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# TUSQ QD ## Overview TUSQ QD is a brand name for **Hydrocodone Bitartrate and Guaifenesin Extended-Release Tablets**. Hydrocodone is an opioid cough suppressant, and guaifenesin is an expectorant. ## Primary Indications * Symptomatic relief of **cough** and **bronchial congestion**. ## Adult Dosing * **10 mg hydrocodone / 600 mg guaifenesin extended-release tablet:** Take one tablet by mouth every 12 hours. * **Maximum daily dose:** Not to exceed 2 tablets in 24 hours. ## Pediatric Dosing * Safety and efficacy in pediatric patients have not been established. ## Dose Adjustments * **Hepatic impairment:** Use with caution. Dose reduction may be necessary. * **Renal impairment:** Use with caution. Dose reduction may be necessary. ## Contraindications * Patients with **known hypersensitivity** to hydrocodone or guaifenesin. * Conditions where **opioid use is contraindicated**, such as significant respiratory depression, acute or severe asthma or COPD, paralytic ileus. * Concurrent use with certain **MAO inhibitors** (see Drug Interactions). ## Adverse Effects * **Common:** Drowsiness, dizziness, nausea, vomiting, constipation, dry mouth, itching. * **Serious:** Respiratory depression, opioid-induced constipation, hypersensitivity reactions, abuse/misuse potential. ## Key Drug Interactions * **Central Nervous System (CNS) Depressants:** (e.g., alcohol, benzodiazepines, sedatives, hypnotics, other opioids) - increased risk of profound sedation, respiratory depression, coma, and death. * **Monoamine Oxidase Inhibitors (MAOIs):** Potentiated and unpredictable cardiovascular effects (hypertensive crises). Avoid concurrent use and for 14 days after discontinuation of MAOIs. * **CYP3A4 Inhibitors/Inducers:** May alter hydrocodone levels. * **Anticholinergic Agents:** Increased risk of urinary retention and severe constipation. ## Monitoring * **Respiratory rate and depth.** * **Level of consciousness.** * **Bowel function** (for constipation). * **Signs of abuse, misuse, or addiction.** ## Clinical Pearls * Extended-release formulation should not be crushed, chewed, or broken, as this can lead to rapid release of potentially toxic dose of hydrocodone. * Due to the abuse potential of hydrocodone, careful patient selection and monitoring are essential. * Advise patients to avoid activities requiring mental alertness until they know how the medication affects them. * Ensure patients are aware of the risks of co-administration with other CNS depressants. *** *Disclaimer: This information is intended for clinical use and does not replace the official prescribing information. Always consult the most current drug monograph or product insert for complete and up-to-date information.*