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Tianeptine

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Tianeptine, Gas Station Heroin, Tianeptine Overdose, Tianeptine Toxicity, Tianeptine Poisoning

  • See Also
  1. Opioid Abuse
  2. Unknown Ingestion
  • Mechanism
  1. Antidepressant that increases brain uptake of Serotonin (5-HT) and increasing central Serotonin activity
    1. Unique to Tianeptine and in contrast with SSRIs that inhibit the synaptic reuptake of Serotonin
    2. Marketed legally in Europe as an Antidepressant and Anxiolytic
  2. Atypical and weak mu-Opioid receptor Agonist when used at high dose
    1. Available in the U.S. as a "dietary supplement", and often sold in gas station convenience stores
    2. Ilicit use for Opioid-like euphoria (typically at excessive doses that risk toxicity)
    3. Patients with addiction will use doses of 100 mg every 2 hours
  • Pharmacokinetics
  1. Rapid oral absorption
  2. Half-Life: 2.5 hours
  • Adverse Effects
  • Toxic Doses
  1. General
    1. Diaphoresis
  2. Neurologic
    1. Agitation
    2. Lethargy
    3. Tremor
  3. Cardiovascular
    1. Tachycardia
    2. Hypertension
  4. Gastrointestinal
    1. Nausea or Vomiting
    2. Abdominal Pain
  • Labs
  1. See Unknown Ingestion
  • Management
  1. ABC Management
  2. Activated Charcoal
    1. Consider if presentation within 1 hour of ingestion
  3. Respiratory depression or apnea
    1. Consider Naloxone (may be ineffective)
  4. Agitation
    1. Benzodiazepines
  5. Withdrawal
    1. Consider Buprenorphine
  6. Disposition
    1. Consider observation for CNS depression
  • References
  1. Tomaszewski (2024) Crit Dec Emerg Med 38(2): 34