What is the best way to take prednisone and benzonatate together for a cough?

How to Take Prednisone and Benzonatate Together for Cough

Take prednisone 30-40 mg once daily in the morning and benzonatate 100-200 mg three to four times daily, but only use prednisone for severe post-infectious cough after ruling out other causes and only after first-line treatments have failed. 1, 2, 3

Treatment Algorithm

Step 1: Determine if Prednisone is Appropriate

• Prednisone should only be used for severe paroxysms of post-infectious cough when other common causes (upper airway cough syndrome, asthma, gastroesophageal reflux disease) have been ruled out 1, 2
• First-line therapy should be inhaled ipratropium bromide, which has demonstrated efficacy in controlled trials 2
• Second-line therapy is inhaled corticosteroids when cough persists despite ipratropium 2
• Oral prednisone is reserved for severe cases only after these measures fail 1

Step 2: Prednisone Dosing Specifics

• Dose: 30-40 mg once daily in the morning 1
• Duration: Short, finite period (2-3 weeks), tapering to zero 1
• Taking prednisone in the morning minimizes sleep disturbance and mimics natural cortisol rhythm 1

Step 3: Benzonatate Dosing Specifics

• Dose: 100-200 mg three to four times daily 3
• Duration: Limited to 7-10 days for acute cough; discontinue if symptoms persist beyond 1 week 3
• Benzonatate works peripherally by anesthetizing stretch receptors in the lungs 3
• The combination of benzonatate with other agents has shown potentiation of antitussive effect 4

Step 4: Timing and Administration

• Take prednisone in the morning (single daily dose) 1
• Take benzonatate 3-4 times throughout the day as needed for cough suppression 3
• There are no specific drug-drug interactions requiring separation of doses between these medications

Important Caveats and Pitfalls

Duration Considerations

• If cough persists beyond 8 weeks, reclassify as chronic cough and evaluate for other causes rather than continuing prednisone 1, 2
• Prolonged use of oral corticosteroids carries significant side effects; keep course short 1
• Benzonatate should not be prescribed for extended periods without reassessing the underlying cause 3

Safety Concerns with Benzonatate

• Benzonatate overdose can cause life-threatening cardiac events including cardiac arrest, even in adults 5
• Patient education is critical: swallow capsules whole, do not chew or dissolve 5
• Ingestion with alcohol increases toxicity risk 5

When This Combination May Not Be Appropriate

• Antibiotics have no role in post-infectious cough unless bacterial infection is confirmed 1, 2
• If cough is due to asthma, inhaled corticosteroids are preferred over oral prednisone 2, 6
• Central-acting antitussives (codeine, dextromethorphan) should be considered when benzonatate and other measures fail 1, 2

Monitoring

• Reassess within 4-6 weeks after initial evaluation 2
• If no improvement after short prednisone course, reconsider the diagnosis 1
• Persistent cough beyond expected timeframe warrants evaluation for chronic cough etiologies 2