Emergency Medical Minute

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