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# TUSQ D ## Overview TUSQ D is a combination medication containing dextromethorphan, an antitussive, and guaifenesin, an expectorant. ## Primary Indications * Symptomatic relief of cough associated with colds, bronchitis, or other upper respiratory tract infections. * Aids in loosening mucus in the airways. ## Adult Dosing * **Dextromethorphan:** 10 mg to 20 mg every 4 hours, or 30 mg every 6-8 hours. Maximum daily dose is typically 120 mg. * **Guaifenesin:** 200 mg to 400 mg every 4 hours as needed. Maximum daily dose is typically 2400 mg. * *Specific dosing and frequency for TUSQ D formulations may vary. Refer to product labeling or local protocol.* ## Pediatric Dosing Dosing for children varies significantly by age and formulation. Consult specific product labeling or pediatric guidelines. Generally, **not recommended for children under 2 years of age** due to risk of serious side effects. * **Ages 6-12 years:** Often half the adult dose. * **Ages 2-6 years:** Dosing is highly variable and requires careful consideration; consult specific product information or a pediatrician. ## Dose Adjustments * **Hepatic Impairment:** No specific dose adjustment is typically recommended, but caution is advised, especially with higher doses of dextromethorphan, due to potential for prolonged effects. ## Contraindications * Hypersensitivity to dextromethorphan or guaifenesin. * Use within 14 days of starting or stopping a monoamine oxidase inhibitor (MAOI) due to risk of serotonin syndrome with dextromethorphan. * Patients with severe hepatic impairment. ## Adverse Effects * **Common:** Drowsiness, dizziness, nausea, vomiting, stomach upset. * **Less Common/Serious:** Confusion, hallucinations, respiratory depression (especially with overdose or in combination with other CNS depressants), serotonin syndrome (if combined with MAOIs or serotonergic agents). ## Key Drug Interactions * **MAOIs and other serotonergic agents:** Increased risk of serotonin syndrome. * **CNS Depressants (e.g., alcohol, benzodiazepines, opioids):** Additive sedative effects, increased risk of respiratory depression. * **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine, quinidine):** Can increase dextromethorphan plasma concentrations, leading to potential toxicity. ## Monitoring * Monitor for effectiveness of cough suppression and mucus expectoration. * Assess for adverse effects, particularly drowsiness, dizziness, confusion, and signs of serotonin syndrome. * Evaluate for potential drug interactions, especially in patients on MAOIs or other serotonergic agents. ## Clinical Pearls * TUSQ D is intended for symptomatic relief; address the underlying cause of the cough if possible. * Ensure adequate hydration to aid guaifenesin's effectiveness. * Advise patients to avoid activities requiring mental alertness until they know how the medication affects them. * Be aware of dextromethorphan's potential for abuse at supra-therapeutic doses. * Many combination products exist; always verify the specific active ingredients and strengths. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature before making clinical decisions. Product availability and labeling may vary.