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 adults and children over 10 years of age is one 100 mg or 200 mg capsule three times daily as needed for cough, with a maximum daily dose of 600 mg divided into three doses. 1

Dosage Guidelines

• The FDA-approved dosing for benzonatate is 100-200 mg three times daily, not to exceed 600 mg per day in divided doses 1
• The American College of Chest Physicians suggests benzonatate as a fourth-line option at 100-200 mg four times daily in their cough management algorithm 2
• Benzonatate should be swallowed whole and never broken, chewed, dissolved, cut, or crushed to prevent local anesthesia of the oral mucosa which could lead to choking 1

Clinical Efficacy

• Benzonatate has demonstrated effectiveness in controlling cough in 80% of patients with malignant pulmonary involvement 2
• It is particularly effective for cough associated with lung cancer that was unresponsive to opioid treatment 2, 3
• When combined with guaifenesin, benzonatate shows enhanced antitussive effects compared to either agent alone in acute viral cough 4

Treatment Algorithm Position

• In the treatment algorithm for cough management, benzonatate is considered after:
  • First-line: demulcents
  • Second-line: opioid derivatives
  • Third-line: peripherally-acting antitussives like levodropropizine 2

Important Safety Considerations

• Benzonatate is chemically related to anesthetic agents of the para-amino-benzoic acid class (e.g., procaine, tetracaine) and may cause adverse CNS effects 1
• If numbness or tingling of the tongue, mouth, throat, or face occurs, patients should refrain from oral ingestion until the numbness resolves 1
• Accidental ingestion has resulted in death in children under 10 years of age, with symptoms appearing within 15-20 minutes and death reported within one hour of ingestion 1, 5
• Safety and effectiveness have not been established in children below the age of 10 1
• Overdose can lead to serious complications including cardiac arrest, as demonstrated in case reports 5

Special Populations

• Pregnancy: Category C - should only be given if clearly needed as animal reproduction studies have not been conducted 1
• Nursing mothers: Use with caution as it is unknown whether benzonatate is excreted in human milk 1
• Geriatric patients: The American Geriatrics Society recommends assessing aspiration risk before using benzonatate in frail patients or those with cancer 2

Administration Instructions

• Patients should be instructed to swallow the capsule whole 1
• If a dose is missed, patients should skip that dose and take the next dose at the scheduled time 1
• Patients should never take two doses at once 1
• Keep medication out of reach of children due to risk of accidental ingestion 1