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# TUSQ (Dextromethorphan Hydrobromide/Guaifenesin) ## Overview TUSQ is a combination product containing dextromethorphan hydrobromide, a cough suppressant, and guaifenesin, an expectorant. ## Primary Indications * Temporarily relieves cough due to minor throat and bronchial irritation. * Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. ## Adult Dosing * **TUSQ (Dextromethorphan HBr 10 mg / Guaifenesin 100 mg) oral suspension:** 20 mL every 4 hours as needed. Do not exceed 6 doses (120 mL) in 24 hours. * **TUSQ (Dextromethorphan HBr 20 mg / Guaifenesin 200 mg) oral suspension:** 10 mL every 4 hours as needed. Do not exceed 6 doses (60 mL) in 24 hours. * **TUSQ CD (Dextromethorphan HBr 30 mg / Guaifenesin 600 mg) extended-release capsules:** 1 capsule every 12 hours. Do not exceed 2 capsules in 24 hours. Dosing may vary based on specific product formulation and local protocol. ## Pediatric Dosing Safety and efficacy have not been established for children under 12 years of age for TUSQ products. Consult specific product labeling or pediatrician for guidance in this age group. ## Dose Adjustments No dose adjustments are typically required for renal or hepatic impairment, but caution is advised. Extreme caution and potential dose reduction may be warranted in patients with severe hepatic impairment. ## Contraindications * Hypersensitivity to dextromethorphan or guaifenesin. * Use within 14 days of MAO inhibitors or within 2 weeks of stopping MAO inhibitors. * Patients currently taking certain selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), or other drugs that affect serotonin levels due to the risk of serotonin syndrome. ## Adverse Effects * **Common:** Dizziness, drowsiness, nausea, vomiting, stomach upset. * **Less Common/Serious:** Confusion, hallucinations, respiratory depression (especially with overdose), serotonin syndrome (agitation, diarrhea, fever, sweating, tremors, fast heart rate). ## Key Drug Interactions * **MAO Inhibitors:** Increased risk of serotonin syndrome, hypertensive crisis. * **SSRIs, TCAs, other serotonergic agents:** Increased risk of serotonin syndrome. * **CNS Depressants (e.g., alcohol, benzodiazepines, opioids):** Additive CNS depression. * **CYP2D6 Inhibitors:** May increase dextromethorphan levels, increasing risk of adverse effects. ## Monitoring * Monitor for cough relief and productive cough. * Assess for signs and symptoms of adverse effects, particularly CNS effects and serotonin syndrome. * Monitor respiratory status in patients at risk for depression. ## Clinical Pearls * TUSQ is intended for short-term use to manage cough symptoms. If cough persists for more than 7 days, recurs, or is accompanied by fever, rash, or persistent headache, discontinue use and consult a healthcare professional. * Guaifenesin may cause nausea; administer with food if stomach upset occurs. * Avoid concomitant use with alcohol or other CNS depressants. * Dextromethorphan can be misused for its psychoactive effects; counsel patients on appropriate use. *** *Please verify the current prescribing information for the specific product being used, as formulations and recommendations can vary. This information is not a substitute for professional medical advice.*