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# TUSQ-D ## Overview TUSQ-D is a brand name for **dextromethorphan hydrobromide** in liquid formulation. Dextromethorphan is a cough suppressant that acts centrally on the cough center in the medulla. ## Primary Indications * Symptomatic relief of cough due to minor throat and bronchial irritation. ## Adult Dosing * **Oral:** 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours. * **Maximum:** 120 mg per 24 hours. ## Pediatric Dosing * **Ages 12 years and older:** Same as adult dosing. * **Ages 6 to under 12 years:** 5 mg to 10 mg every 4 hours, or 15 mg every 6 to 8 hours. * **Maximum (6-11 years):** 60 mg per 24 hours. * **Ages 2 to under 6 years:** 2.5 mg to 5 mg every 4 hours, or 7.5 mg every 6 to 8 hours. * **Maximum (2-5 years):** 30 mg per 24 hours. * **Under 2 years:** Use is generally not recommended due to risk of serious adverse effects. Consult a pediatrician. ## Dose Adjustments * No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised in patients with severe impairment. ## Contraindications * Hypersensitivity to dextromethorphan. * Use within 14 days of MAOI therapy. * Coadministration with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, meperidine, tramadol, bupropion, and other drugs that affect serotonin levels may increase the risk of serotonin syndrome. ## Adverse Effects * Dizziness, drowsiness, nausea, vomiting, constipation, confusion. * Abuse potential with high doses can lead to euphoria, hallucinations, and respiratory depression. ## Key Drug Interactions * **MAOIs, SSRIs, SNRIs, TCAs, triptans, meperidine, tramadol, bupropion:** Increased risk of serotonin syndrome. * **CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, increasing the risk of toxicity. * **Alcohol:** Potentiates CNS depressant effects. ## Monitoring * Monitor for efficacy (cough suppression) and adverse effects, particularly CNS effects and signs of serotonin syndrome. ## Clinical Pearls * TUSQ-D is for symptomatic relief of cough and does not treat the underlying cause. * Avoid use in patients with chronic cough (e.g., asthma, emphysema) unless specifically directed by a healthcare provider. * Consider the risk of abuse, especially in adolescents and young adults. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details before making treatment decisions.*