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## TUSQ-D
### Overview
Tusq-D is a combination medication containing **dextromethorphan hydrobromide** (a cough suppressant) and **guaifenesin** (an expectorant).
### Primary Indications
* Temporarily relieves cough due to minor throat and bronchial irritation.
* Helps loosen phlegm (mucus) and thin bronchial secretions to rid the bronchial passageways of bothersome mucus, and makes bronchial secretions easier to drain.
### Adult Dosing
* **Dextromethorphan:** 10 mg to 20 mg every 4 hours, or 30 mg every 6-8 hours.
* **Guaifenesin:** 200 mg to 400 mg every 4 hours.
* Maximum daily dose for dextromethorphan is typically 120 mg.
* Maximum daily dose for guaifenesin is typically 2400 mg.
* Specific dosing for Tusq-D products will vary by formulation (e.g., syrup, tablet, extended-release). Refer to the specific product labeling.
### Pediatric Dosing
* **Children 6 to under 12 years:** Dosing is typically half the adult dose. Refer to specific product labeling.
* **Children 2 to under 6 years:** Refer to specific product labeling. Dosing should be determined by a healthcare provider.
* **Children under 2 years:** Not recommended for use.
### Dose Adjustments
* **Hepatic impairment:** Use with caution. No specific dose adjustments are universally established, but may require lower doses or increased dosing intervals.
### Contraindications
* Hypersensitivity to dextromethorphan or guaifenesin.
* Use in patients currently taking, or within 14 days of stopping, a monoamine oxidase inhibitor (MAOI).
* Use in patients with chronic cough, persistent or chronic cough, asthma, or where cough is accompanied by excessive secretions.
### Adverse Effects
* **Dextromethorphan:** Dizziness, drowsiness, nausea, vomiting, constipation. At higher doses: confusion, hallucinations, respiratory depression.
* **Guaifenesin:** Nausea, vomiting, dizziness, headache, rash.
### Key Drug Interactions
* **MAOIs:** Potentially life-threatening serotonin syndrome.
* **SSRIs, SNRIs, triptans, certain opioids:** Increased risk of serotonin syndrome.
* **CNS depressants (e.g., alcohol, sedatives, hypnotics):** Additive CNS depression.
* **CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan levels and risk of toxicity.
### Monitoring
* Monitor for effectiveness of cough suppression and expectoration.
* Monitor for adverse effects, particularly CNS effects with dextromethorphan and gastrointestinal effects with guaifenesin.
* Monitor for signs of serotonin syndrome if co-administered with serotonergic agents.
### Clinical Pearls
* Tusq-D is for symptomatic relief of cough and chest congestion. It does not treat the underlying cause of the cough.
* Ensure adequate hydration when using guaifenesin to promote thinning of mucus.
* Advise patients to avoid driving or operating heavy machinery if drowsiness or dizziness occurs.
* Dextromethorphan has a potential for abuse; counsel patients on appropriate use.
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*Disclaimer: This information is intended for healthcare professionals. Always verify current prescribing information and consult with a healthcare provider for specific patient management decisions. Dosing may vary based on specific product formulation and local protocols.*
