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# Tus-QD ## Overview Tus-QD is a brand name formulation containing **Hydrocodone Polistirex** (opioid antitussive) and **Chlorpheniramine Polistirex** (first-generation antihistamine). The "polistirex" complex provides an extended-release mechanism, allowing for once-daily (qd) dosing. ## Primary Indications Symptomatic relief of cough and upper respiratory symptoms associated with allergies or the common cold. Use is generally restricted to adults and children ≥6 years due to opioid content. ## Adult Dosing * **Dose:** 10 mL (containing 10 mg hydrocodone polistirex and 8 mg chlorpheniramine polistirex) orally once every 12 to 24 hours. * **Maximum:** Do not exceed 10 mL in a 24-hour period. ## Pediatric Dosing * **Children 6 to 12 years:** 5 mL orally once every 24 hours. * **Children <6 years:** Not recommended. Safety and efficacy not established. ## Dose Adjustments * **Renal/Hepatic Impairment:** No specific guidelines; however, use with extreme caution in patients with hepatic or renal impairment due to potential accumulation. Reduced dosing may be required based on clinical assessment of toxicity risk. ## Contraindications * Hypersensitivity to hydrocodone, chlorpheniramine, or any product component. * Patients with known or suspected gastrointestinal obstruction (including paralytic ileus). * Concurrent use of MAO inhibitors (or within 14 days of cessation). * Respiratory depression in unmonitored settings or absence of resuscitative equipment. ## Adverse Effects * **Common:** Somnolence, dizziness, dry mouth, constipation, nausea, and blurred vision. * **Serious:** Respiratory depression, physical/psychological dependence, paradoxical excitation (especially in children), and urinary retention. ## Key Drug Interactions * **CNS Depressants:** Alcohol, benzodiazepines, and other opioids significantly increase the risk of profound sedation, respiratory depression, coma, and death. * **MAOIs:** Risk of hypertensive crisis or severe serotonin syndrome. * **Anticholinergics:** Concurrent use with other anticholinergics may exacerbate xerostomia, urinary retention, and constipation. ## Monitoring * Monitor for signs of respiratory depression, especially during initiation or dose changes. * Assess for excessive sedation or cognitive impairment. * Monitor bowel function to prevent fecal impaction. ## Clinical Pearls * **Abuse Potential:** Hydrocodone is a Schedule II controlled substance. Counsel patients on the risks of addiction and diversion. * **Extended Release:** Do not crush or chew. The suspension must be shaken well before each dose. * **Safety Warning:** Concomitant use of other prescription or non-prescription cough/cold preparations containing hydrocodone or antihistamines can lead to fatal overdose. * **Alcohol:** Explicitly warn patients to avoid alcohol consumption while taking this medication. *** **Educational Disclaimer:** This information is for educational purposes and does not contain all possible safety data. Always verify specific dosing, safety warnings, and clinical protocols against the most current institutional formulary, official product labeling, and clinical guidelines before prescribing or administering.