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# Tus-QD (Hydrocodone Polistirex/Chlorpheniramine Polistirex)
## Overview
Tus-QD is an extended-release, oral suspension containing hydrocodone (an opioid antitussive) and chlorpheniramine (a first-generation antihistamine). It utilizes a methyacrylate polymer matrix to provide sustained release of active ingredients.
## Primary Indications
Relief of cough and symptoms associated with upper respiratory allergies or common cold in adults and children 6 years of age and older.
## Adult Dosing
10 mL (hydrocodone 10 mg/chlorpheniramine 8 mg) orally every 12 hours. Do not exceed 20 mL in a 24-hour period.
## Pediatric Dosing
**Children 6 to 12 years:** 5 mL (hydrocodone 5 mg/chlorpheniramine 4 mg) orally every 12 hours. Do not exceed 10 mL in a 24-hour period.
## Dose Adjustments
* **Hepatic/Renal Impairment:** No specific guidelines provided by the manufacturer. Use with extreme caution in patients with severe impairment; initiate at the lower end of the dosing range and monitor for CNS depression.
* **Elderly:** Increased sensitivity to anticholinergic side effects and respiratory depression; initiate at lower doses if necessary.
## Contraindications
* Hypersensitivity to hydrocodone, chlorpheniramine, or any component of the formulation.
* Patients with respiratory depression, acute asthma, or severe bronchial obstruction.
* Patients with known or suspected paralytic ileus.
* Concomitant use of monoamine oxidase inhibitors (MAOIs) or within 14 days of cessation.
## Adverse Effects
* **CNS:** Sedation, dizziness, confusion, somnolence.
* **Respiratory:** Respiratory depression.
* **Gastrointestinal:** Constipation, nausea, vomiting.
* **Anticholinergic:** Dry mouth, urinary retention, blurred vision, tachycardia.
## Key Drug Interactions
* **CNS Depressants:** Alcohol, benzodiazepines, and other opioids significantly increase the risk of respiratory depression and profound sedation.
* **Anticholinergics:** Added risk of urinary retention and constipation.
* **CYP3A4 Inhibitors/Inducers:** Hydrocodone is metabolized by CYP3A4; monitor for altered clinical effect.
## Monitoring
* Monitor respiratory rate and level of consciousness.
* Observe for signs of urinary retention or severe constipation.
* Assess for impairment in activities requiring mental alertness.
## Clinical Pearls
* **Abuse Potential:** Hydrocodone is a Schedule II controlled substance. Prescribe the smallest effective dose for the shortest duration.
* **Administration:** Suspension must be shaken well before each dose to ensure accurate delivery of the polymer-bound medication.
* **Avoid Alcohol:** Patient must be strictly advised to avoid alcohol, as it may result in rapid, potentially fatal drug release from the extended-release matrix.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice protocols may vary by institution. Always verify current prescribing information, Black Box warnings, and patient-specific contraindications via official FDA-approved labeling or institutional electronic health record resources before prescribing or administering medication.
