Tusnel Liquid
It is used to treat nose stuffiness.It is used to thin mucus so it can be taken from the body by coughing.It is used to relieve coughing.
Drug Class
Cough and Cold Preparation
Pharmacologic Class
Expectorant; Alpha-adrenergic Agonist; NMDA Receptor Antagonist
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Tusnel Liquid is an over-the-counter medicine used to relieve coughs, chest congestion, and nasal stuffiness. Guaifenesin helps thin and loosen mucus in your lungs, making it easier to cough up. Pseudoephedrine helps clear up stuffy nose by shrinking blood vessels in the nasal passages. Dextromethorphan helps reduce the urge to cough.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. You can take this medication with or without food, but if it causes stomach upset, take it with food to help minimize discomfort.
It's essential to stay hydrated while taking this medication, so drink plenty of non-caffeinated liquids unless your doctor advises you to limit your fluid intake. When measuring liquid doses, use the measuring device that comes with the medication. If one is not provided, ask your pharmacist for a suitable measuring device to ensure accurate dosing.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your doctor or pharmacist. If you're unsure about the best way to dispose of your medication, consult your pharmacist. You may also have access to drug take-back programs in your area.
What to Do If You Miss a Dose
If you take this medication on a regular schedule, take the missed dose as soon as you remember. However, if it's close to the time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses. If you take this medication as needed, do not take it more frequently than directed by your doctor.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. You can take this medication with or without food, but if it causes stomach upset, take it with food to help minimize discomfort.
It's essential to stay hydrated while taking this medication, so drink plenty of non-caffeinated liquids unless your doctor advises you to limit your fluid intake. When measuring liquid doses, use the measuring device that comes with the medication. If one is not provided, ask your pharmacist for a suitable measuring device to ensure accurate dosing.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your doctor or pharmacist. If you're unsure about the best way to dispose of your medication, consult your pharmacist. You may also have access to drug take-back programs in your area.
What to Do If You Miss a Dose
If you take this medication on a regular schedule, take the missed dose as soon as you remember. However, if it's close to the time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses. If you take this medication as needed, do not take it more frequently than directed by your doctor.
Lifestyle & Tips
- Drink plenty of fluids (water, clear broths) to help thin mucus and stay hydrated.
- Use a humidifier or vaporizer to moisten the air, which can help soothe irritated airways.
- Avoid irritants like smoke, dust, and strong fumes, which can worsen cough and congestion.
- Get adequate rest to help your body recover.
- Do not exceed the recommended dose. Taking more will not make it work better and can cause serious side effects.
- Avoid alcohol while taking this medication, as it can increase drowsiness.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
10 mL (2 teaspoonfuls) every 4 hours as needed
Condition-Specific Dosing:
maximumDailyDose:
Do not exceed 6 doses (60 mL) in 24 hours
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established (generally not recommended for children under 4 years)
Child:
Children 6 to under 12 years: 5 mL (1 teaspoonful) every 4 hours as needed (Do not exceed 6 doses (30 mL) in 24 hours). Not recommended for children under 6 years.
Adolescent:
Children 12 years and over: 10 mL (2 teaspoonfuls) every 4 hours as needed (Do not exceed 6 doses (60 mL) in 24 hours)
Dose Adjustments
Renal Impairment:
Mild:
Use with caution; monitor for adverse effects.
Moderate:
Use with caution; consider dose reduction or extended dosing interval, especially for pseudoephedrine and dextromethorphan.
Severe:
Contraindicated or significant dose reduction required due to pseudoephedrine and dextromethorphan accumulation. Consult physician.
Dialysis:
Not well studied for this combination. Pseudoephedrine is dialyzable to some extent. Avoid use or use with extreme caution and close monitoring.
Hepatic Impairment:
Mild:
Use with caution.
Moderate:
Use with caution; consider dose reduction for dextromethorphan due to CYP2D6 metabolism.
Severe:
Contraindicated or significant dose reduction required due to impaired metabolism of dextromethorphan and pseudoephedrine. Consult physician.
Pharmacology
Mechanism of Action
Guaifenesin acts as an expectorant by increasing the volume and decreasing the viscosity of respiratory tract secretions, thereby facilitating their removal by ciliary action and coughing. Pseudoephedrine is a sympathomimetic amine that acts directly and indirectly on adrenergic receptors. It primarily acts as an alpha-adrenergic agonist, causing vasoconstriction in the nasal mucosa, leading to reduced swelling and congestion. Dextromethorphan is a centrally acting antitussive that elevates the cough threshold in the medulla oblongata. It is an NMDA receptor antagonist and a sigma-1 receptor agonist.
Pharmacokinetics
Absorption:
Bioavailability:
Guaifenesin: Well absorbed; Pseudoephedrine: Well absorbed (approx. 100%); Dextromethorphan: Well absorbed
Tmax:
Guaifenesin: ~1 hour; Pseudoephedrine: 1-2 hours; Dextromethorphan: 2-2.5 hours
FoodEffect:
Minimal or no significant effect on absorption for all components.
Distribution:
Vd:
Guaifenesin: Not well characterized; Pseudoephedrine: 2.6-3.5 L/kg; Dextromethorphan: Not well characterized
ProteinBinding:
Guaifenesin: Not significant; Pseudoephedrine: Low (approx. 10-20%); Dextromethorphan: Not significant
CnssPenetration:
Guaifenesin: Limited; Pseudoephedrine: Yes; Dextromethorphan: Yes
Elimination:
HalfLife:
Guaifenesin: ~1 hour; Pseudoephedrine: 4-6 hours (pH dependent); Dextromethorphan: 3-4 hours (parent), 10-20 hours (dextrorphan)
Clearance:
Not available for combination
ExcretionRoute:
Guaifenesin: Renal (as metabolites); Pseudoephedrine: Renal (43-96% unchanged, pH dependent); Dextromethorphan: Renal (as parent and metabolites)
Unchanged:
Guaifenesin: <1%; Pseudoephedrine: 43-96%; Dextromethorphan: <1%
Pharmacodynamics
OnsetOfAction:
Guaifenesin: ~30 minutes; Pseudoephedrine: 15-30 minutes; Dextromethorphan: 15-30 minutes
PeakEffect:
Guaifenesin: ~1 hour; Pseudoephedrine: 1-2 hours; Dextromethorphan: 2-2.5 hours
DurationOfAction:
Guaifenesin: ~4-6 hours; Pseudoephedrine: 4-6 hours; Dextromethorphan: 4-6 hours
Confidence:
Medium
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
- Signs of an allergic reaction, such as:
- Rash
- Hives
- Itching
- Red, swollen, blistered, or peeling skin (with or without fever)
- Wheezing
- Tightness in the chest or throat
- Difficulty breathing, swallowing, or talking
- Unusual hoarseness
- Swelling of the mouth, face, lips, tongue, or throat
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. Contact your doctor or seek medical help if you experience any of the following side effects or if they persist or bother you:
- Dizziness
- Trouble sleeping
- Feeling nervous and excitable
Note: This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor for advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
- Signs of an allergic reaction, such as:
- Rash
- Hives
- Itching
- Red, swollen, blistered, or peeling skin (with or without fever)
- Wheezing
- Tightness in the chest or throat
- Difficulty breathing, swallowing, or talking
- Unusual hoarseness
- Swelling of the mouth, face, lips, tongue, or throat
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. Contact your doctor or seek medical help if you experience any of the following side effects or if they persist or bother you:
- Dizziness
- Trouble sleeping
- Feeling nervous and excitable
Note: This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor for advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- If cough or congestion worsens or lasts for more than 7 days (5 days for children)
- If cough returns or is accompanied by fever, rash, or persistent headache
- If you experience nervousness, dizziness, or sleeplessness
- If you develop a rapid heartbeat or palpitations
- If you experience severe nausea, vomiting, or stomach pain
- Signs of an allergic reaction (e.g., rash, itching, swelling, severe dizziness, trouble breathing)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
If you have taken certain medications for depression or Parkinson's disease within the last 14 days, including isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to very high blood pressure.
If you are currently taking linezolid or methylene blue, as these medications may interact with this drug.
If you have a cough that produces a lot of mucus, a chronic cough caused by smoking or exposure to smoke, or lung conditions such as asthma or emphysema.
This list is not exhaustive, and it is crucial to disclose all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you may have. Your doctor and pharmacist need this information to ensure it is safe for you to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
If you have taken certain medications for depression or Parkinson's disease within the last 14 days, including isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to very high blood pressure.
If you are currently taking linezolid or methylene blue, as these medications may interact with this drug.
If you have a cough that produces a lot of mucus, a chronic cough caused by smoking or exposure to smoke, or lung conditions such as asthma or emphysema.
This list is not exhaustive, and it is crucial to disclose all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you may have. Your doctor and pharmacist need this information to ensure it is safe for you to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. To minimize the risk of severe side effects, do not exceed the dosage prescribed by your doctor. Adhering to the recommended treatment duration is also crucial; do not take this drug for longer than the period specified by your doctor.
When considering administration to children, note that different brands of this medication may be approved for use in various age groups. Therefore, it is crucial to consult with your doctor before giving this drug to a child to ensure the appropriate brand and dosage are used.
If you are pregnant, planning to become pregnant, or are breastfeeding, it is vital to discuss your situation with your doctor. This conversation will help weigh the benefits and risks of taking this medication to both you and your baby, allowing for an informed decision about your treatment.
When considering administration to children, note that different brands of this medication may be approved for use in various age groups. Therefore, it is crucial to consult with your doctor before giving this drug to a child to ensure the appropriate brand and dosage are used.
If you are pregnant, planning to become pregnant, or are breastfeeding, it is vital to discuss your situation with your doctor. This conversation will help weigh the benefits and risks of taking this medication to both you and your baby, allowing for an informed decision about your treatment.
Overdose Information
Overdose Symptoms:
- Guaifenesin: Nausea, vomiting, stomach upset, dizziness.
- Pseudoephedrine: Severe nervousness, restlessness, insomnia, tremors, seizures, hallucinations, rapid or irregular heartbeat, high blood pressure, severe headache, shortness of breath.
- Dextromethorphan: Nausea, vomiting, dizziness, drowsiness, blurred vision, nystagmus (involuntary eye movements), ataxia (loss of coordination), slurred speech, hallucinations, agitation, confusion, stupor, coma, respiratory depression, serotonin syndrome (agitation, confusion, rapid heart rate, fever, sweating, muscle stiffness, twitching, loss of coordination, nausea, vomiting, diarrhea).
What to Do:
Seek immediate medical attention or call Poison Control at 1-800-222-1222. Bring the medication bottle with you. Treatment is supportive and symptomatic.
Drug Interactions
Contraindicated Interactions
- Monoamine Oxidase Inhibitors (MAOIs) (concurrent use or within 14 days of stopping MAOIs due to risk of hypertensive crisis with pseudoephedrine and serotonin syndrome with dextromethorphan)
- Linezolid (due to MAOI activity)
Major Interactions
- Other sympathomimetics (e.g., decongestants, appetite suppressants, amphetamines) - increased cardiovascular effects
- Tricyclic Antidepressants (TCAs) - increased pressor effects of pseudoephedrine
- Beta-blockers (non-selective) - reduced antihypertensive effect, increased risk of hypertension with pseudoephedrine
- Serotonergic drugs (e.g., SSRIs, SNRIs, triptans, tricyclic antidepressants, fentanyl, tramadol, St. John's Wort) - increased risk of serotonin syndrome with dextromethorphan
- CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine, amiodarone, bupropion) - increased dextromethorphan levels and toxicity
Moderate Interactions
- Antihypertensive drugs (e.g., alpha-blockers, ACE inhibitors) - pseudoephedrine may reduce their effect
- Digoxin - increased risk of arrhythmias with pseudoephedrine
- Alcohol and other CNS depressants - increased sedation with dextromethorphan
- Anticholinergic drugs - increased risk of side effects (e.g., dry mouth, urinary retention) with pseudoephedrine
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
Blood pressure and heart rate
Rationale: Pseudoephedrine can increase blood pressure and heart rate, especially in susceptible individuals.
Timing: Prior to initiation in patients with pre-existing cardiovascular conditions or hypertension.
Routine Monitoring
Symptom relief (cough, congestion, mucus)
Frequency: Daily, as needed
Target: Reduction in severity and frequency of symptoms
Action Threshold: If symptoms worsen or persist beyond 7 days, discontinue and consult a healthcare professional.
Adverse effects (e.g., nervousness, insomnia, dizziness, palpitations, nausea)
Frequency: Daily, as needed
Target: Absence or mild, tolerable side effects
Action Threshold: If severe or persistent adverse effects occur, discontinue and seek medical attention.
Symptom Monitoring
- Effectiveness in reducing cough frequency and intensity
- Reduction in nasal congestion and sinus pressure
- Ease of expectoration of mucus
- Presence of nervousness, restlessness, or insomnia
- Heart palpitations or increased heart rate
- Dizziness or lightheadedness
- Nausea, vomiting, or stomach upset
- Skin rash or allergic reactions
- Signs of serotonin syndrome (agitation, hallucinations, rapid heart beat, fever, overactive reflexes, nausea, vomiting, diarrhea, uncoordinated movements)
Special Patient Groups
Pregnancy
Category C. Use only if the potential benefit justifies the potential risk to the fetus. Pseudoephedrine use in the first trimester has been associated with a small increased risk of gastroschisis and hemifacial microsomia, though data are conflicting. Vasoconstrictive effects of pseudoephedrine could theoretically reduce uterine blood flow. Dextromethorphan and guaifenesin are generally considered low risk but should be used cautiously.
Trimester-Specific Risks:
First Trimester:
Pseudoephedrine: Potential small risk of birth defects (e.g., gastroschisis, hemifacial microsomia). Guaifenesin/Dextromethorphan: Limited data, generally considered low risk but avoid if possible.
Second Trimester:
Pseudoephedrine: Generally considered safer than first trimester, but still use with caution due to vasoconstrictive effects. Guaifenesin/Dextromethorphan: Generally considered low risk.
Third Trimester:
Pseudoephedrine: Avoid close to term due to potential for vasoconstriction and effects on fetal circulation. Guaifenesin/Dextromethorphan: Generally considered low risk.
Lactation
L3 (Moderately Safe). All three components are excreted into breast milk. Pseudoephedrine can decrease milk supply, especially in the early postpartum period, and may cause irritability or sleep disturbances in the infant. Guaifenesin and dextromethorphan are generally considered compatible with breastfeeding, but data are limited. Monitor infant for irritability, drowsiness, or feeding changes.
Infant Risk:
Low to Moderate. Pseudoephedrine poses the highest risk (irritability, decreased milk supply). Guaifenesin and dextromethorphan generally low risk.
Pediatric Use
Not recommended for children under 6 years of age due to potential for serious side effects and lack of proven efficacy in this age group. Use with extreme caution and only as directed by a healthcare professional for children 6-12 years. Accidental overdose in young children can be fatal.
Geriatric Use
Use with caution in elderly patients, who may be more susceptible to the adverse effects of pseudoephedrine (e.g., cardiovascular effects, CNS stimulation, urinary retention) and dextromethorphan (e.g., sedation, dizziness). Start with the lowest effective dose and monitor closely.
Clinical Information
Clinical Pearls
- Advise patients to stay well-hydrated to maximize the expectorant effect of guaifenesin.
- Caution patients about potential for CNS stimulation (insomnia, nervousness) from pseudoephedrine, especially if taken close to bedtime.
- Warn patients about the risk of serotonin syndrome when combining dextromethorphan with other serotonergic drugs, including common antidepressants.
- Emphasize the importance of not exceeding recommended doses, particularly in children, due to the risk of overdose from pseudoephedrine and dextromethorphan.
- Patients with underlying conditions such as hypertension, heart disease, thyroid disease, diabetes, or prostate enlargement should consult a doctor before using this product due to pseudoephedrine content.
- This product is for symptomatic relief and does not treat the underlying cause of cough or congestion.
Alternative Therapies
- Single-ingredient guaifenesin (e.g., Mucinex)
- Single-ingredient pseudoephedrine (e.g., Sudafed)
- Single-ingredient dextromethorphan (e.g., Delsym)
- Saline nasal sprays for congestion
- Humidifiers or vaporizers
- Honey for cough relief (for children over 1 year)
- Nasal decongestant sprays (e.g., oxymetazoline - for short-term use only)
Cost & Coverage
Average Cost:
$5 - $20 per 4 oz (120 mL) bottle
Generic Available:
Yes
Insurance Coverage:
Often OTC, may be covered by FSA/HSA. Prescription versions may be covered by insurance, but this specific combination is typically OTC.
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe and effective treatment, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it's a good idea to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the overdose, including the medication taken, the amount, and the time it occurred.