{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T19:48:41Z","timestamp":1775677721077,"version":"3.50.1"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>We describe the case of a 33-year-old female patient with a past medical history of substance use disorder admitted for bilateral lower extremity infections characteristic of intravenous xylazine use. The patient\u2019s medical management was complicated by co-occurring xylazine and fentanyl withdrawal, for which there is little evidence-based guidance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Utilizing evidence from local guidance and case reports, the patient was treated using a multipronged approach. A wound care protocol from the Philadelphia Department of Public Health was added to systemic antibiotics to manage leg wounds. The patient\u2019s history of complicated opioid withdrawal requiring intensive care unit admission prompted the use of a 5-day buprenorphine microinduction protocol. The protocol lasted longer than anticipated due to difficulties with veinous access and management of withdrawal symptoms. A variety of \u03b12-adrenergic receptor agonists were administered to mitigate xylazine-specific withdrawal symptoms, with varying levels of tolerance and effectiveness. Lastly, the patient\u2019s underlying history of depression and anxiety was addressed using a combination of pharmacotherapy and psychiatry, with plans for outpatient follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>By harnessing the principles behind the various \u03b1-adrenergic receptor agonists, medication management of co-occurring xylazine and fentanyl withdrawal may be tailored to patient-specific factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajhp\/zxaf325","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T12:57:50Z","timestamp":1764680270000},"page":"381-388","source":"Crossref","is-referenced-by-count":0,"title":["The XYZs of xylazine: Management of withdrawal and complications"],"prefix":"10.1093","volume":"83","author":[{"given":"Sarah","family":"Khaddage","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Northwestern Memorial Hospital , Chicago, IL ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelsey","family":"Schultz","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Northwestern Memorial Hospital , Chicago, IL ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamy","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Northwestern Memorial Hospital , Chicago, IL ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"key":"2026040814534837000_zxaf325-B1","author":"National Institute on Drug Abuse"},{"key":"2026040814534837000_zxaf325-B2","author":"Illinois Department of Human 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