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# TUSQ D
## Overview
TUSQ D is a combination product containing hydrocodone bitartrate (an opioid cough suppressant) and guaifenesin (an expectorant).
## Primary Indications
TUSQ D is indicated for the temporary relief of cough and nasal congestion associated with the common cold, bronchitis, and other respiratory tract conditions.
## Adult Dosing
* **Cough and Congestion:** 5 mL to 10 mL every 4 to 6 hours as needed.
* **Maximum Dose:** Do not exceed 60 mL in 24 hours.
## Pediatric Dosing
* **Children 6 to 12 years:** 5 mL every 4 to 6 hours as needed.
* **Children under 6 years:** Safety and efficacy have not been established. Consult a pediatrician.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution and consider reduced dosage due to potential accumulation.
* **Renal Impairment:** Use with caution and consider reduced dosage.
## Contraindications
* Hypersensitivity to hydrocodone, guaifenesin, or any component of the formulation.
* Significant respiratory depression.
* Acute or severe asthma or other conditions where bronchodilation is potentially harmful.
* Known or suspected gastrointestinal obstruction, including paralytic ileus.
## Adverse Effects
* **Common:** Drowsiness, dizziness, constipation, nausea, vomiting, dry mouth.
* **Less Common:** Blurred vision, headache, itching, rash, respiratory depression, urinary retention.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, benzodiazepines, sedatives):** Increased risk of respiratory depression, profound sedation, coma, and death.
* **MAO Inhibitors:** May potentiate the effects of hydrocodone. Avoid concurrent use and for 14 days after discontinuation of MAO inhibitors.
* **Serotonergic Drugs (e.g., SSRIs, SNRIs):** Increased risk of serotonin syndrome.
## Monitoring
* Monitor for signs of respiratory depression (slowed breathing, decreased alertness).
* Assess for effectiveness in cough and congestion relief.
* Monitor bowel function for constipation.
* Assess for signs of misuse or diversion.
## Clinical Pearls
* Hydrocodone is a Schedule II controlled substance, requiring careful prescribing and dispensing.
* Guaifenesin works by thinning mucus, making it easier to cough up. Adequate hydration is important for its efficacy.
* The sedative effects of hydrocodone can impair the ability to drive or operate heavy machinery.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making any clinical decisions. Dosing may vary based on individual patient factors and local protocols.
