Mixing Codeine (lean) and Xylazine (tranq)

Q: How dangerous is Codeine with Xylazine?

Dangerous: High risk of death or life-changing injury. Do not combine.

Q: Is it safe to mix lean and tranq?

MixSafe lists lean under Codeine and tranq under Xylazine. That combination is rated "Dangerous". Additive sedation and slowed breathing, with codeine's real strength already unpredictable between people and xylazine's effect out of naloxone's reach.

Dangerous

Codeine's real strength varies between people, and naloxone can't reverse xylazine.

Do this

Do not combine. Put anyone who won't wake on their side.

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 “Dangerous” means

High risk of death or life-changing injury. Do not combine.

How the ratings work

The longer explanation

Additive sedation and slowed breathing, with codeine's real strength already unpredictable between people and xylazine's effect out of naloxone's reach.

Sources (6)

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
Codeine Intoxication Associated with Ultrarapid CYP2D6 Metabolism. NEJMnejm.org
Codeine Therapy and CYP2D6 Genotype. Medical Genetics Summaries, NCBIncbi.nlm.nih.gov

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Other names

Codeine: lean, purple drank, co-codamol, dihydrocodeine; Weak, but metabolised unpredictably between people
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

Codeine with

What not to mix with Codeine →

Xylazine with

What not to mix with Xylazine →

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Can you mix Codeine (lean) and Xylazine (tranq)?

MixSafe rates mixing Codeine and Xylazine as "Dangerous" — high risk of death or life-changing injury. Do not combine. Source: MixSafe research. Educational information, not medical advice.