Mixing Buprenorphine (Suboxone) and Xylazine (tranq)

Q: How dangerous is Buprenorphine with Xylazine?

Unsafe: Risk of serious physical or psychological harm. Not recommended under any circumstances.

Q: Is it safe to mix Suboxone and tranq?

MixSafe lists Suboxone under Buprenorphine and tranq under Xylazine. That combination is rated "Unsafe". Buprenorphine's ceiling on slowed breathing covers opioid effects only. Xylazine slows breathing through a different receptor, as alcohol and benzodiazepines do, and those are the combinations behind most deaths on buprenorphine. Tranq usually arrives with fentanyl, which brings its own precipitated-withdrawal problem with buprenorphine.

Unsafe

Buprenorphine's ceiling doesn't cover xylazine, which slows breathing the way alcohol and benzos do.

Do this

Avoid this combination, and never use alone.

Where the risk isTap for why

In an emergency, call 911911 Never Use Alone Poison Control

What to do

Say what was taken and how much.Responders need it, and in most US states Good Samaritan laws protect both of you from drug possession charges when you call for an overdose.
Unresponsive: put them on their side, tilt the head back, and stay until help arrives.Never leave someone alone to “sleep it off”.
Give naloxone (Narcan) if you have it.It is sold over the counter in every US state and does no harm if opioids turn out not to be involved.
Never Use Alone 1-800-484-3731Stays on the line and sends help if you stop responding.
Full steps: what to do if it is already happeningOverdose signs, the recovery position, what to say on the call, and whether you can be charged for making it.
Poison Control 1-800-222-1222Free and 24/7, for “is this bad?” before it becomes an emergency.

What “Unsafe” means

Risk of serious physical or psychological harm. Not recommended under any circumstances.

How the ratings work

The longer explanation

Buprenorphine's ceiling on slowed breathing covers opioid effects only. Xylazine slows breathing through a different receptor, as alcohol and benzodiazepines do, and those are the combinations behind most deaths on buprenorphine. Tranq usually arrives with fentanyl, which brings its own precipitated-withdrawal problem with buprenorphine.

Sources (7)

Choi S, Irwin MR, Kiyatkin EA. Xylazine effects on opioid-induced brain hypoxia. Psychopharmacology. 2023link.springer.com
Watkins JM et al. Xylazine exacerbates fentanyl-induced respiratory depression and prevents rescue by naloxone in mice. Psychopharmacology. 2026pmc.ncbi.nlm.nih.gov
What You Should Know About Xylazine. CDCcdc.gov
Friedman J et al. Xylazine spreads across the US. Drug Alcohol Depend. 2022pubmed.ncbi.nlm.nih.gov
Buprenorphine precipitated opioid withdrawal: Prevention and management in the ED settingsciencedirect.com
Buprenorphine-Precipitated Withdrawal Among Hospitalized Patients Using Fentanylpmc.ncbi.nlm.nih.gov
Practice-Based Guidelines: Buprenorphine in the Age of Fentanyl. SAEMsaem.org

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Other names

Buprenorphine: subutex, suboxone, bupe, bup, buprenorphine/naloxone, zubsolv; Partial agonist — displaces other opioids off the receptor
Xylazine: tranq, tranq dope, zombie drug, anestesia de caballo, rompun, medetomidine; Animal sedative cut into fentanyl, as is its stronger cousin medetomidine — naloxone reverses neither

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Related combinations

Buprenorphine with

What not to mix with Buprenorphine →

Xylazine with

What not to mix with Xylazine →

All combinations →

Can you mix Buprenorphine (Suboxone) and Xylazine (tranq)?

MixSafe rates mixing Buprenorphine and Xylazine as "Unsafe" — risk of serious physical or psychological harm. Not recommended under any circumstances. Source: MixSafe research. Educational information, not medical advice.