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# TUSQ (TUSSO-QR)
## Overview
TUSQ (TUSSO-QR) is a combination product containing **guaifenesin** and **dextromethorphan hydrobromide**. Guaifenesin is an expectorant that helps thin and loosen mucus. Dextromethorphan is a cough suppressant.
## Primary Indications
* Relief of cough associated with the common cold or other respiratory conditions.
* Aids in loosening mucus.
## Adult Dosing
* **Guaifenesin 600 mg / Dextromethorphan HBr 30 mg extended-release tablets:**
* **Dose:** 1 tablet every 12 hours.
* **Maximum:** 2 tablets in 24 hours.
## Pediatric Dosing
* Dosing for children under 12 years of age is generally not recommended or should be specifically guided by a healthcare provider. Available pediatric formulations and dosing vary. Always consult product labeling or a pediatrician for age-appropriate dosing.
## Dose Adjustments
* **Renal Impairment:** No specific dose adjustments are established. Caution may be warranted.
* **Hepatic Impairment:** No specific dose adjustments are established. Caution may be warranted.
## Contraindications
* Hypersensitivity to guaifenesin or dextromethorphan.
* Use within 14 days of monoamine oxidase inhibitor (MAOI) therapy.
* Dextromethorphan-containing products are generally not recommended for patients with chronic cough, persistent cough, asthma, or when cough is accompanied by excessive secretions.
## Adverse Effects
* **Common:** Dizziness, drowsiness, nausea, vomiting, headache.
* **Less Common:** Rash, confusion, hallucinations (especially with higher doses of dextromethorphan).
## Key Drug Interactions
* **MAOIs and other serotonergic agents (e.g., SSRIs, SNRIs):** Increased risk of serotonin syndrome. Avoid concomitant use.
* **CNS Depressants (e.g., alcohol, benzodiazepines, opioids):** Additive CNS depression.
* **CYP2D6 Inhibitors:** May increase dextromethorphan levels, increasing risk of toxicity.
## Monitoring
* Assess for relief of cough symptoms.
* Monitor for adverse effects, particularly CNS effects and signs of serotonin syndrome.
## Clinical Pearls
* The extended-release formulation should be swallowed whole and not crushed or chewed.
* Adequate hydration can help thin mucus and improve the efficacy of guaifenesin.
* Be aware of dextromethorphan-containing products in other medications to avoid accidental overdose.
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**Disclaimer:** This information is intended for clinical pharmacists and healthcare professionals. It is crucial to consult the most current prescribing information and product labeling for TUSQ (TUSSO-QR) and to consider individual patient factors before making any treatment decisions. Local protocols may also influence prescribing.
