advanced cancer cough, showing effectiveness and safety when used at recommended daily doses 3
• It is one of several antitussives that have demonstrated relatively high efficacy and safety profiles in both acute and chronic cough settings 3

Important Safety Considerations

• Benzonatate carries significant risks in overdose situations, including:

  • Cardiac arrhythmias including torsades de pointes 4
  • Cardiac arrest 2, 4
  • Rapid onset of life-threatening adverse events 2

• Risk of serious adverse effects is particularly concerning because:

  • Effects can occur rapidly after ingestion (within 2 hours) 2
  • Limited treatment options exist in overdose settings 2
  • Both adults and children are vulnerable to these effects 2, 4

Alternative Cough Treatments

If benzonatate is not appropriate or available, consider these alternatives:

• Dextromethorphan:

  • Non-sedating opiate that suppresses acute cough 5
  • Maximum cough reflex suppression occurs at 60 mg and can be prolonged 5
  • Dose-response relationship exists, with potentially improved symptom control at higher doses (around 0.5 mg/kg) 6

• For acute viral cough:

  • Simple home remedies like honey and lemon may be effective 7
  • Central cough suppressants have limited efficacy for symptomatic relief of URI-related cough 7
  • Peripheral cough suppressants also have limited efficacy for URI-related cough 7

• For chronic bronchitis:

  • Central cough suppressants like codeine and dextromethorphan are recommended for short-term symptomatic relief 7
  • Peripheral cough suppressants like levodropropizine and moguisteine are recommended for short-term symptomatic relief 7
  • Inhaled ipratropium bromide is recommended for cough suppression 7

When to Consider Other Approaches

• For postinfectious cough persisting beyond 3 weeks:

  • Consider inhaled ipratropium as it may attenuate the cough 7
  • For cough that persists despite ipratropium, consider inhaled corticosteroids 7
  • Central acting antitussives should be considered when other measures fail 7

• For severe or treatment-resistant cough:

  • In cases of severe paroxysms of postinfectious cough, short courses of prednisone (30-40 mg daily) may be considered 7
  • For opioid-resistant cough in specific populations, local anesthetics including nebulized lidocaine/bupivacaine or benzonatate may be tried 7

Remember that benzonatate should always be swallowed whole, and patients should be educated about the potential risks of overdose and the importance of keeping this medication away from children under 10 years of age.