What is the recommended dosage of Tessalon Perles (benzonatate) for adults?

Tessalon Perles (Benzonatate) Dosing for Adults

The recommended adult dosage 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

Standard Dosing Regimen

• Usual dose: One 100 mg or 200 mg capsule three times daily as needed for cough 1
• Maximum daily dose: 600 mg divided into three doses 1
• Maximum single dose: Do not exceed 200 mg per dose 1

Critical Administration Instructions

Capsules must be swallowed whole—never broken, chewed, dissolved, cut, or crushed. 1

• 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 should refrain from eating or drinking until numbness resolves 1

Dosing Context from Guidelines

While the FDA label provides definitive dosing, guideline evidence offers additional context:

• The 2017 CHEST guideline for lung cancer patients lists benzonatate at 100-200 mg four times daily as a local anesthetic option for opioid-resistant cough 2
• This represents a slightly different dosing frequency than the FDA-approved regimen, though the per-dose amount remains consistent

Critical Safety Warnings

Benzonatate carries significant overdose risk with rapid onset of life-threatening effects:

• Signs of overdose (restlessness, tremors, convulsions, cardiac arrest) can occur within 15-20 minutes of ingestion 1
• Death has been reported within one hour of overdose 1
• Fatal outcomes have occurred in both children and adults, including cases with as few as 14 capsules (2800 mg total) 3, 4

Missed Dose Protocol

• If a dose is missed, skip that dose and take the next dose at the scheduled time 1
• Never take two doses at once 1

Special Populations

• Children under 10 years: Safety and effectiveness not established; accidental ingestion has resulted in death 1
• Pregnancy: Category C—use only if clearly needed 1
• Nursing mothers: Unknown if excreted in breast milk; use with caution 1

Storage and Dispensing Considerations

Keep benzonatate out of reach of children at all times. 1 Pharmacists should counsel patients on:

• Signs and symptoms of overdose requiring immediate medical attention 5
• Proper storage away from children 5
• The critical importance of swallowing capsules whole 1