Tianeptine
Standing risks
| Risk | Recorded values | Confidence | Article section |
|---|---|---|---|
| Dangerous withdrawal, taper carefully |
| high | View in article: Dangerous withdrawal, taper carefully |
| Compulsive use risk, monitor frequency |
| high | View in article: Compulsive use risk, monitor frequency |
| High dependence, taper carefully |
| high | View in article: High dependence, taper carefully |
Lethal interactions
| Combination | Type | Severity | Mechanisms | Confidence |
|---|---|---|---|---|
| Benzodiazepines, Barbiturates | Drug class | lethal | 2 | high |
| GHB, Baclofen | Drug class | lethal | 2 | high |
| GHB, GBL | Drug class | lethal | 2 | high |
| Local anesthetics | Drug class | lethal | 4 | medium |
Dangerous interactions
28 dangerous interactions recorded for this substance.
See the full interactions tableContraindications
| Condition | Severity | Note |
|---|---|---|
| Respiratory | ||
| respiratory insufficiency | relative | Clinically negligible at therapeutic doses (37.5 mg/day) but relevant in patients who may self-escalate to supratherapeutic doses or who obtain tianeptine from unregulated sources where dosing is imprecise. |
| Renal | ||
| severe renal impairment | relative | Dose reduction to 25 mg/day recommended. Not an absolute contraindication but requires monitoring and dose adjustment. |
| Pregnancy & Breastfeeding | ||
| pregnancy | absolute | Documented case of severe NOWS following chronic maternal tianeptine supplement use. Infant required oral morphine after phenobarbital failure. Tianeptine is not detected on standard urine drug screens, complicating prenatal identification. |
| Age | ||
| elderly | relative | Dose reduction to 25 mg/day (two tablets) recommended. Emsley 2018 established efficacy at 25-50 mg/day in elderly patients with recurrent MDD. |
| Other | ||
| concurrent opioid use | absolute | Co-administration with other MOR agonists (morphine, oxycodone, methadone, fentanyl, heroin) increases overdose risk. The diagnostic invisibility of tianeptine on standard screens is an additional hazard. |
| alcohol use disorder | relative | The only confirmed fatal tianeptine case involved alcohol co-ingestion (ethanol 0.53 g/L). While pharmacokinetic interaction reduces tianeptine plasma levels, the pharmacodynamic synergy is dangerous in overdose contexts. |
| concurrent benzodiazepine or CNS depressant use | relative | Case report of concurrent etizolam and tianeptine withdrawal documented complex clinical management requirements. |