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# TUSQ-QD ## Overview TUSQ-QD is a combination medication containing Tussionex® (chlorpheniramine and hydrocodone) and a quick-dissolve formulation of guaifenesin. The specific composition and concentrations can vary. This combination is intended for symptomatic relief of cough and to loosen mucus. ## Primary Indications * Symptomatic relief of cough. * Adjuvant to expectorants in the treatment of productive coughs. ## Adult Dosing * Refer to the specific product labeling for the TUSQ-QD formulation being used, as concentrations of each component may vary. * Typically, one quick-dissolve tablet is taken as directed, usually every 4 to 6 hours. * The maximum dose of hydrocodone is not explicitly defined for this combination product but is typically limited by the risk of adverse effects. ## Pediatric Dosing * Safety and efficacy in pediatric patients have not been established for this specific combination product. * Refer to the specific product labeling and institutional guidelines for age-appropriate dosing if used. Hydrocodone and guaifenesin have separate pediatric dosing guidelines. ## Dose Adjustments * **Renal Impairment:** No specific dosing adjustments are typically provided for TUSQ-QD. However, hydrocodone and guaifenesin are renally cleared, and dose reduction may be considered in severe renal impairment. * **Hepatic Impairment:** No specific dosing adjustments are typically provided for TUSQ-QD. However, hydrocodone is hepatically metabolized, and dose reduction may be considered in severe hepatic impairment. ## Contraindications * Known hypersensitivity to hydrocodone, chlorpheniramine, guaifenesin, or any component of the formulation. * Patients with a history of respiratory depression. * Acute or severe asthma or other conditions where the drug might cause harm. * Use with or within 14 days of MAOI therapy. * Concomitant use with strong CYP3A4 inhibitors. ## Adverse Effects Common adverse effects include: * Sedation, dizziness, drowsiness, confusion * Nausea, vomiting, constipation * Respiratory depression (especially at higher doses or with co-administered CNS depressants) * Dry mouth, blurred vision, urinary retention (anticholinergic effects from chlorpheniramine) * Hypotension ## Key Drug Interactions * **CNS Depressants (e.g., benzodiazepines, alcohol, other opioids):** Increased risk of profound sedation, respiratory depression, coma, and death. * **MAO Inhibitors:** Potential for hypertensive crisis. * **CYP3A4 Inhibitors (e.g., ritonavir, ketoconazole):** Increased plasma concentrations of hydrocodone, leading to increased risk of adverse effects. * **Serotonergic Drugs (e.g., SSRIs, SNRIs):** Potential for serotonin syndrome. ## Monitoring * Respiratory rate and depth. * Level of consciousness and sedation. * Bowel function (for constipation). * Signs of abuse or diversion. ## Clinical Pearls * TUSQ-QD contains an opioid (hydrocodone), which carries risks of addiction, abuse, and misuse. * The quick-dissolve formulation may lead to faster onset of action and increased risk of overdose if not used as directed. * Advise patients to avoid driving or operating heavy machinery until they know how this medication affects them. * Ensure adequate hydration when taking guaifenesin. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making clinical decisions.