Tianeptine- Gas Station Heroin

Dr. Basrai
ghb

Introduction

  • Launched in Europe in 1980s under trade name

  • Commonly sold under names: Stablon, Coaxil, Tatinol, ZaZa, Tia, and Tianaa

  • Commonly referred to as Gas Station Heroin

  • Sold in US as a nootropic- Substance that enhances mood and cognitive function

    • Marketed to improve memory and ease anxiety

  • Often packaged in colorful, shot-sized bottles

  • Commonly Co-administered with alcohol, benzodiazepines, and antidepressants

Regulation

  • Not FDA Approved

  • Not on the list of Federally Controlled Substances

  • Growing number of states are banning

  • Used by millions of people in Europe, Asia, and South America

Mechanism of Action

  • Atypical antidepressant

  • Acts on multiple neurochemicals and receptors including serotonin, glutamate, NMDA, and opioid

Toxicity Symptoms

  • AMS, Coma

  • Confusion, Agitation

  • Respiratory depression

  • Tachycardia- EKG may revealed widened QRS, Prolonged QTc

Management of Overdose

  • Airway management including intubation

  • Naloxone

Treatment f Tianeptine Use Disorder

  • Buprenorphine has been reported in the treatment of Tianeptine Use Disorder

    • No exact guidelines present for starting dose

    • One case report pt who was taking 50 mg of Tianeptine every 4 to 5 hours, was started at 2mg of bup and titrated to 2mg bid with adequate symptom control.

References

  1. Parnia, S., Jain, L., Ali, M. et al. Gas station heroin- tianeptine and its impact: a systematic review and exploratory analysis. BMC Public Health 25, 3591 (2025). https://doi.org/10.1186/s12889-025-24666-0

  2. Tianeptine toxicity. WikiEM website. https://wikem.org/wiki/Tianeptine_toxicity. Accessed June 13, 2024.

  3. Trowbridge, Paul MD, MPH; Walley, Alexander Y. MD, MSc. Use of Buprenorphine-Naloxone in the Treatment of Tianeptine Use Disorder. Journal of Addiction Medicine 13(4):p 331-333, July/August 2019. | DOI: 10.1097/ADM.0000000000000490

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