Dosage of Tessalon Perles (Benzonatate)
For adults and children over 10 years of age, the standard dose is one 100 mg or 200 mg capsule 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: 100-200 mg three times daily (TID) as needed 1
- Maximum daily dose: 600 mg total, divided into three doses 1
- Maximum single dose: Do not exceed 200 mg per dose 1
- Administration: Capsules must be swallowed whole—never broken, chewed, dissolved, cut, or crushed 1
Critical Safety Considerations
Age Restrictions
- Contraindicated in children under 10 years: Safety and effectiveness have not been established in this population 1
- Accidental ingestion has resulted in death in children below age 10 1
- Keep completely out of reach of children due to fatal overdose risk 1
Administration Warnings
- Swallow capsules intact only: Breaking or chewing the capsule releases benzonatate in the mouth, causing temporary local anesthesia of oral mucosa and potential choking 1
- If numbness or tingling of the tongue, mouth, throat, or face occurs, refrain from eating or drinking until numbness resolves 1
- If symptoms worsen or persist, seek immediate medical attention 1
Overdose Risk
- Signs of overdose appear within 15-20 minutes, with death reported within one hour of ingestion 1
- Overdose symptoms include restlessness, tremors, convulsions, coma, and cardiac arrest 1
- Fatal outcomes have occurred in both children and adults 1, 2, 3
- Serious cardiac effects (ventricular dysrhythmias, cardiac arrest, asystole) and neurological effects (seizures, coma) occur even at relatively low overdoses 2, 3
Dosing in Clinical Context
When used as part of a stepwise cough management approach, benzonatate at 100-200 mg four times daily (QID) may be considered for opioid-resistant cough, particularly as a local anesthetic alternative 4. However, this QID dosing from guideline tables should not exceed the FDA-approved maximum of 600 mg daily 1.
Missed Dose Instructions
- If a dose is missed, skip that dose entirely 1
- Take the next dose at the regularly scheduled time 1
- Never take two doses at once 1
Common Pitfall to Avoid
The most dangerous error is prescribing benzonatate to households with young children or failing to emphasize that capsules must remain intact when swallowed. Even small ingestions (median dose ≥200 mg) can produce serious outcomes including seizures, dysrhythmias, and death within minutes to an hour 2, 3, 5.