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# TUSQ/D
## Overview
TUSQ/D is a combination medication containing **hydrocodone bitartrate** (an opioid analgesic and antitussive) and **guaifenesin** (an expectorant).
## Primary Indications
* Symptomatic relief of cough.
* Aids in loosening phlegm (mucus) and thinning bronchial secretions.
## Adult Dosing
* **Usual dose:** 10 mL orally every 4-6 hours as needed.
* **Maximum dose:** Not to exceed 40 mL in 24 hours.
## Pediatric Dosing
* **Children 6 to under 12 years:** 5 mL orally every 4-6 hours as needed.
* **Children under 6 years:** Safety and efficacy have not been established. Consult with a pediatrician.
## Dose Adjustments
* **Hepatic impairment:** Use with caution; dose reduction may be necessary. Data is limited.
* **Renal impairment:** Use with caution; dose reduction may be necessary. Data is limited.
## Contraindications
* Hypersensitivity to hydrocodone, guaifenesin, or any component of the formulation.
* Significant respiratory depression.
* Acute or severe asthma or other conditions where bronchodilation is dangerous.
* Concurrent use with monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping an MAOI.
* Ileus.
## Adverse Effects
* **Common:** Drowsiness, dizziness, constipation, nausea, vomiting, lightheadedness, dry mouth, itching.
* **Serious:** Respiratory depression, serotonin syndrome (especially with co-administration of serotonergic drugs), severe allergic reactions, abuse/dependence potential.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, benzodiazepines, other opioids):** Additive CNS depression, potentially leading to severe sedation, respiratory depression, coma, and death.
* **Serotonergic Drugs (e.g., SSRIs, SNRIs, triptans, fentanyl):** Increased risk of serotonin syndrome.
* **MAOIs:** Increased risk of hypertensive crisis or exaggerated CNS depressant effects.
* **CYP3A4 Inhibitors (e.g., ketoconazole, ritonavir):** Increased hydrocodone plasma concentrations, potentially leading to enhanced adverse effects.
## Monitoring
* Respiratory rate and depth.
* Level of consciousness.
* Bowel function (for constipation).
* Signs of dependence or abuse.
* Signs of serotonin syndrome if co-administered with serotonergic agents.
## Clinical Pearls
* Hydrocodone is an opioid and carries a risk of abuse, addiction, and diversion.
* Guaifenesin's efficacy is controversial; patient response may vary.
* Advise patients to avoid driving or operating heavy machinery until they know how this medication affects them.
* Encourage adequate fluid intake when using guaifenesin to help thin mucus.
***
*Disclaimer: This information is intended for healthcare professionals and does not replace a thorough review of the most current prescribing information, including full prescribing information and boxed warnings, for Tus%25252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520qd. Always verify dosing and safety information with the official product labeling or a reliable drug database.*
