What is the recommended dose of Tessalon Perles (Benzonatate) for a patient with a cough, considering their age, weight, and medical history, including conditions such as chronic obstructive pulmonary disease (COPD) or asthma?

Tessalon Perles (Benzonatate) Dosing

The standard adult dose of Tessalon Perles (benzonatate) is 100-200 mg three times daily as needed for cough, with a maximum daily dose of 600 mg. 1, 2

Standard Dosing Regimen

• Adults and children over 10 years: 100-200 mg orally three times daily as needed 1, 2
• Maximum daily dose: 600 mg (three 200 mg capsules) 1, 2
• Timing: Doses should be spaced throughout the day, typically every 8 hours 1, 2

Special Populations

Elderly Patients

• No specific dose adjustment is required for elderly patients with COPD or asthma 3
• However, first treatment should be supervised due to potential for adverse effects 3

Renal Impairment

• No dose adjustment is required for patients with chronic kidney disease, as benzonatate is not renally excreted 1

Pediatric Considerations

• Contraindicated in children under 10 years due to risk of fatal overdose 4
• Accidental ingestion or chewing of capsules can cause rapid onset of severe toxicity including seizures and cardiac arrest 4

Critical Safety Considerations

Administration Instructions

• Capsules must be swallowed whole - never chewed, dissolved, or opened 4
• Chewing or sucking the capsule can cause local anesthesia of the oral mucosa and choking 4
• Patients should be instructed to take with water 4

Overdose Risk

• Benzonatate overdose can cause rapid progression to cardiac arrest, even in adults 4
• Ingestion of as few as 30 capsules (6000 mg) has resulted in cardiac arrest requiring 30 minutes of resuscitation 4
• Life-threatening toxicity can develop within 2 hours of ingestion 4

Clinical Context for Use

When to Consider Benzonatate

• Benzonatate offers an alternative to dextromethorphan with a different adverse effect profile 1
• It may be preferred when opioid antitussives are contraindicated 1, 2
• It acts peripherally rather than centrally, unlike dextromethorphan 2

Comparative Efficacy

• Benzonatate 200 mg has been shown to inhibit cough reflex sensitivity in acute viral cough 5
• The combination of benzonatate with guaifenesin may provide greater antitussive effect than either agent alone 5

Common Pitfalls to Avoid

• Do not prescribe for children under 10 years - this is an absolute contraindication due to fatal overdose risk 4
• Ensure patient education about swallowing capsules whole - chewing causes immediate local anesthetic toxicity 4
• Do not exceed 600 mg daily - higher doses significantly increase risk of life-threatening cardiac and neurologic toxicity 4
• Consider simpler alternatives first - honey and lemon may be as effective for benign viral cough without medication risks 1, 6, 7
• Avoid in patients with alcohol use - concurrent alcohol ingestion increases overdose risk 4

Duration of Treatment

• Benzonatate should be used for short-term symptomatic relief only 1
• If cough persists beyond 3 weeks, discontinue and evaluate for alternative diagnoses rather than continuing antitussive therapy 1, 6
• Chronic use is not recommended without identifying and treating the underlying cause of cough 3