Benzonatate Dosage
For adults and children over 10 years of age, the standard dose of benzonatate is 100-200 mg three times daily as needed for cough, with a maximum daily dose of 600 mg in three divided doses. 1
Adult Dosing
- Standard dose: 100 mg or 200 mg capsule three times daily as needed 1
- Maximum daily dose: 600 mg in three divided doses 1
- Maximum single dose: Do not exceed 200 mg per dose 1
Pediatric Dosing
- Children ≥10 years: Same as adult dosing (100-200 mg three times daily, maximum 600 mg/day) 1
- Children <10 years: Safety and effectiveness have not been established; benzonatate is contraindicated in this age group 1
Critical Administration Instructions
Benzonatate capsules must be swallowed whole and never broken, chewed, dissolved, cut, or crushed. 1 This is a critical safety issue because:
- Release of benzonatate in the mouth produces temporary local anesthesia of oral mucosa and can cause choking 1
- If numbness or tingling of the tongue, mouth, throat, or face occurs, patients must refrain from oral ingestion until numbness resolves 1
Safety Considerations and Warnings
Pediatric Toxicity Risk
Accidental ingestion in children below age 10 has resulted in death, with signs and symptoms of overdose occurring within 15-20 minutes and death reported within one hour of ingestion. 1, 2 The FDA specifically warns about fatal overdoses in children as young as 2 years old 2.
Overdose Potential in All Ages
Benzonatate overdose can cause life-threatening complications including:
- Seizures, cardiac arrest, and coma occurring within 15 minutes of ingestion 2
- Torsades de pointes and ventricular arrhythmias 3, 4
- Respiratory arrest and apnea 2
- Death in adults with intentional overdose 3, 5
Dosing Pitfalls to Avoid
- Never double dose: If a dose is missed, skip it and take the next scheduled dose—do not take 2 doses at one time 1
- Storage: Keep out of reach of children due to rapid and potentially fatal toxicity 1
- Chemical similarity: Benzonatate is chemically related to para-amino-benzoic acid anesthetics (procaine, tetracaine) and may cause adverse CNS effects in patients with prior sensitivity to related agents 1
Special Populations
- Pregnancy: Category C—should only be given if clearly needed 1
- Nursing mothers: Unknown if excreted in breast milk; use with caution 1
- Drug interactions: May interact with concomitant medications due to chemical similarity to local anesthetics 1
Clinical Context
Benzonatate has demonstrated efficacy and safety in recommended doses for cough management in advanced cancer and other settings 6, but the narrow therapeutic window and potential for rapid fatal toxicity—particularly in children—necessitates strict adherence to dosing guidelines and storage precautions.