Episode 854: Tranq (xylazine) with Heroin

<p dir="ltr"><strong>Contributor:</strong> Aaron Lessen, MD</p> <p dir="ltr"><strong>Educational Pearls:</strong></p> <p dir="ltr">What is Tranq?</p> <ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Tranq is the street name for xylazine, a sedative drug typically used in veterinary medicine.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Xylazine has recently emerged as a recreational drug, often mixed with heroin or fentanyl. </p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">The mechanism of action of xylazine is similar to dexmedetomidine (Precedex), an alpha-2 adrenergic receptor agonist.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">At toxic levels, either by itself or when combined with opioids, can cause apnea, bradycardia, coma, and hypotension.</p> </li> </ul> <p dir="ltr">How is it different from other adulterants, such as fentanyl?</p> <ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Because It is not an opioid, naloxone (Narcan) does not reverse its effects.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">It may cause local peripheral vasoconstriction leading to necrotic ulcerations at sites of repeated injection.</p> </li> </ul> <p dir="ltr">How do you treat a suspected overdose of Tranq +/- an opioid?</p> <ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Consult with a clinical toxicologist.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Naloxone should still be used despite its limited effect. At the very least it will not make the situation worse.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Be ready to intubate.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Provide supportive care.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Non-selective alpha antagonists are NOT recommended.</p> </li> </ul> <p dir="ltr">References</p> <ul> <li dir="