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# Tus-QD (Tussionex/Hydrocodone Polistirex and Chlorpheniramine Polistirex)
## Overview
Tus-QD is a long-acting, extended-release oral suspension containing a Schedule II narcotic antitussive (hydrocodone) and a first-generation antihistamine (chlorpheniramine). It utilizes a sulfonated styrene-divinylbenzene copolymer (polistirex) resin to provide a 12-hour sustained-release profile.
## Primary Indications
Symptomatic relief of cough and upper respiratory symptoms associated with allergies or the common cold.
*Note: FDA-approved only for adults and children ≥6 years. Guidelines generally advise against opioid use for routine cough due to the risk of misuse and lack of superior efficacy.*
## Adult Dosing
* **Standard Dose:** 5 mL (containing 10 mg hydrocodone and 8 mg chlorpheniramine) orally every 12 hours.
* **Maximum Dose:** 10 mL (20 mg hydrocodone) per 24 hours.
## Pediatric Dosing
* **Children 6 to 12 years:** 2.5 mL orally every 12 hours.
* **Maximum Dose:** 5 mL per 24 hours.
* **Safety Note:** Use is contraindicated in patients <6 years of age due to risk of fatal respiratory depression.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific manufacturer guidelines exist for polistirex formulations; however, use with extreme caution. Start at the lowest possible dose and monitor for prolonged sedation or respiratory depression.
* **Geriatric:** Increased sensitivity to anticholinergic effects (confusion, urinary retention, sedation). Use the lowest effective dose.
## Contraindications
* Known hypersensitivity to hydrocodone or chlorpheniramine.
* Patients <6 years of age.
* Significant respiratory depression.
* Acute or severe bronchial asthma or hypercapnia in unmonitored settings.
* Known or suspected gastrointestinal obstruction.
* Concomitant use of MAO inhibitors (or within 14 days).
## Adverse Effects
* **Common:** Sedation, dizziness, somnolence, nausea, constipation, and dry mouth.
* **Serious:** Respiratory depression, apnea, bronchospasm, urinary retention, severe constipation, and paralytic ileus.
## Key Drug Interactions
* **CNS Depressants:** Alcohol, benzodiazepines, and other opioids significantly increase the risk of respiratory depression and profound sedation.
* **Anticholinergics:** Additive effects (e.g., increased risk of urinary retention, constipation, and confusion).
* **CYP3A4 Inhibitors/Inducers:** Hydrocodone is metabolized by CYP3A4; concurrent use may unpredictably alter drug serum levels.
## Monitoring
* **Respiratory Status:** Monitor for signs of respiratory depression, especially during stabilization or dose increases.
* **Neurological:** Monitor for excessive sedation or altered mental status.
* **GI:** Assess for constipation (consider prophylactic stool softeners).
* **Abuse/Misuse:** Screen for signs of substance use disorder.
## Clinical Pearls
* **Must Shake Well:** The medication is a suspension; improper mixing leads to inconsistent dosing. Use the provided calibrated measuring device.
* **Extended Release:** Do not crush, chew, or divide the dose; this can lead to a rapid dump of the entire hydrocodone dose (risk of fatal overdose).
* **Narrow Therapeutic Index:** Hydrocodone is potent; emphasize that exceeding the 12-hour dosing interval is dangerous.
* **Anticholinergic Burden:** Due to chlorpheniramine, avoid in patients with narrow-angle glaucoma or prostatic hypertrophy.
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**Disclaimer:** This information is for educational purposes and is not a substitute for professional clinical judgment. Prescribing practices vary by local protocol and institutional policy. Always verify specific dosing, safety precautions, and current FDA-approved labeling (Package Insert) before prescribing or administering medication.
