What is the recommended dosage of Tessalon (benzonatate) for cough treatment?

Tessalon (Benzonatate) Dosing for Cough

The recommended dosage of benzonatate (Tessalon) 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

• Adults and children over 10 years: One 100 mg or 200 mg capsule three times daily as needed 1
• Maximum daily dose: 600 mg divided into three doses 1
• Capsules must be swallowed whole — never broken, chewed, dissolved, cut, or crushed 1

Critical Safety Warnings

Immediate Risks

• Release of medication in the mouth causes temporary oral anesthesia and choking risk 1
• If numbness or tingling of tongue, mouth, throat, or face occurs, avoid eating or drinking until numbness resolves 1
• Accidental ingestion in children has resulted in death — keep out of reach of children under 10 years 1
• Signs of overdose (restlessness, tremors, convulsions, coma, cardiac arrest) can occur within 15-20 minutes, with death reported within one hour 1
• Overdose resulting in death may occur in adults — do not exceed 200 mg single dose or 600 mg daily 1, 2

Administration Precautions

• Never take two doses at once if a dose is missed 1
• Benzonatate is chemically related to local anesthetics (procaine, tetracaine) and may cause adverse CNS effects in sensitive individuals 1

Clinical Role in Cough Management

When to Use Benzonatate

• Benzonatate is a peripherally-acting antitussive recommended for opioid-resistant cough 3
• The CHEST guideline suggests benzonatate as a trial option for adult patients with lung cancer experiencing opioid-resistant cough that does not respond to peripheral antitussives 3
• Benzonatate has been shown effective in cancer-related cough, particularly when opioids fail 4, 5

Position in Treatment Algorithm

• First-line: Simple remedies (honey, lemon) or dextromethorphan 10-15 mg three to four times daily 6, 7
• Second-line: Opioid derivatives (codeine, morphine) if demulcents fail 3
• Third-line: Peripherally-acting antitussives like benzonatate for opioid-resistant cough 3
• Fourth-line: Nebulized local anesthetics (lidocaine, bupivacaine) if benzonatate fails 3

Evidence for Efficacy

• Benzonatate combined with guaifenesin showed greater cough suppression than either agent alone in acute viral cough 8
• Case reports demonstrate effectiveness in opioid-resistant chronic cough in advanced cancer patients 5, 9
• Benzonatate was one of few antitussives specifically studied in cancer and advanced cancer cough, showing effectiveness and safety at recommended doses 4

Common Pitfalls to Avoid

• Never prescribe for children under 10 years — fatal overdoses have occurred in this age group 1
• Do not use as first-line therapy — reserve for cases where simpler, safer options (dextromethorphan, opioids) have failed 3, 6
• Ensure patients understand swallowing instructions — chewing or dissolving capsules causes dangerous oral anesthesia 1
• Counsel on overdose risk — even in adults, exceeding recommended doses can be fatal 1, 2