Xylazine is a veterinary drug used for sedation, analgesia and muscle relaxation. It has been used as an adulterant to opiate/opioids such as heroin and fentanyl. This practice can cause a number of side effects, include skin necrosis.
Mechanism of action: alpha-2 adrenergic agonist.
While central action can produce vasodilation and hypotension, peripheral action in small arterioles can result in vasoconstriction.
Reason for use as an adulterant:
(1) prolongation of the "high", especially with fentanyl
(2) cutting agent to main product
Clinical features:
(1) injection drug use
(2) skin lesions at sites of injection, ranging from ulcers to skin infarcts to areas of necrosis
(3) skin lesions may be painless even if extensive
(4) secondary infection
The drug may be introduced into the soft tissue either intentionally or accidentally (missed vein, leakage).
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