What is the appropriate benzonatate dosing regimen for a 15-year-old male?

Benzonatate Dosing for a 15-Year-Old Male

For a 15-year-old male with cough, administer benzonatate 100-200 mg orally three times daily as needed, with a maximum daily dose of 600 mg in three divided doses. 1

Standard Dosing Regimen

• Initial dose: One 100 mg or 200 mg capsule three times daily as needed for cough 1
• Maximum daily dose: 600 mg divided into three doses if necessary to control cough 1
• Age qualification: This dosing applies to all children over 10 years of age and adults 1

Critical Administration Instructions

• Capsules must be swallowed whole — benzonatate capsules must never be broken, chewed, dissolved, cut, or crushed 1
• Chewing or breaking the capsules can cause rapid release of the medication, leading to local anesthesia of the oral mucosa and potentially life-threatening complications 2

Safety Considerations and Overdose Risk

Serious Toxicity Profile

• Benzonatate overdose can cause seizures, cardiac arrest, dysrhythmias, coma, CNS depression, and death — with symptoms appearing within 15 minutes of ingestion in some cases 3, 2
• Fatal outcomes have been reported, particularly with intentional overdoses; 20 of 31 overdose cases in the FDA database resulted in death 2
• Benzonatate has sodium channel blocking properties similar to local anesthetics (tetracaine, procaine), which accounts for its toxicity in overdose 4

Age-Specific Risk Context

• While the FDA specifically warns about accidental ingestion in children under 10 years old, serious toxicity can occur at any age 2
• A 15-year-old is well above the minimum age threshold and can safely receive standard adult dosing 1
• Intentional exposures (22% experienced serious adverse effects) carry significantly higher risk than unintentional exposures (0.7% serious adverse effects) 3

Patient Counseling Points

• Emphasize proper storage: Keep benzonatate in a secure location away from younger siblings or children, as even small amounts can be fatal in young children 2
• Warn about immediate medical attention: If more than the prescribed dose is taken, seek emergency care immediately — do not wait for symptoms 2
• Reinforce swallowing whole: Stress that chewing or breaking capsules can cause numbness of the mouth and throat, choking risk, and potentially life-threatening complications 1, 2
• Disposal guidance: Properly dispose of unused medication to prevent accidental ingestion 2

Common Pitfalls to Avoid

• Do not prescribe for children under 10 years of age — benzonatate is contraindicated in this population due to high risk of fatal overdose 1, 2
• Do not assume benzonatate is "safer" because it is non-narcotic — it carries significant overdose risk with rapid onset of life-threatening symptoms 4, 2
• Do not overlook the importance of capsule integrity — patients must understand that breaking or chewing capsules can be dangerous 1
• Do not prescribe without counseling on safe storage — pharmacist counseling on overdose risks and safe storage is essential 2