Zoletil 50-induced mental and behavioral abnormalities: a case report and literature review.

Background: Zoletil 50, mixed with tiletamine and zolazepam, a veterinary anesthetic, has increasingly been used as a substitute drug by substance abusers in recent years. Recently, it has been found in China that tiletamine has been added to electronic cigarettes as a stimulant, highlighting the need for further evaluation of its safety. Case presentation: A 22-year-old, previously healthy, unmarried male presented to a psychiatric outpatient clinic with a 4-month history of progressive low mood, anhedonia, and feelings of detachment from self and surroundings (depersonalization/derealization). He reported recreational use of powdered Zoletil 50, insufflated approximately 1-2 times per week. Following repeated use, he began experiencing acute, paroxysmal episodes characterized by intense panic, terror, tachycardia, and palpitations, lasting 30-60 min. There was no significant past medical or psychiatric history. Physical examination was unremarkable. Routine blood tests, thyroid function, and ECG were within normal limits. Conclusion: The use of Zoletil 50 or electronic cigarettes containing tiletamine can lead to addiction, suicidal tendencies, depressed mood, panic attacks. Long-term use of Zoletil 50 may result in various psychiatric and behavioral symptoms, while overdose can be fatal. There is an urgent need for society to strengthen regulations and oversight in this regard.