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# TUSQ (Dextromethorphan Polistirex and Chlorpheniramine Polistirex) ## Overview TUSQ is a combination product containing dextromethorphan polistirex (a cough suppressant) and chlorpheniramine polistirex (an antihistamine). The polistirex formulation is an extended-release suspension. ## Primary Indications * Temporary relief of cough and symptoms of the common cold, including sneezing and runny nose. ## Adult Dosing * **Dosing:** 10 mL every 12 hours. * **Maximum:** 20 mL per 24 hours. ## Pediatric Dosing * **Ages 6 to <12 years:** 5 mL every 12 hours. * **Maximum:** 10 mL per 24 hours. * **Ages <6 years:** Safety and efficacy not established. ## Dose Adjustments * No specific dose adjustments are recommended for hepatic or renal impairment. However, caution is advised in patients with severe liver disease due to potential accumulation of chlorpheniramine. ## Contraindications * Hypersensitivity to dextromethorphan or chlorpheniramine. * Concurrent use with MAO inhibitors or within 14 days of stopping MAO inhibitors. * Use in newborns or premature infants. * Use in patients with acute asthma attacks. ## Adverse Effects * **Common:** Drowsiness, dizziness, dry mouth, nausea, constipation, blurred vision. * **Serious:** Sedation, confusion, respiratory depression (especially with overdose or in children), anticholinergic effects (urinary retention, tachycardia), paradoxical excitation (especially in children). ## Key Drug Interactions * **MAO Inhibitors:** Risk of severe hypertension and serotonin syndrome. * **CNS Depressants (e.g., alcohol, benzodiazepines, opioids):** Additive sedation and respiratory depression. * **CYP2D6 Inhibitors:** May increase dextromethorphan levels, leading to increased adverse effects. * **Anticholinergic Agents:** Additive anticholinergic effects. ## Monitoring * Monitor for signs of sedation, dizziness, confusion, and respiratory depression. * Monitor for anticholinergic effects such as dry mouth, urinary retention, and constipation. * Assess cough relief and symptom improvement. ## Clinical Pearls * The polistirex formulation allows for twice-daily dosing, which may improve adherence compared to more frequent dosing regimens. * Dextromethorphan can be abused for its euphoric and dissociative effects; counsel patients on appropriate use. * Chlorpheniramine is a first-generation antihistamine and can cause significant drowsiness. Advise patients to avoid operating heavy machinery or driving until they know how this medication affects them. * Due to the risk of respiratory depression, caution is advised when used in very young children or in patients with underlying respiratory conditions. --- *This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and your healthcare provider for any questions regarding medication use.*