Management of Xylazine Toxicity, Overdose, Dependence and Withdrawal: A Systematic Review

Xylazine is a veterinary sedative that is increasingly found mixed into fentanyl and other illicit drugs. It causes sedation, slow heart rate, low blood pressure and a higher risk of fatal overdose, yet there is no antidote and no evidence-based treatment guidance. This CME activity is based on a systematic review of 34 studies in The American Journal on Addictions, published between 1957 and 2024. It brings together what is known about how xylazine toxicity presents and how it has been managed. That includes supportive care, using naloxone when opioids are also involved, and alpha-2 agonists such as clonidine and GABAergic medications for withdrawal. It also flags gaps such as the lack of routine toxicology testing and of established toxic doses, and suggests practical steps for assessing and stabilizing patients.

Target Audience

Healthcare Professionals

Learning Objectives

  • Describe how xylazine works in the body and the signs of xylazine toxicity and overdose.
  • Explain the role and limits of naloxone when xylazine is used together with opioids.
  • Identify the main gaps in the evidence, including limited toxicology testing, no established toxic doses, and no antidote proven in humans.
  • Apply the proposed approaches to managing xylazine toxicity, overdose and withdrawal, including supportive care, alpha-2 agonists and GABAergic medications.

Activity Disclosure

No commercial support has been accepted related to the development or publication of this activity. This activity underwent peer review in line with the standards of editorial integrity and publication ethics.

Course summary

Available credit: 
  • 1.00 AMA PRA Category 1 Credit(s)™
Course opens: 
10/21/2025
Course expires: 
10/20/2028
Cost:
$0.00

Article Authors

Owusu, Philipa (proxy) (contact); Appiah-Kubi, Edmund; Atodaria, Priya; Shah, Zainab; Garcia, Elpidio

The authors declare no conflicts of interest.

This activity underwent peer review in line with the standards of editorial integrity and publication ethics. Conflicts of interest have been identified and resolved in accordance with John Wiley and Sons, Inc.’s Policy on Activity Disclosure and Conflict of Interest.

 

John Wiley & Sons, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

John Wiley and Sons, Inc. designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity. For information on applicability and acceptance of continuing medical education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within 1 hour. To successfully earn credit, participants must complete the activity during the valid credit period, which is up to three years from initial publication. Additionally, up to 3 attempts and a score of 80% or better is needed to pass the post test and claim CC credit. [ACGME competency/CC category: Medical Knowledge].

Available Credit

  • 1.00 AMA PRA Category 1 Credit(s)™

Price

Cost:
$0.00
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