UMEM Educational Pearls

Title: "Tianna Red" - Tianeptine, a new medication of abuse?

Keywords: tianeptine, clinical characteristics, poison center (PubMed Search)

Posted: 7/23/2020 by Hong Kim, MD, MPH
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Tianeptine is an antidepressant with mu-opioid receptor agonism. It is available in several European countries for therapeutic use, but not available in the US.

There has been an increase in tianeptine exposure in the US since August 2019. Recently a retrospective observation study was done to characterize the clinical features associated with tianeptine exposure.

Result

48 cases of tianeptine exposure were identified from January 1, 2015 to March 15, 2020 from a single poison center
37 cases (77%) occurred from May 2019 to March 2020.

Intoxication (n=11)

Withdrawal (n=27)

Symptoms

· Lethargy: 7 (63%)

· Agitation: 3 (27%)

· Tachycardia: 3 (27%)

· GI distress: 2 (18%)

· Myoclonic/hallucination: 2 (18)

Symptoms

· Anxiety: 12 (44%)

· GI distress: 3 (33%)

· Hypertension: 8 (30%)

· Agitation: 8 (30%)

· Tachycardia: 7 (26%)

Treatment

· Naloxone: 3 (27%)

· Benzodiazepines: 2 (18%)

· Antipsychotics: 2 (18%)

· Antimuscarinic: 1 (9%)

Treatment

· Benzodiazepine: 10 (37%)

· Opioids: 6 (22%)

· Alpha-2-agonist: 5 (19%)

· Antipsychotics: 5 (19%)

· Antimuscarinic: 5 (19%)

Disposition

· ICU: 6 (55%)

· Non-ICU: 2 (18%)

· Discharged home: 2 (18%)

Disposition

· ICU: 4 (15%)

· Non-ICU: 7 (26%)

· Psych: 1 (4%)

· Discharged home: 10 (37%)

Conclusion

Tianeptine exposure is increasing in the US .
Intoxication frequently results in lethargy and/or agitation.

References

Rushton W et al. Characteristics of tianeptine effects reported to a poison control center: a growing threat to pubic health. Clin Toxicol (Phila) 2020. DOI: 10.1080/15563650.2020.1781151