Tessalon Perles (Benzonatate) Dosing
For adults and children over 10 years of age, the standard dose 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
- Usual dose: One 100 mg or 200 mg capsule three times daily as needed for cough 1
- Maximum dose: Up to 600 mg daily in three divided doses (200 mg three times daily) if necessary to control cough 1
- Age restriction: Only approved for adults and children over 10 years of age 1
Critical Administration Requirements
- Capsules must be swallowed whole - they are not to be broken, chewed, dissolved, cut, or crushed 1
- Breaking or chewing the capsules can cause rapid release of the medication, leading to local anesthesia of the oral mucosa and potentially life-threatening complications 2
Essential Safety Warnings
Benzonatate poses extreme danger in overdose, particularly in young children, with deaths reported after accidental ingestion. 2
Overdose Risks
- Fatal outcomes have occurred in children as young as 2 years of age after accidental ingestion 2
- Signs and symptoms of overdose can develop within 15 minutes of ingestion and include seizures, cardiac arrest, coma, torsades de pointes, apnea, tachycardia, and respiratory arrest 3, 2
- Of 31 overdose cases reported to the FDA, 20 had fatal outcomes, with 5 fatalities occurring in children 2 years and younger 2
Storage and Patient Education
- Patients must be counseled on the critical importance of storing benzonatate in a child-resistant container and completely out of reach of children 2
- Immediate medical care is required for any suspected overdose or accidental ingestion 2
- The soft gelatin capsule appearance may be mistaken for candy by children, increasing accidental ingestion risk 2
Common Pitfalls to Avoid
- Never prescribe for children under 10 years of age - this is an absolute contraindication 1
- Do not exceed 600 mg total daily dose 1
- Ensure patients understand capsules cannot be chewed or opened, as this releases the local anesthetic effect in the mouth and can lead to choking or aspiration 2
- Recognize that as a structural analog of local anesthetics (tetracaine, procaine), benzonatate carries sodium channel blocking properties that cause its severe toxicity profile 4