---
title: "Tiletamine‑zolazepam (Zoletil 50) inhalation: neuropsychiatric and multisystem toxicity with two‑y"
id: "pubmed-42665695"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42665695"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42665695/"
doi: "10.1007/s00415-026-14098-0"
published_at: "2026-08-29T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Tiletamine‑zolazepam (Zoletil 50) inhalation: neuropsychiatric and multisystem toxicity with two‑y
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42665695
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42665695/)
- **DOI:** [10.1007/s00415-026-14098-0](https://doi.org/10.1007%2Fs00415-026-14098-0)
- **Published At:** 2026-08-29T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This retrospective case series examined 36 patients with recreational inhalation exposure to **tiletamine‑zolazepam (Zoletil 50)** presenting to a single institution. - All patients (100%) had **postural tremor**; 61% had sustained high‑amplitude tremor early after admission. - Cerebellar **ataxia** occurred in 83% and **visual disturbance** in 56%; 44% experienced concomitant hallucinations. - Parkinsonian features (bradykinesia and rigidity) were present in 11% of patients. - Systemic laboratory abnormalities included elevated transaminases in 53% and hypokalemia in 44%. - Two patients died in hospital from cardiorespiratory failure; a third death occurred during follow‑up after repeated relapses. - Of 34 discharged patients, 59% relapsed (20 patients), and 17 relapsed within the first month, indicating **early and common relapse**. - At two years, 11 of 33 survivors had persistent deficits: subjective memory decline (7), visual impairment (6), and bradykinesia requiring levodopa (2). - The authors emphasize that standard toxicology screens do not detect tiletamine‑zolazepam and recommend clinicians consider this exposure in young patients with unexplained tremor, ataxia, or perceptual disturbances. - The study calls for prospective controlled research to confirm causation and fully define the toxicity spectrum.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China. * 2 Jiangsu Health Vocational College, Nanjing, 210029, Jiangsu, China. * 3 Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China. guangxicj@163.com. * PMID: **42665695** * DOI: [ 10.1007/s00415-026-14098-0 ](https://doi.org/10.1007/s00415-026-14098-0) Item in Clipboard # Neuropsychiatric and multisystem toxicity following recreational inhalation of tiletamine-zolazepam (Zoletil 50): a retrospective case series with two-year prospective follow-up Ping Hua et al. J Neurol. 2026. Show details Display options Display options Format Abstract PubMed PMID J Neurol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Neurol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Neurol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) . 2026 Aug 29;273(9):555. doi: 10.1007/s00415-026-14098-0. ### Authors [Ping Hua](https://pubmed.ncbi.nlm.nih.gov/?term=Hua+P&cauthor_id=42665695)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42665695/#short-view-affiliation-1 "Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China."), [Xing Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+X&cauthor_id=42665695)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42665695/#short-view-affiliation-2 "Jiangsu Health Vocational College, Nanjing, 210029, Jiangsu, China."), [Jie Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+J&cauthor_id=42665695)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42665695/#short-view-affiliation-3 "Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China. guangxicj@163.com."), [Weiguo Liu](https://pubmed.ncbi.nlm.nih.gov/?term=Liu+W&cauthor_id=42665695)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42665695/#short-view-affiliation-1 "Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China."), [RuiJuan Sha](https://pubmed.ncbi.nlm.nih.gov/?term=Sha+R&cauthor_id=42665695)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42665695/#short-view-affiliation-1 "Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China."), [WeiWei Jiang](https://pubmed.ncbi.nlm.nih.gov/?term=Jiang+W&cauthor_id=42665695)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42665695/#short-view-affiliation-1 "Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China.") ### Affiliations * 1 Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China. * 2 Jiangsu Health Vocational College, Nanjing, 210029, Jiangsu, China. * 3 Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China. guangxicj@163.com. * PMID: **42665695** * DOI: [ 10.1007/s00415-026-14098-0 ](https://doi.org/10.1007/s00415-026-14098-0) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## 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 inhalation is associated with a broad spectrum of neurological and systemic injury, with tremor, ataxia, and visual disturbance as the most consistent features. Relapse is common and early; one-third of long-term survivors still had neurological deficits at two years. Clinicians should consider tiletamine-zolazepam exposure when evaluating young patients with unexplained tremor, ataxia, and perceptual disturbance as standard toxicology screens do not detect this compound. Prospective controlled studies are needed to confirm causation and define the full spectrum of toxicity. **Keywords:** Movement disorders; Neurotoxicity; Relapse; Tiletamine; Veterinary drug abuse; Zolazepam. © 2026. Springer-Verlag GmbH Germany, part of Springer Nature. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Conflicts of interest: The authors declare no competing interests. Ethical approval: All procedures performed in this study were approved by the Ethics Committee of Nanjing Medical University (Approval No.: 2026-KY064-01) and were conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent: Because this study is a retrospective study, the local ethic committee stated that it does not require informed consent for each participant. ## References 1. 1. 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J Am Assoc Lab Anim Sci 46:74–80 - [PubMed](https://pubmed.ncbi.nlm.nih.gov/17343357/) Show all 32 references ## MeSH terms * Administration, Inhalation Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Administration%2C+Inhalation%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Administration%2C+Inhalation) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) * Adult Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Adult%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Adult) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) * Drug Combinations Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Drug+Combinations%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Drug+Combinations) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) * Female Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Female%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Female) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) * Follow-Up Studies Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Follow-Up+Studies%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Follow-Up+Studies) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) * Male Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Male%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Male) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) * Neurotoxicity Syndromes* / etiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Neurotoxicity+Syndromes%2Fetiology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Neurotoxicity+Syndromes) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) * Neurotoxicity Syndromes* / physiopathology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Neurotoxicity+Syndromes%2Fphysiopathology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Neurotoxicity+Syndromes) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) * Prospective Studies Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Prospective+Studies%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Prospective+Studies) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) * Retrospective Studies Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Retrospective+Studies%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Retrospective+Studies) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) * Tiletamine* / administration & dosage Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Tiletamine%2Fadministration+and+dosage%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Tiletamine) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) * Tiletamine* / adverse effects Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Tiletamine%2Fadverse+effects%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Tiletamine) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665695/) * Tiletamine* / toxicity Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Tiletamine%2Ftoxicity%22%5BMAJR%5D&sort=date&sor
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