Tessalon Perles (Benzonatate) - Usage and Dosage
Critical Safety Warning
Tessalon (benzonatate) is NOT benzocaine—it is a non-narcotic antitussive (cough suppressant) that requires extreme caution due to severe toxicity risk, particularly in children, and must never be chewed or crushed. 1
Standard Dosing
Adults and children over 10 years old: 100-200 mg orally three times daily as needed, with a maximum daily dose of 600 mg (three 200 mg capsules). The capsules must be swallowed whole without chewing, crushing, or dissolving in the mouth. 2
- Onset of action: Cough suppression begins within 15-20 minutes and lasts 3-8 hours 2
- Administration frequency: Every 8 hours as needed, not to exceed three doses in 24 hours 2
Critical Safety Considerations
Life-Threatening Risks
Fatal overdoses have been documented in both children and adults, with death occurring within 1 hour of ingestion in overdose situations. 1
- Pediatric contraindication: Tessalon perles pose extreme danger to young children due to choking risk and rapid-onset toxicity 1
- Capsule integrity is essential: If the capsule is chewed, sucked, or dissolved in the mouth, it causes immediate oropharyngeal anesthesia that can lead to choking, aspiration, and potentially fatal CNS and cardiovascular toxicity 1, 2
Mechanism of Specialized Use
Benzonatate has been studied for rapid oral anesthesia in awake intubations, where capsules are intentionally opened for topical effect (200 mg providing oropharyngeal anesthesia in approximately 55 seconds). 2 However, this specialized anesthesia application is distinctly different from its FDA-approved antitussive use and should only be performed by trained anesthesiologists in controlled settings.
Common Pitfalls to Avoid
- Never prescribe to children under 10 years old due to fatal toxicity risk 1
- Emphasize to patients: Must swallow whole—never chew, break, or suck on capsules 1, 2
- Storage warning: Keep out of reach of children; the soft gelatin capsules are attractive to young children and can be mistaken for candy 1
- Do not confuse with benzocaine: Tessalon contains benzonatate, not benzocaine (though both are local anesthetics with different applications and safety profiles) 3, 2
Monitoring and Duration
- Maximum treatment duration: Use only as needed for symptomatic cough relief; chronic use is not indicated 2
- No routine monitoring required for standard antitussive use at therapeutic doses 2
- Discontinue if: Cough persists beyond 7 days, worsens, or is accompanied by fever, rash, or persistent headache (these may indicate serious underlying conditions requiring medical evaluation) 2