What is the recommended dosage and usage of Benzonatate for cough relief?

Benzonatate Dosage and Usage for Cough Relief

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

Dosing Guidelines

• Benzonatate capsules should be swallowed whole and never broken, chewed, dissolved, cut, or crushed 1
• For adults and children over 10 years of age, the standard dose is one 100 mg or 200 mg capsule three times daily 1
• Maximum daily dose should not exceed 600 mg divided into three doses 1
• Safety and effectiveness have not been established in children under 10 years of age 1

Therapeutic Role in Cough Management

Benzonatate is primarily indicated for:

• Symptomatic relief of cough in various conditions 2
• Treatment of opioid-resistant cough, particularly in advanced cancer patients 3
• In lung cancer patients, benzonatate is recommended as a trial therapy when cough does not respond to demulcents, opiates, and peripheral antitussives 4

Mechanism of Action

• Benzonatate is chemically related to anesthetic agents of the para-amino-benzoic acid class (like procaine and tetracaine) 1
• Acts as a peripherally acting antitussive by anesthetizing stretch receptors in the lungs, thereby reducing the cough reflex 2

Treatment Algorithm for Cough Management

For patients requiring pharmacological management of cough:

1. First-line: Trial with demulcents (where available) 4
2. Second-line: Opioid derivatives titrated to acceptable side-effect profile 4
3. Third-line: Peripherally-acting antitussives like levodropropizine (where available) 4
4. Fourth-line: Local anesthetics including benzonatate at 100-200 mg four times daily 4

Efficacy

• Benzonatate has shown effectiveness in controlling cough in 80% of patients with malignant pulmonary involvement 4
• Particularly effective for cough associated with lung cancer that was unresponsive to opioid treatment 4, 3
• In combination with guaifenesin, benzonatate has demonstrated enhanced antitussive effects compared to either agent alone in acute viral cough 5

Important Safety Considerations

• Risk of serious adverse events with overdose, including cardiac arrest 6
• Temporary local anesthesia of oral mucosa can occur if capsules are broken or chewed, potentially causing choking 1
• Patients should be instructed to refrain from oral ingestion if numbness or tingling of mouth/throat occurs 1
• Accidental ingestion has resulted in death in children; keep out of reach of children 1
• Signs of overdose can appear within 15-20 minutes and may include restlessness, tremors, convulsions, coma, and cardiac arrest 1, 6
• Pregnancy Category C - should be given to pregnant women only if clearly needed 1

Special Populations

• Not recommended for children under 10 years of age 1
• Use with caution in nursing mothers as excretion in breast milk is unknown 1
• Before using benzonatate in frail patients or those with cancer, assess aspiration risk as local anesthetics can increase this risk 4

Benzonatate represents an important option in the pharmacological management of cough, particularly when other treatments have failed. Its proper use according to recommended dosing guidelines can provide significant relief while minimizing potential risks.