Benzonatate (Tessalon Perles) Dosage Recommendations
The recommended dosage for Tessalon Perles (benzonatate) is one 100 mg or 200 mg capsule three times a day as needed for cough. 1
Standard Dosing Regimen
- The FDA-approved dosing for adults and children over 10 years of age is one 100 mg or 200 mg capsule three times daily (TID) as needed for cough 1
- If necessary to control cough, the maximum daily dose may be increased up to 600 mg daily, still divided into three doses 1
- Benzonatate capsules should always be swallowed whole and never broken, chewed, dissolved, cut, or crushed 1
Clinical Considerations
- Benzonatate works as a peripheral oral antitussive that dampens the activity of cough stretch receptors 2
- In patients with lung cancer experiencing opioid-resistant cough that does not respond to peripheral antitussives, benzonatate may be used at a dose of 100-200 mg four times daily (QID) 3
- Benzonatate is typically used as a later-line agent in the management of cough, particularly when other approaches have failed 3
Safety Considerations
- Benzonatate has a structural similarity to other local anesthetics including tetracaine and procaine, which contributes to its potential toxicity profile 4
- Overdose can lead to serious adverse events including cardiac arrest - a case report documented cardiac arrest after ingestion of less than 30 pills of benzonatate 200 mg with alcohol 4
- Fatal cases have been reported with benzonatate overdose, highlighting the importance of proper dosing and patient education 5
- Benzonatate undergoes rapid ester hydrolysis in plasma producing 4-(butylamino) benzoic acid (BBA) and methylated polyethylene glycol polymer 2
Efficacy Data
- When combined with guaifenesin, benzonatate has demonstrated enhanced antitussive effects compared to either agent alone in patients with acute viral cough 6
- In clinical studies, benzonatate alone did not significantly inhibit cough-reflex sensitivity compared to placebo, but showed synergistic effects when combined with other antitussives 6
Important Administration Instructions
- Benzonatate capsules must be swallowed whole to prevent local anesthetic effects in the mouth and throat that could increase the risk of choking 1
- The medication should be stored safely away from children as accidental ingestion can be fatal 5
- Effects typically begin within 15-20 minutes of oral administration, making it suitable for on-demand use for cough control 6
Remember that benzonatate is not a first-line treatment for cough in most clinical scenarios and should be used when other more established therapies have failed or are contraindicated 3.