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# TUSQ/D (Guaifenesin/Dextromethorphan)
## Overview
TUSQ/D is a combination product containing guaifenesin, an expectorant, and dextromethorphan, a cough suppressant.
## Primary Indications
* Relief of cough associated with colds, bronchitis, and other upper respiratory tract infections.
* Aids in loosening mucus (guaifenesin).
* Suppresses the cough reflex (dextromethorphan).
## Adult Dosing
* **Tablets:** 1-2 tablets (containing guaifenesin 200 mg and dextromethorphan HBr 10 mg per tablet) every 4 hours as needed.
* **Liquid:** 10-20 mL every 4 hours as needed.
* **Maximum Dose:** Not clearly defined in most standard references, but generally avoid exceeding recommended dosing intervals.
## Pediatric Dosing
* **Children 6 to under 12 years:**
* **Tablets:** 1 tablet every 4 hours as needed.
* **Liquid:** 5-10 mL every 4 hours as needed.
* **Children under 6 years:** Use is generally not recommended without physician guidance due to increased risk of adverse effects. Consult product labeling or pediatrician for specific recommendations if approved for use in this age group.
## Dose Adjustments
* No dose adjustments are typically required for hepatic or renal impairment based on standard product labeling, but caution may be advised in severe cases.
## Contraindications
* Hypersensitivity to guaifenesin or dextromethorphan.
* Concurrent use with or within 2 weeks of discontinuing MAO inhibitors.
* Use in patients with severe respiratory impairment or persistent cough (e.g., asthma, COPD) without medical supervision.
## Adverse Effects
* **Common:** Dizziness, drowsiness, nausea, vomiting, stomach upset.
* **Less Common/Serious:** Confusion, hallucinations, respiratory depression (especially with overdose or in susceptible individuals), serotonin syndrome (rare, particularly with concurrent serotonergic agents).
## Key Drug Interactions
* **MAO Inhibitors:** Risk of hypertensive crisis or serotonin syndrome.
* **Serotonergic Agents (e.g., SSRIs, SNRIs, triptans):** Increased risk of serotonin syndrome.
* **CNS Depressants (e.g., alcohol, sedatives, opioids):** Additive sedative effects.
* **CYP2D6 Inhibitors (e.g., quinidine, fluoxetine):** May increase dextromethorphan plasma concentrations, potentially leading to increased adverse effects.
## Monitoring
* Monitor for effectiveness of cough suppression and mucus expectoration.
* Assess for signs and symptoms of adverse effects, including dizziness, drowsiness, and confusion.
* Monitor for signs of respiratory depression or serotonin syndrome, especially in patients with risk factors.
## Clinical Pearls
* Ensure adequate hydration to facilitate expectoration with guaifenesin.
* Dextromethorphan can be habit-forming or lead to abuse; use as directed.
* This product may cause drowsiness; advise patients to avoid operating heavy machinery or driving until they know how it affects them.
* Consider alternative agents if cough is productive and requires aggressive secretion mobilization without suppression.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for comprehensive prescribing information. Always verify current product labeling and consult with the prescribing physician or pharmacist for patient-specific recommendations.
