A narrative review of the clinical applications of tiletamine-zolazepam in canine and feline anesthesia

Tiletamine-zolazepam is a widely utilized anesthetic combination in canine and feline medicine for chemical restraint, anesthetic induction, and minor surgical procedures. This narrative review synthesizes current evidence regarding the pharmacology, clinical applications, dosage regimens, and adverse effect profiles of tiletamine-zolazepam. Tiletamine functions as a non-competitive N-methyl-D-aspartate receptor antagonist, while zolazepam modulates gamma-aminobutyric acid neurotransmission. The combination provides a rapid onset of anesthesia, though recovery profiles vary significantly between species due to differing metabolic rates. In cats, intramuscular tiletamine-zolazepam is administered for immobilization and minor surgery; however, its use is contraindicated in cats with cardiorespiratory, hepatic, or renal disease. Clinical dosages are generally lower than manufacturer label recommendations, particularly for intravenous administration, which requires titration to clinical effect. In dogs, tiletamine-zolazepam is indicated for short procedures or as an induction drug prior to inhalant maintenance. Hemodynamic studies demonstrate dose-dependent increases in sympathetic tone and potential respiratory depression, necessitating peri-anesthetic monitoring, airway protection, and the integration of multimodal analgesia. Various combinations of tiletamine-zolazepam with ketamine, xylazine, dexmedetomidine, and opioids are commonly reported in veterinary medicine, offering predictable anesthesia but occasionally resulting in prolonged recovery. While tiletamine-zolazepam maintains a wide safety margin in healthy animals, it is contraindicated in those with head trauma, increased intracranial pressure, or pregnancy. This review underscores the necessity of balanced anesthesia and monitoring to optimize animal safety.