All about Tianeptine (Coaxil, Tianna): Types, Uses, Risks and How to Get Help
Drug abuse is a critical issue, particularly in the digital age where access to information and networking is seamless. While people may create online communities to help each other combat addiction, they may also share information on new ways to use medications. Take, for instance, the case of Tianeptine. Although individuals should solely use it for medical purposes under prescription, most in the U.S. abuse it through recreational use as it is widely available in various markets. Tianeptine might not have the same reputation as other street drugs, but there is increasing evidence that this substance is not only dangerous but has a high potential for abuse.
Tianeptine substance is currently legal and regulated in several parts of the world, such as Europe, where it has been used in recent years as an alternative antidepressant and anxiolytic. The drug has different brands and comes in varied forms, like pills or bulk powder.
Tianeptine may positively combat depression and possibly even asthma and improve cognition but negatively lead to addiction and withdrawal issues. In the U.S.A. where the drug is illegal to be prescribed, the FDA has warned consumers about other available forms of tianeptine, stating it may be as dangerous as opioids.
Obtaining the drug from the market and not from a doctor means individuals can self-medicate or use it without professional help or monitoring, resulting in misuse, overdose, and other related issues, like death.
In This Article
What is Tianeptine? Is it a Legal drug?
Tianeptine is a synthetic antidepressant from the chemical class Dibenzothiazepine. This drug has some highly unique chemical compounds and mechanisms of activity. It also has a distinct therapeutic and symptomatic profile, meaning that its effects on users is unique in some more positive and some more negative ways than other comparable substances. Despite this, there is still much research to be done on the drug at this time in part because of its apparent addictive potential and concerns over abuse.
For this reason, tianeptine is not approved by the FDA but also not outright banned or confiscated in the United States, though its profile as an unregistered pharmaceutical drug, makes it essentially illegal to be prescribed, manufactured or sold in the United States. The FDA claims to have been trying more recently to increase awareness of the possible dangers of tianeptine, indeed issuing a statement in 2022 regarding the growing body of evidence showing that the drug has serious potential for abuse and dangerous side effects.
However, critics say that other than a limited amount of blocking large shipments of Tianeptine at the U.S. border, and a handful of warnings to vendors, the federal government is not adequately active in removing the drug from the country. Recently, over the past few years individual states have moved to ban and criminalize the sale or possession of Tianeptine, in an attempt to stop the rampant misuse of the drug with its own more localized tools of law and enforcement. The small list of states are: Michigan, Alabama, Minnesota, Tennessee, Georgia, Indiana and Ohio.
Tianeptine Brands and its Various Forms
Tianeptine occurs in various forms, especially for its illicit uses. The pharmaceutically used form, where legal, appears usually as a white tablet and sometimes as a capsule pill. There are seven international Tianeptine brand names under which Tianeptine is available as a medical drug. These include Stablon, Tatinol, Salymbra, Tianeurax, Zinosal, Neptine and Coaxil. This substance is currently legal and regulated in several parts of the world, such as certain countries in Europe and Asia, where it has been used in recent years primarily as an alternative antidepressant and anxiolytic (anxiety treatment).
According to the U.S. Drug Enforcement Administration, illicit Tianeptine occurs in a bulk powder form, or individual stamp bags (as is used to distribute cocaine), either as a sodium or sulfate – with many users preferring the latter due to its supposed balanced and longer effect- and as counterfeit pills that mimic hydrocodone and oxycodone pharmaceutical products. Users can take Tianeptine in various oral forms, but it is also used sometimes as an injectable taken intravenously. Considering the different forms that Tianeptine occurs in, it is often susceptible to misuse.
Often, Tianeptine brand names are sold illegally online in the U.S. At the same time, tianeptine is appearing in other products, which is a significant cause for concern. Even though it is illegal to market this non-FDA-approved substance as a supplement, there have been hundreds of documented cases of tianeptine being sold in various, misleading formats. Increasingly, Tianeptine has appeared online and in some health shops and retail stores, especially gas stations and convenience stores, as a “health” or “dietary” “supplement” or nootropic.
Sellers and consumers have come to know some common street brand names such as: Zaza (red, silver, or white), Pegasus, Tiana, Tianna (red, white, and green) and TD Red. Other more slang-like names include: Tia, gas-station dope, gas-station heroin, among others. Some tianeptine users also obtain it in bulk from online vendors that sell it with an apparent wink and a nod as “for research purposes only.”
What does Tianeptine do? Tianeptine Uses in the Medical and Health Market
On the one hand, Tianeptine has primary uses within the legal market, such as treating or reducing the effects of anxiety and depressive disorders, as is the case in most European countries. However, the Food and Drug Administration (FDA) has not approved the drug in the United States for medical or commercial use, stating that the purported medical benefits of the drug have not been clearly established while the safety concerns are known. Still, Tianeptine is considered effective in patients with depression and anxiety. According to researchers, Tianeptine has a similar efficacy element or profile to other better known so-called tricyclic antidepressants (TCAs). For instance, since patients with dementia or Alzheimer’s Disease are likelier to experience depression, like other antidepressant drugs, Tianeptine can show antidepressant effects after a particular period for depression in dementia, and can create a better environment for memory enhancement.
Additionally, Tianeptine has other noticeable secondary uses in the legal market, including pain relief as well as combating asthma. Tianeptine addresses asthma attacks by reducing the level of free serotonin in the blood and empowering the lung bronchi to contract and control the asthmatic reaction. Some scientists argue that the ideal treatment of asthma complications should include a combination of a non-sedating antidepressant like Tianeptine along with conventional drugs including a “bronchodilator,” and “anti-inflammatory actor”. Besides, asthma shares some not fully understood similar biological linkage with depression; thus, antidepressants, including Tianeptine, may offer therapeutic benefits.
According to some researchers, similar to other better known so-called tricyclic antidepressants (TCAs), Tianeptine can show antidepressant and anti-dementia effects following a particular regiment for patients suffering from depression with dementia, and can create a better environment for memory enhancement.
It is also used by some prescribers to help ease the symptoms of IBS -irritable bowel syndrome, a highly common condition which creates an “uneasy stomach” or poor digestive function. Though as is the case with other alleged benefits of the drug such as the effects on memory, stress, pain and possibly even asthma, the actual mechanism of this effect is unclear. It may indeed be just another positive outcome of reducing depression and its stresses, remedying along with them the various physiological maladies they inflict.
Cycle of addiction: Tianeptine abuse and withdrawal difficulty
As a lesser-known drug, most people are not necessarily familiar with the signs that someone is using tianeptine. Importantly also, tianeptine does not show up in regular drug screenings or tests. When observing the behavior of users, one who is familiar with tianeptine powers may be able to discern the drug’s effects. In standard medical doses, the drug can produce mild euphoria, stress-relieving effects, anxiety-relieving and anti-depressant effects. In lower doses, the drug is absorbed and produces effects quickly, providing users with cognitive and mental performance benefits.
While early studies on tianeptine indicated that the drug was less likely to produce addiction, more recent studies have shown that this is not necessarily the case. For this reason, the Food & Drug Administration (FDA) has warned consumers that tianeptine is considered unsafe and can produce addiction in users.
Since, as mentioned, Tianeptine has cognitive enhancement abilities, and considerable antidepressant and anti-anxiolytic profile, it enhances daily life and learning especially in users with depression, focus and memory troubles. This likely multiplies the risk of developing dependency and addiction through abuse, as the potential euphoric effects of high doses may cause some users to exceed recommended amounts, which could quickly raise tolerance and propel a vicious upward spiral ultimately intensifying negative side effects. Also, with these likely benefits and considering that the drug is not FDA-approved in the US and illegal some countries, individuals are more likely to get Tianeptine unsubscribed and unsupervised from the illegal market, increasing the likelihood of abuse.
A 2017 medical literature review indicated that women and men aged between 30-45 years old had a higher frequency of Tianeptine abuse. They would increase their Tianeptine uptake ten times more than the recommended daily dosage. In some cases, people with major depressive disorder self-medicate with Tianeptine to treat apathy and boredom. However, often they eventually escalate the dosage and suffer withdrawal syndrome, making it challenging to discontinue the drug intake. Particularly because of tianeptine’s short duration of effects, it may compel some to frequent redosing. The FDA reports that “Poison control center cases involving tianeptine exposure have increased nationwide, from 11 total cases between 2000 and 2013 to 151 cases in 2020 alone”.
When taken in dosages of over 100mg, the effects can be more similar to heroin or opiates. For perspective, prescription doses are normally between 25-50mg per day, but recreational doses can be much higher, anywhere from 100 to 3000mg per day. While fatal dosages depend on a user’s characteristics, overdoses have been reported in cases where users and more than 2.0 mg/L in their blood, and the risk of death is multiplied when mixed with certain other drugs.
Tianeptine abuse seems to also have a uniquely difficult and often severe withdrawal reaction, causing a prolonged cycle of use and increasing dosages. Many users describing the attempts at withdrawal as “much more excruciating than any other drug withdrawal”. Some law enforcement officials have described tianeptine as being “worse than heroin”, and one former user described it saying: “Withdrawal and detox was 10 times more severe than any opiate withdrawal” (Consumer Reports)
For this reason, the FDA has warned the public that tianeptine can produce significant withdrawal effects that are very much like those of opioid toxicity and withdrawal (FDA). Many of these withdrawal symptoms can require medical treatment. For individuals with tianeptine dependence, withdrawal can entail anxiety, sweating, myalgias, chills, and even paranoia.
Tianeptine’s unique effect on the brain
It is worth noting that although Tianeptine has a similar anxiolytic efficacy profile to other antidepressants, it has a notable differing mechanism of action. For instance, other tricyclic antidepressants (TCAs) act by inhibiting the reuptake of norepinephrine or serotonin from enhancing their synaptic concentrations in the brain. However, rather than blocking this reuptake, Tianeptine mostly remains elusive in its mechanism of action. It actually seems to increase and stimulate the responsiveness and concentration of dopamine and serotonin, a fact which has confounded scientists seeking to understand the means by which depression and mood can be modified through antidepressants.
The drug mainly shows a dual activation of mu and delta opioid receptors responsible for the potent and chronic effects of Tianeptine, including antidepressant or antianxiety reactions, which makes it a unique choice for addressing depression and anxiety simultaneously. Tianeptine also shows a unique ability to increase brain elasticity, which can improve various cognitive functions such as focus, clarity and memory.
These are many of the potential benefits proponents of Tianeptine highlight. On the other hand, individuals can use Tianeptine in the illegal market as a recreational drug for cognitive enhancement and euphoria. Patients who take much more than the recommended drug dosage experience euphoria -a feeling of intense happiness or a “high”, though on a milder level than most illicit drugs, which motivates further drug use and abuse.
Tia is Dangerous? The side-effects & dangers of tianeptine addiction & Polydrug use
While Tianeptine use is perhaps uniquely identified by its tendency to induce nausea, constipation, pain in the abdominal region and liver trouble. In reality, unregulated Tianeptine use can pose various potentially dangerous risks, including: Psychological and physical dependence; Overdose resulting in difficulty breathing or loss of consciousness; Withdrawal complications such as flu-like symptoms, vomiting, and -when done abruptly- cardiac failure; Health complications such as hepatotoxicity, liver and kidney damage, and gastrointestinal problems including strictures and bleeding.
Abusing Tianeptine can also cause mental or behavioral troubles including dizziness, anxiety, excitability, and even psychosis.
When used intravenously, it can be deadly due to its sticky yet coarse nature, the injections often cause severe skin and vein damage sometimes requiring surgery, and there are reports of extensive and permanent damage to blood veins due to frequent injections.
As is the case with many similar supplement drugs, tianeptine is commonly used together with other drugs for enhanced effect. The practice of what is known as polydrug use, poses significant risks and dangers. While it is used with many other drugs, Tianeptine is most commonly associated with co-use of kratom, phenibut, and racetrams. (From a study provided by the HHS & NIH analyzing online social media forums regarding supplement drug use. One of these forums is dedicated specifically to Tianeptine, with members offering stories, advice, warnings, and tips regarding this substance. Although not medically supervised and representing non-science based ideas, the existence of the Reddit forum named r/Quittingtianeptine demonstrates the popularity of the drug and the recognition of the severe problems often caused by it.)
Indeed, some of the worst outcomes are born of abusing Tianeptine together with certain other drugs, but evidence also suggests that the drug itself can be fatal. Combining tianeptine with other drugs can increase the risk of serious side effects and may increase the risk of overdose. For example, the risk or severity of gastrointestinal bleeding can be increased when Tianeptine is combined with Acemetacin, Aceclofenac or Acenocoumarol.
For more on the possible side effects and dangers of tianeptine, see our article on “Dangers & Side effects of Tianeptine”.
Getting help for Tianeptine drug addiction or misuse
If you or someone you know may be struggling with unwanted Tianeptine misuse, they may be stuck in a cycle of addiction, which can be almost impossible to break out of alone. Addiction usually causes one to obsess over the substance they have developed a dependency on, and to seek it out and use it at all costs, even when it may be detrimental to them or their relationships. Additionally, most addictions stem from an underlying emotional or mental cause which may need to be addressed professionally and carefully in a thorough and deep manner.
If someone you care about is exhibiting signs of social or emotional deterioration, as well as other behaviors that may hint at a substance misuse or addiction, you might want to help them research the best available options for caring for and recovering from addiction. Someone stuck in a cycle of addiction may need longer term inpatient care, or a lower level of care, depending on their situation and circumstances. This evaluation is best done by a trained and certified addiction treatment specialist or a doctor. All quality addiction rehabilitation facilities provide access to proper evaluation of treatment needs, along with full applicable health screenings.
Along with finding the suitable care options, you may want to turn to an addiction care provider to assist you in finding a way to encourage and convince the one struggling with addiction to go ahead and commit themselves to treatment. This intervention is usually successful only when approached with sincere respect and compassion.
Journal of Analytical Toxicology
“Tianeptine in Dietary Supplements.” U.S. Food and Drug Administration
‘Worse than Heroin’ – Consumer Reports
An Illegal Dietary Supplement Named Tianeptine Is Being Sold to Americans—and the FDA Knows It -Consumer Reports
“Tianeptine Abuse and Dependence: Case Report and Literature Review.” -Psychosomatics
NIH National Library of Medicine
DRUGBANK Online -Tianeptine
“The Rise in Tianeptine Abuse: Our next Kratom Problem?” Practical Pain Management
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“Addictive potential of Tianeptine-the threatening reality.” Georgian Medical News. Vadachkoria, D., et al. 174 (2009): 92-94.