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# TUSQ-D (DEXTROMETHORPHAN HYDROBROMIDE) ## Overview TUSQ-D is an over-the-counter (OTC) cough suppressant. It works centrally in the brain to reduce the cough reflex. ## Primary Indications Temporary relief of cough due to minor throat and bronchial irritation associated with the common cold and temporarily relieves other symptoms due to the common cold. ## Adult Dosing 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours. Maximum: 120 mg in 24 hours. ## Pediatric Dosing Children 12 years and older: 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours. Maximum: 120 mg in 24 hours. Children 6 to under 12 years: 5 mg to 10 mg every 4 hours, or 15 mg every 6 to 8 hours. Maximum: 60 mg in 24 hours. Children under 6 years: Consult a healthcare provider. Dosing is not well established, and caution is advised due to potential for serious adverse events. ## Dose Adjustments No dose adjustment is typically required for renal or hepatic impairment, but caution and reduced dosing may be considered based on clinical assessment. ## Contraindications Hypersensitivity to dextromethorphan. Use within 14 days of MAOI therapy. ## Adverse Effects Dizziness, drowsiness, nausea, vomiting, constipation, nervousness, restlessness. Large doses can cause hallucinations, confusion, and respiratory depression. ## Key Drug Interactions * **MAO inhibitors:** Risk of severe hypertensive crisis. * **SSRIs, SNRIs, tricyclic antidepressants:** Risk of serotonin syndrome. * **Alcohol and CNS depressants:** Increased risk of sedation and respiratory depression. * **CYP2D6 inhibitors (e.g., quinidine, fluoxetine):** May increase dextromethorphan plasma concentrations, increasing the risk of adverse effects. ## Monitoring Monitor for effectiveness of cough suppression. Assess for adverse effects, particularly sedation, confusion, and signs of serotonin syndrome. ## Clinical Pearls Dextromethorphan is an NMDA receptor antagonist and sigma-1 receptor agonist. It is a common ingredient in many combination cold and cough products; care must be taken to avoid exceeding the maximum daily dose if multiple products are used. Abuse of dextromethorphan can lead to serious psychiatric and physical effects. --- **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making clinical decisions. Product formulations and recommendations may vary.