Tianeptine: Gas station heroin
The bottom line
Tianeptine is a medication approved in some non-US countries for anxiety and depression. It has not been approved by the FDA, but there has been an increase in people using tianeptine in the US. Taking tianeptine can lead to adverse effects and sometimes overdose. Tianeptine can be abused and severe withdrawal symptoms can occur when people who are dependent stop taking it.
Prevention Tips
Do not take medications or supplements that are not approved by the FDA.
Store all medications and supplements up and away from children.
Keep bystander naloxone handy if you or someone you know uses tianeptine.
Safely discard any recalled tianeptine products.
Treatment is available to help with tianeptine withdrawal.
This Really Happened
Case 1: A 37-year-old man was found in a car after taking a combination of tianeptine and kratom. He was unresponsive and needed a breathing tube and was placed on a ventilator. He was admitted to the intensive care unit for 3 days because he could not breathe on his own and his heart rhythm was abnormal. He was discharged after 5 days in the hospital, but made a full recovery.
Case 2: A 40-year-old woman with a history of chronic back problems took tianeptine she purchased at a gas station to help her pain. She was brought to the emergency department when she passed out at the dinner table. She spent the night in the emergency department while the effects of tianeptine wore off, but made a full recovery.
Case 3: A 43-year-old man presented to the emergency department with tremors, nausea, vomiting, and body aches. He had been taking a tianeptine supplement (a bottle a day) for over a year and was trying to cut back. The withdrawal symptoms were so uncomfortable that he could not function. He was seen in the emergency department and was treated with medications to help the withdrawal, but he had to go to an outpatient rehabilitation program to be tapered off.
What is tianeptine?
Tianeptine is a medication that has been approved in non-US countries to treat anxiety and depression. Like many other antidepressants, it works by increasing the amount of serotonin in the brain. In addition, it acts on opioid receptors in the body similarly to traditional opioids such as oxycodone, heroin, and fentanyl. Because it acts like an opioid in the brain, people can feel euphoria or a high when they take tianeptine. People can also overdose or become addicted.
Is tianeptine legal?
Tianeptine is not approved for use by the FDA, but it is legal in other countries. Even though it is not FDA-approved, many companies are illegally marketing and selling products containing tianeptine. Some common names are Neptune’s Fix, ZaZa Red, and Tianna Red. They are often sold in gas stations and can be found in online supplements. Tianeptine is also called “gas station heroin.” Some products claim tianeptine can help treat depression, anxiety, and pain, and can improve brain function. Other products are marketed as an alternative to opioids.
There are no adequate studies to show that tianeptine is effective or safe, which is why the FDA has not approved tianeptine. Since tianeptine is not FDA-approved, tianeptine products are not regulated, so there is no knowing how much tianeptine is in a particular product, or if there are contaminants in the product. For example, synthetic cannabinoids may also be present. Because tianeptine is not well-studied, we have a limited understanding of potential drug-drug interactions. Tianeptine is not considered a controlled substance by the Drug Enforcement Agency at this time.
Why have there been recalls of tianeptine products, like Neptune’s Fix?
Several serious adverse events involving tianeptine products have been reported to the FDA. The FDA has issued a warning to avoid using Neptune’s Fix and other tianeptine products. The manufacturer of Neptune’s Fix has voluntarily recalled their products and the FDA is conducting an investigation.
What adverse effects occur with tianeptine use? Is tianeptine poisonous?
Several adverse effects have been reported with regular use and overdose of tianeptine. These include confusion or drowsiness, as well as coma and stopping breathing. Nausea, vomiting, abnormal electrolytes, seizures, high blood pressure, and rapid heartbeat have occurred as well. Several deaths have been associated with tianeptine overdose.
How long does tianeptine stay in your system?
Tianeptine stays in the body for a relatively short period. Most of it is eliminated from the body within 12 hours of taking it. It may last longer in older people and those with kidney problems. Tianeptine is not detected on routine urine drug screens. Since the drug is relatively short-acting, people who take tianeptine regularly can develop symptoms of withdrawal quickly.
How long does it take to get addicted to tianeptine?
It’s hard to predict how long it takes to become addicted to tianeptine because it depends on how long the person has taken it, how frequently it is used, and the dose. There is also individual variability. However, it is important to recognize that people can become dependent on tianeptine. When an individual becomes dependent, withdrawal symptoms occur if the drug is stopped suddenly. Tianeptine withdrawal symptoms are very similar to opioid withdrawal and can include intestinal upset, sweating, agitation, and elevated heart rate and blood pressure. Withdrawal can be uncomfortable, but there are treatments available.
What should I do if someone I know has ingested tianeptine?
If someone is having trouble breathing or is hard to wake up, administer bystander naloxone if it’s readily available and call 911. Because tianeptine is similar to opioids, naloxone may be effective in reversing some of the effects of tianeptine while awaiting medical transport. For less serious exposures (such as alert patients without depressed breathing), use the webPOISONCONTROL® online tool to get help, or call your poison center at 1-800-222-1222. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day.
