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## TUSQ
### Overview
TUSQ (Tusso-XR) is an extended-release formulation of **codeine phosphate** and **guaifenesin**. Codeine is an opioid cough suppressant, and guaifenesin is an expectorant.
### Primary Indications
* Symptomatic relief of cough associated with respiratory conditions.
### Adult Dosing
* **TUSQ (Tusso-XR):** One tablet every 12 hours as needed. Do not exceed 2 tablets in 24 hours.
* **Note:** Dosing for codeine alone can vary. Maximum daily dose of codeine should not exceed 120 mg.
### Pediatric Dosing
* **TUSQ (Tusso-XR):** Safety and efficacy in pediatric patients have not been established. Use is generally not recommended. Specific pediatric dosing for codeine and guaifenesin depends on age and weight and should be guided by specific product labeling or clinical judgment.
### Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary.
### Contraindications
* Hypersensitivity to codeine, guaifenesin, or any component of the formulation.
* Significant respiratory depression.
* Acute or severe asthma.
* Conditions where the patient is likely to vomit.
* Use in children under 12 years of age for cough due to increased risk of serious adverse events, including respiratory depression and death.
### Adverse Effects
* **Common:** Drowsiness, dizziness, constipation, nausea, vomiting, dry mouth, pruritus.
* **Serious:** Respiratory depression, opioid withdrawal syndrome (with prolonged use or abrupt discontinuation), confusion, seizures, bradycardia, hypotension.
### Key Drug Interactions
* **CNS Depressants (e.g., alcohol, benzodiazepines, sedatives, hypnotics):** Increased risk of respiratory depression, profound sedation, coma.
* **CYP2D6 Inhibitors (e.g., quinidine, fluoxetine, paroxetine):** May reduce the analgesic effect of codeine and increase the risk of adverse effects due to reduced conversion to morphine.
* **MAO Inhibitors:** May potentiate the effects of opioids.
### Monitoring
* Assess effectiveness of cough suppression.
* Monitor for signs of CNS depression (e.g., drowsiness, sedation).
* Monitor for signs of constipation and manage proactively.
* Assess for potential for abuse or dependence with prolonged use.
### Clinical Pearls
* TUSQ is an extended-release formulation. Do not crush or chew tablets.
* Due to the risk of respiratory depression, especially in children, use the lowest effective dose for the shortest duration necessary.
* Codeine is metabolized to morphine by CYP2D6; genetic variability can affect efficacy and toxicity.
* Advise patients to avoid alcohol and other CNS depressants.
* Constipation is a common and dose-limiting side effect; preventative measures are recommended.
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**Disclaimer:** This information is intended for healthcare professionals. It is crucial to consult the most current prescribing information and relevant clinical guidelines for definitive patient management decisions. Dosing and safety recommendations can change.
