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# TUSQ-QD (TUSSO-QD)
## Overview
TUSQ-QD is a combination product containing guaifenesin and dextromethorphan. Guaifenesin is an expectorant, and dextromethorphan is a cough suppressant.
## Primary Indications
* Symptomatic relief of cough and to loosen mucus associated with the common cold, bronchitis, and other respiratory conditions.
## Adult Dosing
* **Guaifenesin 600 mg / Dextromethorphan HBr 30 mg extended-release tablet:**
* **Dose:** One tablet every 12 hours.
* **Maximum Dose:** Two tablets in 24 hours.
## Pediatric Dosing
* **Guaifenesin 600 mg / Dextromethorphan HBr 30 mg extended-release tablet:**
* **Ages 12 years and older:** One tablet every 12 hours.
* **Ages under 12 years:** Safety and efficacy have not been established. Use with caution and consider alternative agents or consult a pediatrician.
## Dose Adjustments
* **Hepatic Impairment:** No specific dosing adjustments are provided in the labeling. However, caution is advised as hepatic metabolism is involved in the elimination of both components.
* **Renal Impairment:** No specific dosing adjustments are provided in the labeling.
## Contraindications
* Hypersensitivity to guaifenesin or dextromethorphan or any component of the formulation.
* Use in patients currently taking, or within 2 weeks of stopping, a monoamine oxidase inhibitor (MAOI).
* COPD, persistent cough, or cough accompanied by excessive secretions.
## Adverse Effects
* **Common:** Nausea, vomiting, dizziness, drowsiness, headache.
* **Serious:** Serotonin syndrome (especially with concomitant serotonergic agents), respiratory depression (in overdose or patients with impaired respiratory function), abuse/misuse of dextromethorphan.
## Key Drug Interactions
* **MAOIs:** Co-administration can lead to hypertensive crisis.
* **Serotonergic Agents (e.g., SSRIs, SNRIs, triptans, tramadol):** Increased risk of serotonin syndrome.
* **CNS Depressants (e.g., alcohol, benzodiazepines):** Potentiated CNS depression.
* **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan levels, increasing the risk of adverse effects.
## Monitoring
* Monitor for effectiveness of cough suppression and expectoration.
* Monitor for adverse effects, particularly CNS depression and signs of serotonin syndrome.
* Assess for potential for abuse or misuse.
## Clinical Pearls
* Extended-release formulation provides longer-lasting relief.
* Ensure adequate hydration to aid in mucus expectoration.
* Avoid alcohol while taking this medication due to increased risk of CNS depression.
* Dextromethorphan carries a risk of abuse; educate patients on proper use and storage.
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***Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions. Local protocols and specific patient factors may influence dosing and management.*
