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# TUSQ QD ## Overview Tusq QD is a once-daily combination medication containing hydrocodone bitartrate, a Schedule II opioid analgesic and cough suppressant, and phenylephrine hydrochloride, a nasal decongestant. ## Primary Indications * Relief of moderate to severe pain. * Temporary relief of nasal congestion due to the common cold, hay fever, or other upper respiratory allergies. ## Adult Dosing * **Pain:** 1-2 tablets orally every 4-6 hours as needed for pain. Maximum daily dose not established for pain due to risk of opioid dependence and respiratory depression. * **Nasal Congestion:** 1-2 tablets orally every 4-6 hours as needed for nasal congestion. Maximum daily dose not established. *Note: The specific dosage regimen for pain management should be individualized based on pain severity and patient response. For nasal congestion, follow package instructions or local protocol.* ## Pediatric Dosing Safety and efficacy in pediatric patients have not been established. Use is not recommended. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Hydrocodone is extensively metabolized in the liver. Dose reduction may be necessary. Phenylephrine also undergoes hepatic metabolism. * **Renal Impairment:** Use with caution. Opioid accumulation may occur. Dose reduction may be necessary. Phenylephrine is renally excreted. ## Contraindications * Known hypersensitivity to hydrocodone or phenylephrine. * Severe asthma or other conditions where the patient has demonstrated hypersensitivity to opioid agonists. * Significant respiratory depression. * Acute or severe bronchial asthma or hypercapnia. * Concurrent use with MAO inhibitors or within 14 days of stopping MAO inhibitors. * Gastrointestinal obstruction, including paralytic ileus. ## Adverse Effects * **Common:** Drowsiness, dizziness, nausea, vomiting, constipation, lightheadedness, pruritus, dry mouth, confusion. * **Serious:** Respiratory depression, opioid-induced constipation, dependence, addiction, abuse, neonatal withdrawal syndrome, seizures, hypertension, arrhythmias, myocardial infarction (especially in patients with pre-existing cardiovascular disease). ## Key Drug Interactions * **CNS Depressants (e.g., alcohol, benzodiazepines, other opioids, sedatives, hypnotics):** Increased risk of profound sedation, respiratory depression, coma, and death. * **MAO Inhibitors:** Hypertensive crisis can occur. Avoid concurrent use and within 14 days of discontinuation. * **Anticholinergic Agents:** Increased risk of severe constipation and urinary retention. * **CYP3A4 Inhibitors (e.g., ketoconazole, itraconazole, ritonavir):** May increase hydrocodone plasma concentrations, leading to increased adverse effects. * **CYP3A4 Inducers (e.g., rifampin, carbamazepine, phenytoin):** May decrease hydrocodone plasma concentrations. ## Monitoring * Pain relief and efficacy. * Signs of opioid withdrawal. * Respiratory rate and depth. * Bowel function. * Blood pressure. * Signs of hypersensitivity or allergic reaction. ## Clinical Pearls * Tusq QD contains a Schedule II controlled substance; exercise caution regarding diversion and abuse potential. * The phenylephrine component may cause paradoxical bronchospasm in some individuals. * Due to the risk of respiratory depression, the lowest effective dose should be used for the shortest duration necessary. * Patients should be advised against operating heavy machinery or driving until they know how this medication affects them. * Concomitant use of other hydrocodone-containing products should be avoided to prevent exceeding the maximum recommended dose. *** **Disclaimer:** This information is intended for clinical use and does not replace professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any clinical decisions.