September 4, 2023

Managing ‘Tranq’ (Xylazine) Withdrawal: Symptoms, Risks, and Treatments

Table of Contents

Table of Contents

Contributors & Editors

Julie Miller

Addiction & Mental Health Writer

Last Update on September 5, 2023

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In recent years, the veterinary tranquilizer Xylazine, commonly referred to as “Tranq,” has found its way into illicit human consumption, posing serious health risks that are still not fully understood.

Primarily intended for animal anesthesia, this drug has been increasingly misused, often mixed with other substances like opioids or alcohol.

This article aims to illuminate the poorly understood but critically important issue of Xylazine withdrawal, exploring its symptoms, associated risks, and potential treatments.

As Xylazine misuse becomes an emergent public health concern, understanding the intricacies of withdrawal is essential for medical professionals and the public.


Understanding Xylazine Withdrawal

Understanding Xylazine withdrawal necessitates a deeper look into how the drug interacts with the brain and body.

Xylazine or “Tranq” is a shortened form of “tranquilizer,” which refers to Xylazine’s initial purpose as a veterinary sedative.

Xylazine functions as a central nervous system depressant, binding to alpha-2 adrenergic receptors, which leads to sedative, analgesic, and muscle relaxant effects.

While these properties make it suitable for veterinary applications, misuse in humans can lead to the development of both physical and psychological dependence.

Physically, the body may adapt to the presence of the drug, requiring higher doses to achieve the same effects—a phenomenon known as tolerance.

Simultaneously, psychological dependence can develop, where users may be compulsive to continue using Xylazine to escape emotional discomfort or psychological distress.

This interplay of physical and psychological factors makes withdrawal from Xylazine a complex and potentially dangerous process that demands medical oversight.


Common Withdrawal Symptoms

Withdrawal from Xylazine can manifest in a myriad of symptoms that affect both the body and the mind.

Physical symptoms often include nausea, vomiting, muscle aches, sweating, and tremors, all of which can range from mild to severe, making the withdrawal process physically uncomfortable or even debilitating.

On the psychological front, individuals may experience anxiety, depression, irritability, and mood swings, complicating the withdrawal process by adding emotional and mental distress to the already challenging physical symptoms.

Moreover, there is a potential for severe withdrawal symptoms that pose significant health risks.

These can include hallucinations, which can disorient the individual and make it difficult to distinguish reality, seizures that can be life-threatening if not properly managed, and cardiovascular issues like irregular heart rhythms or elevated blood pressure.

These symptoms’ comprehensive range and severity underscore the importance of a medically supervised withdrawal process to manage these risks effectively.1


Symptom Onset After Last Dose Duration
Yawning 6-12 hours after last dose Variable
Runny Nose and Teary Eyes 6-12 hours after last dose Variable
Sweating 12-24 hours after last dose Variable
Restlessness 12-24 hours after last dose Variable
Insomnia 12-48 hours after last dose Days to weeks
Muscle Aches and Pains 12-48 hours after last dose Days to weeks
Abdominal Cramping, Diarrhea 24-72 hours after last dose Days to weeks
Dilated Pupils 24-72 hours after last dose Variable
Goosebumps, Chills 24-72 hours after last dose Variable
Nausea and Vomiting 24-72 hours after last dose Days to weeks


Typical Withdrawal Timeline

Withdrawals from Xylazine usually appear 6-12 hours after the last use and can persist for 3-5 days or even longer.2

It is common for early symptoms of anxiety, irritability, and restlessness to occur during withdrawal from opioids and xylazine.

Unlike alcohol or benzodiazepine withdrawal, xylazine withdrawal does not typically cause issues with vital signs or seizures.

However, xylazine withdrawal can affect the use of COWS scoring when determining readiness for buprenorphine if the patient has decided on using medication-assisted treatment (MAT).

Due to Xylazine being commonly combined with Fentanyl, people are experiencing withdrawal symptoms from both drugs simultaneously.

The onset of withdrawal can vary, and symptoms may not appear until 12-24 hours after the last use.

For those heavily using fentanyl, xylazine withdrawal symptoms may be mistaken for opioid withdrawal.

An important feature of xylazine withdrawal is that increasing doses of full agonist opioids will not alleviate the symptoms.

As for doctors and prescribers, asking patients for feedback on their symptoms can help provide valuable insights into whether they are experiencing xylazine or opioid withdrawal.


Withdrawal Stage Symptoms Timeline
Early Withdrawal Initial symptoms often include mild nausea, irritability, and anxiety. Sweating and tremors may also start to appear. Starts within a few hours to a few days after the last dose.
Peak Withdrawal Symptoms escalate in intensity, with the potential for vomiting, severe muscle aches, heightened anxiety, and depressive episodes. During this phase, psychological symptoms like irritability and mood swings are often at their worst. Typically occurs 2-7 days after the last dose and may last for a week or more.
Post-Acute Withdrawal The intensity of most symptoms diminishes, but psychological symptoms like anxiety and depression may persist. There is the potential for occasional flare-ups of physical symptoms. It can last for weeks or months after the initial withdrawal phase has passed.


Potential Complications and Risks

Withdrawal from Xylazine presents several potential complications and risks that should not be underestimated.

Attempting unsupervised withdrawal can lead to severe health issues, including dehydration from excessive vomiting and diarrhea, cardiovascular complications, and even life-threatening seizures.3

Furthermore, individuals with co-occurring conditions, such as mental health disorders or additional substance abuse issues, may experience exacerbated or prolonged withdrawal symptoms, adding layers of complexity to an already challenging process.

Given these risks, consulting medical professionals for a supervised detoxification process is crucial.

Strategies to minimize complications may include tapering off the drug under medical guidance, using medications to manage symptoms and concurrent treatment for any co-occurring conditions.

In some cases, intensive care and dexmedetomidine infusion may become necessary.

All of these precautions can significantly mitigate the risks associated with Xylazine withdrawal.


Factors Influencing Withdrawal Severity

The severity of Xylazine withdrawal can vary significantly from person to person, influenced by many factors.

One primary determinant is the dosage and duration of Xylazine use; higher doses and longer periods of use generally lead to more intense and prolonged withdrawal symptoms.

Individual differences also play a crucial role; metabolic rates, genetic predispositions, and overall health status can impact how quickly the body processes the drug and how severe the withdrawal symptoms may be.

Additionally, the presence of co-occurring substance abuse or mental health disorders can complicate the withdrawal process.

For example, someone who is also addicted to opioids or has an underlying anxiety disorder may experience exacerbated withdrawal symptoms.

Combining these variables creates a unique and challenging experience during Xylazine withdrawal, requiring direct medical supervision.


Medical Management of Xylazine Withdrawals

Managing Xylazine withdrawals is a complex process that necessitates professional medical intervention.

Given the wide range of potential symptoms, from physical discomforts like nausea and muscle aches to severe complications like seizures and cardiovascular issues, it is crucial to seek medical guidance for a safe and controlled withdrawal process.

Medically supervised detoxification typically involves close monitoring of vital signs, symptom management, and potentially using medications to alleviate specific withdrawal symptoms and reduce discomfort.

Drugs like clonidine may be used to manage blood pressure and reduce sweating, while medications like benzodiazepines could be prescribed in certain cases to manage anxiety and insomnia.

These medical protocols are designed to make the withdrawal process safer and more tolerable, helping individuals navigate Xylazine withdrawal’s physical and psychological challenges.


Psychological Support and Coping Strategies

The role of psychological support in navigating Xylazine withdrawal cannot be overstated, given that the process often entails not just physical but also significant psychological symptoms like anxiety, depression, and mood swings.

Various forms of therapy can complement medical treatments to offer a more holistic approach to withdrawal management.

Cognitive-behavioral therapy (CBT) can be particularly effective in helping individuals understand the triggers and thought patterns that lead to substance abuse, equipping them with coping strategies for both the withdrawal period and long-term recovery.

Counseling services provide an additional layer of emotional support and can guide individuals through the complex psychological aspects of withdrawal.

Support groups, too, offer invaluable peer support, allowing individuals to share experiences and coping strategies in a non-judgmental setting.

Together, these psychological support systems can significantly enhance the effectiveness of medical treatments and contribute to a more manageable withdrawal experience.



Symptom Coping Strategy Detailed Description
Anxiety Mindfulness Meditation Engage in mindfulness practices to center your thoughts and focus on your breathing. This can reduce stress hormones and alleviate symptoms of anxiety.
Anxiety Physical Exercise Engage in moderate exercise like walking or jogging. Exercise releases endorphins, which act as natural mood lifters.
Depression Seek Professional Help If depression worsens, consult a healthcare provider for potential medication or targeted therapy options like Cognitive Behavioral Therapy.
Depression Stay Connected Stay in touch with family and friends, even if it’s through virtual means. Social support is crucial for mental health.
Cravings Distraction Techniques When a craving hits, immediately engage in an activity that requires focus and attention to divert your mind.
Cravings Healthy Substitutes Keep healthy snacks or engage in healthy activities as substitutes when cravings hit. This can divert your need for the substance and lessen the severity of cravings over time.


Long-Term Recovery and Relapse Prevention

The journey to recovery from Xylazine addiction extends well beyond the withdrawal phase, making long-term planning for recovery a critical aspect of sustained wellness.

One key component of this is relapse prevention, which often involves recognizing triggers, developing coping mechanisms, and maintaining a supportive social network to help navigate moments of vulnerability.

Strategies like contingency management and ongoing therapy can provide incentives and psychological tools to maintain sobriety.

It’s essential to approach recovery comprehensively, addressing both the physical dependency through medical treatment and the psychological factors through therapy and lifestyle changes.

This multi-pronged approach is often the most effective way to ensure long-term recovery and minimize the risk of relapse, enabling individuals to rebuild their lives in a meaningful and sustainable.


The Importance of Education and Awareness

The issue of Xylazine abuse and its associated withdrawal symptoms remains largely under-discussed, underscoring the importance of public education and awareness.

This lack of information perpetuates the cycle of abuse and adds an unnecessary layer of stigma to those seeking help, effectively turning the issue into a hidden epidemic.

Education programs targeting at-risk populations, including schools, high-risk employment sectors, and community centers, can provide valuable preventative information and remove some of the shame often associated with substance abuse.

Addressing the prevailing stigmas around addiction and recovery is crucial, which can often deter individuals from seeking the help they need.

By offering factual, non-judgmental information about the risks of Xylazine abuse and the realities of withdrawal, society can facilitate more open conversations about this issue, encouraging early intervention and effective treatment.

In the long run, awareness and education are vital tools for preventing abuse and supporting those on the path to recovery.


If you or a loved one faces the challenges of ‘Tranq’ (Xylazine) addiction, we invite you to connect with us at Cornerstone Healing Center in Scottsdale, AZ.

We specialize in holistic healing approaches that aim to provide lasting and compassionate recovery.

You’re not alone in this journey; we’re here to provide the support and care you deserve.




[1] Management of Xylazine Withdrawal in a Hospitalized Patient: A Case Report

[2] Best Practices for Management of Xylazine Withdrawal and Xylazine-related Overdose

[3] Xylazine: What Clinicians Need to Know

Published: 9/4/2023

Contributor: Julie Miller

Editor: Susana Spiegel 

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Author & Reviewers

julie miller recovery writer and author
Julie is a recovery advocate, with over two years sober. She is a recovery speaker who believes people can change for the better. Her mission is to write factual, helpful information about addiction, treatment, and recovery. She believes that no one should be left in the dark about the process at any stage of their recovery.
lionel estrada lisac clinical director

Lionel is the Clinical Director of Cornerstone’s treatment facilities in Arizona. He has had over 4 years at Cornerstone. He is personally in recovery and passionate about helping others overcome substance abuse and mental health challenges, he is trained as an EMDR, adopting a trauma-informed approach to treat the underlying issues of conditions.

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