Neuropsychiatric and multisystem toxicity following recreational inhalation of tiletamine-zolazepam (Zoletil 50): a retrospective case series with two-year prospective follow-up
Abstract
BACKGROUND: Tiletamine-zolazepam (Zoletil) is a veterinary anesthetic, which is increasingly being abused by humans. However, the chronic neurotoxicity of this compound in humans and its long-term clinical outcomes have rarely been reported.
OBJECTIVE: To characterize the neurological and systemic injury following recreational Zoletil 50 inhalation, including relapse behavior and persistent deficits.
METHODS: We performed a retrospective case series of patients presenting to our institution with Zoletil 50 toxicity. We analyzed the clinical features, laboratory results, and neuroimaging findings, and assessed long-term outcomes and relapse rates during a two-year observation period.
RESULTS: All 36 subjects (100%) demonstrated postural tremor, with 22 (61.1%) showing sustained, high-amplitude tremor early after admission. Four patients (11%) presented with bradykinesia and rigidity. Cerebellar ataxia was present in 30 (83%), visual disturbance in 20 (56%), and concomitant hallucinations in 16 (44%). Biochemical abnormalities included elevated transaminases (53%) and hypokalemia (44%). Two patients died in hospital due to cardiorespiratory failure. Of 34 discharged patients, 20 (59%) relapsed, 17 within the first month. A third death occurred during follow-up after a fifth relapse. At two years, residual deficits persisted in 11 of 33 survivors: subjective memory decline in seven, visual impairment in six, and bradykinesia requiring levodopa in two.
CONCLUSIONS: Zoletil 50…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 36 participants or records.
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