Xylazine Withdrawal Symptoms: Timeline, Stages, and What to Expect

Experiencing xylazine withdrawal symptoms? Reach out to DevotedDOc for physician-led support.

Xylazine withdrawal symptoms can be confusing, especially because xylazine is rarely used alone. Often called “tranq,” xylazine is commonly found mixed with fentanyl and other illicit opioids, which means many people experience withdrawal from multiple substances at the same time. This can make symptoms more difficult to recognize and manage.

Unlike opioid withdrawal, xylazine withdrawal is not yet fully understood. Researchers continue to study how it affects the body, but current evidence suggests it may cause anxiety, restlessness, irritability, elevated blood pressure, and other symptoms that do not always improve with additional opioids alone. Because of these differences, withdrawal often requires careful medical evaluation and treatment tailored to the individual’s needs.

If you or someone you know has been using fentanyl, heroin, or other street drugs that may contain xylazine, understanding what to expect during withdrawal can help you seek appropriate care and reduce the risk of complications.

What Is Xylazine?

Xylazine is a veterinary medication used as a sedative, muscle relaxant, and pain reliever for animals. It is not approved by the U.S. Food and Drug Administration (FDA) for use in humans because it can cause profound central nervous system depression, slowed breathing, low heart rate, and dangerously low blood pressure. Although intended for veterinary medicine, xylazine has become increasingly common in the illicit drug supply throughout the United States. The New York State Department of Health reports that it is frequently mixed with fentanyl and heroin, often without the user’s knowledge.

Many people refer to xylazine-contaminated drugs as “tranq” or “tranq dope.” Dealers may add xylazine because it can extend the sedating effects of fentanyl, whose euphoric effects are relatively short-lived. As a result, individuals may unknowingly develop dependence on both opioids and xylazine simultaneously.

What Causes Xylazine Withdrawal?

Repeated exposure to xylazine can cause the body to adapt to its effects. When use suddenly stops or is significantly reduced, the nervous system may become overactive as it adjusts to the absence of the drug.

Unlike opioids, xylazine acts primarily on alpha-2 adrenergic receptors, making its withdrawal pattern different from traditional opioid withdrawal. Researchers are still defining the full withdrawal syndrome, but current evidence suggests that xylazine withdrawal may occur alongside opioid withdrawal in people using fentanyl or other illicit opioids contaminated with xylazine.

Because the illicit drug supply is unpredictable, many people do not realize they have been exposed to xylazine until they develop unexpected withdrawal symptoms or require treatment.

Xylazine Withdrawal Symptoms

Current clinical guidance suggests that xylazine withdrawal symptoms may include:

• Anxiety
• Irritability
• Restlessness
• Agitation
• Dysphoria or depressed mood
• Rapid heart rate (tachycardia)
• High blood pressure (hypertension)
• Sweating
• Tremors
• Difficulty sleeping (insomnia)

Some individuals may also experience symptoms that overlap with opioid withdrawal, particularly when fentanyl or heroin is involved. These may include:

• Muscle aches
• Chills
• Runny nose
• Nausea
• Vomiting
• Diarrhea
• Abdominal cramping
• Dilated pupils

Because xylazine and opioids are frequently used together, separating one withdrawal syndrome from the other can be difficult. Providers often evaluate the timing, severity, and response to treatment to determine which symptoms are related to opioids, xylazine, or both. Clinical guidance from Penn CAMP notes that one distinguishing feature is that xylazine-related symptoms may not improve after additional opioid doses, unlike typical opioid withdrawal.

How Is Tranq Withdrawal Different From Opioid Withdrawal?

Although tranq withdrawal and opioid withdrawal share several symptoms, they are not exactly the same.

The sudden absence of opioids such as fentanyl, heroin, or oxycodone causes opioid withdrawal. Symptoms commonly include muscle aches, nausea, diarrhea, sweating, yawning, and intense cravings. These symptoms generally improve when medications such as buprenorphine or methadone are started under medical supervision.

Xylazine withdrawal, however, appears to involve a different mechanism because xylazine is not an opioid. Early clinical reports suggest that symptoms such as anxiety, agitation, elevated blood pressure, and restlessness may be more prominent. Since xylazine does not act on opioid receptors, medications used to treat opioid withdrawal alone may not fully relieve these symptoms.

For many patients, withdrawal is actually a combination of both conditions. This is why clinicians often treat opioid withdrawal while also monitoring for signs that additional supportive medications may be needed to address xylazine-related symptoms.

Why Xylazine Withdrawal Can Be Difficult to Recognize

One of the biggest challenges is that xylazine is not routinely tested for in standard drug screens. Many people have no idea they have been exposed until they seek treatment for withdrawal or an overdose.

Recent research comparing patients withdrawing from fentanyl with and without xylazine found that withdrawal symptoms can look very similar during the first few days of treatment. However, patients with xylazine exposure tended to have higher blood pressure early in withdrawal and were more likely to leave treatment before completion, highlighting the need for continued research and individualized medical care.

Because the illicit drug supply continues to change, healthcare providers increasingly consider possible xylazine exposure when evaluating people with opioid use disorder, especially in regions where xylazine has become common.

Xylazine Withdrawal Timeline

Many people want to know how long xylazine withdrawal symptoms last and when they are most likely to begin. Unlike opioid withdrawal, there is no universally established timeline because xylazine withdrawal remains an emerging area of research. The exact course depends on how much xylazine was used, whether it was combined with fentanyl or other substances, and a person’s overall health.

However, current clinical guidance provides a general timeline that healthcare providers use when monitoring patients.

Within 6–12 Hours After the Last Use

Early xylazine withdrawal symptoms may begin approximately 6 to 12 hours after the last exposure. According to Penn CAMP, these early symptoms often overlap with opioid withdrawal and may include:

• Anxiety
• Irritability
• Restlessness
• Feeling uneasy or on edge
• Trouble relaxing

During this stage, it can be difficult to determine whether symptoms are caused by xylazine, opioids, or both because the withdrawal syndromes often occur together.

Within 8–24 Hours

As withdrawal progresses, some people develop more noticeable autonomic symptoms that may include:

• Elevated blood pressure
• Rapid heart rate
• Increased sweating
• Tremors
• Continued agitation

Clinical guidance notes that these symptoms may occur within 8 to 24 hours after stopping xylazine. Unlike opioid withdrawal, additional opioid use may not significantly improve these symptoms because xylazine affects different receptors in the nervous system.

During the First Several Days

For many individuals, symptoms gradually improve over several days with appropriate medical care. However, people who are also withdrawing from fentanyl or other opioids may continue experiencing opioid withdrawal symptoms even as xylazine-related symptoms begin to stabilize.

Healthcare providers often monitor:

• Blood pressure
• Heart rate
• Hydration status
• Mental status
• Ongoing opioid withdrawal symptoms

Treatment plans are adjusted based on how symptoms evolve throughout the detoxification process.

How Long Do Xylazine Withdrawal Symptoms Last?

There is currently no definitive answer because researchers are still studying xylazine withdrawal symptoms.

Available clinical reports suggest that the most noticeable symptoms often occur during the first one to several days after the last use. The exact duration depends on factors such as:

• How often xylazine was used
• Whether fentanyl or other opioids were also used
• The severity of physical dependence
• Individual health conditions
• Whether medical treatment is started promptly

Because xylazine withdrawal frequently occurs alongside opioid withdrawal, recovery timelines can vary considerably from one person to another.

Xylazine Detox

Xylazine detox is often more complicated than detoxing from opioids alone because many patients are withdrawing from multiple substances simultaneously.

Current clinical guidance recommends careful medical monitoring since patients may require treatment for both opioid withdrawal and xylazine-related symptoms. Healthcare providers evaluate blood pressure, heart rate, hydration, pain, and other symptoms while adjusting medications as needed.

Detox may involve:

• Monitoring vital signs
• Treating opioid withdrawal
• Managing anxiety and agitation
• Controlling elevated blood pressure
• Maintaining hydration and nutrition
• Addressing any wounds or infections associated with xylazine use

Because xylazine withdrawal is still being studied, treatment plans are individualized rather than based on a single standardized protocol.

Xylazine Withdrawal Treatment

There is currently no FDA-approved medication specifically for xylazine withdrawal treatment. Instead, healthcare providers focus on relieving symptoms while also treating co-occurring opioid withdrawal.

According to current clinical guidance, treatment may include medications that help reduce autonomic symptoms such as elevated blood pressure and restlessness, along with medications for nausea, pain, anxiety, or insomnia when appropriate. Patients withdrawing from opioids at the same time may also receive medications for opioid use disorder under medical supervision.

For individuals with opioid dependence, Suboxone treatment for opioid withdrawal or other forms of MAT for opioid use disorder may be recommended as part of a comprehensive treatment plan. While these medications help manage opioid withdrawal, additional supportive care may still be necessary for symptoms related to xylazine.

Why Medical Supervision Is Important

Attempting to manage tranq withdrawal alone can be challenging because symptoms may be unpredictable and can overlap with opioid withdrawal.

Medical supervision allows healthcare providers to:

• Monitor blood pressure and heart rate
• Differentiate opioid withdrawal from xylazine withdrawal
• Treat multiple withdrawal syndromes simultaneously
• Adjust medications based on symptom severity
• Reduce the risk of complications

Patients who have used fentanyl regularly may not realize they have also been exposed to xylazine. Because of this, providers increasingly consider possible xylazine exposure when withdrawal symptoms do not respond as expected to standard opioid treatment.

Individuals experiencing both xylazine and opioid withdrawal may also benefit from learning more about managing opioid withdrawal symptoms while working with a healthcare provider to develop an individualized treatment plan.

Recovery After Xylazine Withdrawal

Completing withdrawal is an important first step, but long-term recovery usually requires ongoing treatment and support. Because xylazine is frequently mixed with fentanyl and other opioids, many people who experience xylazine withdrawal also meet the criteria for opioid use disorder.

After detox, healthcare providers often recommend continuing treatment with medications for opioid use disorder (MOUD), behavioral therapy, counseling, peer support, and regular follow-up care. These approaches help reduce cravings, lower the risk of relapse, and support long-term recovery.

For many patients, an effective treatment for opioid use disorder includes medication-assisted treatment combined with individualized counseling and recovery planning.

Can Xylazine Addiction Be Treated?

Although there is currently no medication approved specifically for xylazine dependence, xylazine addiction treatment focuses on managing withdrawal symptoms, treating co-occurring opioid use disorder, and addressing the physical and psychological effects of long-term substance use.

Treatment plans may include:

• Medical detoxification when appropriate
• Medications for opioid use disorder if opioids are also involved
• Behavioral health counseling
• Mental health support
• Wound care for xylazine-related skin injuries
• Long-term recovery planning

Because many people unknowingly consume xylazine through fentanyl or other illicit opioids, treatment often addresses multiple substances rather than xylazine alone.

Frequently Asked Questions

Get Help for Opioid Withdrawal and Recovery with DevotedDOc

If you are experiencing withdrawal after using fentanyl, heroin, or other opioids that may contain xylazine, you do not have to go through it alone. While there is no medication specifically approved for xylazine withdrawal, evidence-based treatment for opioid use disorder can help manage opioid withdrawal symptoms and support long-term recovery.

DevotedDOc provides physician-led telehealth care for patients seeking treatment for opioid use disorder. Our providers can evaluate your symptoms, discuss your treatment options, and determine whether medication-assisted treatment is appropriate for your situation.

Connect with DevotedDOc to learn more about physician-led opioid addiction treatment and take the first step toward recovery.