Adult Dosing and Duration for Tessalon Perles (Benzonatate)
Adults and children 2 years of age and older should use Tessalon Perles up to 4 times daily or as directed by a physician, with the standard dose being 100-200 mg per dose (one to two perles), not exceeding 600 mg total daily dose. 1
Standard Dosing Regimen
- Dose per administration: 100-200 mg (one to two Tessalon Perles) 1
- Frequency: Up to 4 times daily 1
- Maximum daily dose: 600 mg (six 100-mg perles) 1
- Duration: Typically 4-7 days for acute cough, similar to other antitussive agents, though specific duration guidance for benzonatate is not established in the FDA labeling 1
Critical Safety Considerations
Tessalon Perles must be swallowed whole and never chewed, crushed, or dissolved in the mouth, as local anesthesia of the oral mucosa can occur, leading to choking risk and potentially life-threatening complications. 1
Severe Toxicity Risk
- Benzonatate overdose can cause rapid-onset cardiac arrest, seizures, and death, with fatalities reported after ingestion of as few as 10 capsules (2000 mg) in adolescents and even single capsule ingestion in young children. 2, 3
- Symptoms can develop within 1-2 hours of overdose, including CNS depression, seizures, ventricular arrhythmias, and cardiovascular collapse. 3
- Residual neurological deficits, including permanent blindness and confabulation, have been reported in overdose survivors despite aggressive supportive care. 3
Prescribing Precautions
- Children under 2 years: Do not use 1
- Children under 12 years: Should be supervised in use of the product 1
- Patient education is critical: Emphasize the importance of keeping medication away from children and never chewing the capsules, as benzonatate is structurally similar to local anesthetics (tetracaine, procaine) and poses significant toxicity risk. 3
Clinical Context
While benzonatate remains one of the most widely prescribed antitussives, the risk-benefit profile warrants careful consideration, particularly given the limited treatment options in overdose settings and the potential for rapid development of life-threatening adverse events. 3 Rational prescribing includes limiting quantities dispensed and thorough patient counseling about proper use and storage. 3