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## TUSQ® QD
### Overview
TUSQ® QD is a brand name for guaifenesin and dextromethorphan hydrobromide. Guaifenesin is an expectorant, and dextromethorphan is a cough suppressant.
### Primary Indications
* Relief of cough
* Thinning of mucus secretions to aid expectoration
### Adult Dosing
* **Guaifenesin 600 mg / Dextromethorphan HBr 30 mg:** Take one tablet orally every 12 hours. Do not exceed 2 tablets in 24 hours.
### Pediatric Dosing
* **Children 12 years and older:** Same as adult dosing.
* **Children 6 to under 12 years:** Consult product labeling or local protocol. Dosing is typically halved or adjusted based on weight, but specific recommendations for TUSQ® QD in this age group are not universally established and vary by formulation.
* **Children under 6 years:** Safety and efficacy not established. Consult a pediatrician.
### Dose Adjustments
* **Renal Impairment:** No specific dose adjustment is typically recommended, but caution may be advised due to potential for accumulation with impaired renal function.
* **Hepatic Impairment:** No specific dose adjustment is typically recommended, but caution may be advised due to potential for altered metabolism.
### Contraindications
* Hypersensitivity to guaifenesin or dextromethorphan.
* Use within 14 days of MAOI therapy.
* Patients with significant respiratory impairment (e.g., asthma, emphysema) may be at risk for respiratory depression with dextromethorphan.
### Adverse Effects
* **Common:** Dizziness, drowsiness, nausea, vomiting, stomach pain.
* **Serious:** Serotonin syndrome (rare, especially with exceeding recommended doses or concomitant serotonergic agents), respiratory depression (especially in high doses or in patients with underlying respiratory conditions), paradoxical excitation.
### Key Drug Interactions
* **MAO Inhibitors:** Risk of hypertensive crisis or serotonin syndrome. Avoid concomitant use.
* **Serotonergic Agents (SSRIs, SNRIs, triptans, etc.):** Increased risk of serotonin syndrome. Use with caution and monitor for symptoms.
* **CNS Depressants (alcohol, benzodiazepines, opioids):** Additive sedative effects.
### Monitoring
* Effectiveness of cough suppression and mucus expectoration.
* Signs of adverse effects, particularly drowsiness, dizziness, nausea, and signs of serotonin syndrome.
### Clinical Pearls
* TUSQ® QD contains dextromethorphan, which can be abused at high doses for its psychoactive effects.
* Ensure adequate hydration to promote effective expectoration with guaifenesin.
* Advise patients to avoid driving or operating heavy machinery if experiencing drowsiness.
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**Disclaimer:** This information is intended for clinical use and does not replace a thorough review of the official prescribing information for TUSQ® QD. Always consult the most current product labeling and consider individual patient factors before initiating therapy. Local protocols may also influence dosing and management.
