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# TUSQ QD ## Overview TUSQ QD is a brand name for a combination product containing **guaifenesin and dextromethorphan**. Guaifenesin is an expectorant that thins and loosens mucus. Dextromethorphan is a cough suppressant that acts on the cough center in the brain. ## Primary Indications * Relief of cough associated with the common cold. * Temporary relief of cough due to minor throat and bronchial irritation. ## Adult Dosing * **Guaifenesin 600 mg / Dextromethorphan 60 mg extended-release tablet:** * 1 tablet by mouth every 12 hours. * Do not exceed 2 tablets in 24 hours. *Note: Specific dosing for other available formulations may vary. Always consult the product labeling or local protocol.* ## Pediatric Dosing * **Children 12 years and older:** Same as adult dosing. * **Children under 12 years:** Safety and efficacy have not been established. Consult product labeling or pediatrician for appropriate alternatives. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Dosing adjustments may be necessary; consult prescribing information. * **Renal Impairment:** Use with caution. Dosing adjustments may be necessary; consult prescribing information. ## Contraindications * Hypersensitivity to guaifenesin or dextromethorphan or any component of the formulation. * Use in patients currently taking, or within 14 days of stopping, a monoamine oxidase inhibitor (MAOI). * Use in patients with chronic cough (e.g., asthma, emphysema, persistent cough) or cough accompanied by excessive secretions. ## Adverse Effects * **Common:** Nausea, vomiting, dizziness, drowsiness, headache. * **Less Common:** Rash, stomach pain, confusion, hallucinations, serotonin syndrome (especially with concomitant serotonergic agents). ## Key Drug Interactions * **Monoamine Oxidase Inhibitors (MAOIs):** Concomitant use is contraindicated due to risk of serotonin syndrome. * **Serotonergic Agents (e.g., SSRIs, SNRIs, triptans):** Increased risk of serotonin syndrome. * **CNS Depressants (e.g., alcohol, sedatives, benzodiazepines):** Additive CNS depression. * **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine):** May increase dextromethorphan plasma concentrations. ## Monitoring * Monitor for effectiveness of cough suppression and expectoration. * Monitor for adverse effects, particularly CNS effects and signs of serotonin syndrome. ## Clinical Pearls * TUSQ QD is an extended-release formulation; do not crush, chew, or break tablets. * Adequate hydration can aid in the effectiveness of guaifenesin. * Dextromethorphan has a potential for abuse at higher doses. * Advise patients to avoid alcohol and other CNS depressants while taking this medication. *** *Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and product labeling for complete details, including potential contraindications, warnings, precautions, and adverse reactions. Local protocols may also influence drug use and dosing.*