What is the recommended dose and duration of Tessalon Perles (Benzonatate) for cough treatment?

Tessalon Perles (Benzonatate) Dosing and Duration

The standard dose of benzonatate is 100-200 mg three times daily as needed for cough, with treatment duration typically limited to short-term symptomatic relief (generally 7-14 days for acute cough). 1, 2

Standard Dosing Regimen

• Dose: 100-200 mg orally three times daily as needed 1
• Maximum daily dose: 600 mg per day (200 mg three times daily) 1
• Administration: Swallow capsules whole; do not chew or dissolve as this can cause local anesthesia of the oral mucosa and potential choking hazard

Duration of Treatment

• Acute cough: Limit use to short-term symptomatic relief, typically 7-14 days 1, 2
• Chronic cough: Benzonatate may be used for longer periods in specific populations (such as advanced cancer patients), but this requires ongoing reassessment 1
• Treatment duration should be guided by the underlying cause of cough and response to therapy

Clinical Context and Positioning

Benzonatate is a peripherally acting antitussive that offers an alternative to centrally acting agents like dextromethorphan, particularly when opioids are contraindicated. 3, 1

When to Consider Benzonatate:

• First-line considerations: After simple non-pharmacological measures (honey, lemon) have been tried for benign viral cough 3, 4
• Alternative to dextromethorphan: When central acting antitussives are not preferred or have failed 3
• Opioid-sparing option: Benzonatate has a different adverse effect profile compared to codeine-based products and may be preferred when opioid side effects are concerning 3, 1

Efficacy Profile:

• Benzonatate has been extensively studied in both acute and chronic cough settings with relatively high efficacy and safety profiles 1
• It was specifically studied in cancer and advanced cancer cough, demonstrating effectiveness and safety at recommended daily doses 1

Important Safety Considerations

• Do not chew or break capsules: This is critical as local anesthetic effects can occur in the mouth and throat, potentially leading to choking
• Minimal side effects: Generally well-tolerated with fewer systemic effects compared to opioid antitussives 1
• Contraindications: Hypersensitivity to benzonatate or related compounds (ester-type local anesthetics)

Practical Algorithm for Cough Management

1. Start with non-pharmacological approaches: Honey and lemon mixtures for benign viral cough 3, 4
2. Consider dextromethorphan first: 30-60 mg for additional relief if non-pharmacological measures insufficient 3, 4
3. Use benzonatate as alternative: 100-200 mg three times daily when dextromethorphan is not suitable or ineffective 3, 1
4. Avoid codeine-containing products: These offer no efficacy advantage over benzonatate or dextromethorphan but have greater adverse effects 3, 4

Common Pitfalls to Avoid

• Crushing or chewing capsules: This eliminates the protective coating and causes dangerous local anesthetic effects
• Prolonged use without reassessment: Persistent cough beyond 2-3 weeks requires evaluation for underlying causes rather than continued symptomatic suppression 5
• Using for productive cough: Antitussives like benzonatate should not be used when clearance of secretions is beneficial 3