All compounds

Tianeptine

Also sold as Stablon, Coaxil, Tianaa, Zaza, Neptune's Fix, Pegasus, tianeptine sodium. Full μ-opioid receptor agonist; licensed as an atypical antidepressant outside the US.

The evidence says don’t (5 of 5)

Tianeptine is a prescription antidepressant in France that turns out to be a full opioid agonist, and the version sold in American petrol stations as a mood supplement produces opioid dependence in people who have no idea they are taking an opioid.

What it is

Tianeptine is a genuine pharmaceutical. It was developed in France in the 1960s and has been prescribed there for depression for decades under the name Stablon, and in other countries as Coaxil. In the places where it is licensed, it is an ordinary prescription antidepressant with a reasonable clinical record at therapeutic amounts.

It has never been approved in the United States, the United Kingdom, Canada or Australia.

Despite that, it is widely available in America — sold in petrol stations, smoke shops and online under brand names like Tianaa, Zaza, Neptune’s Fix and Pegasus, packaged as a mood or energy supplement. It is not a dietary supplement, and the US Food and Drug Administration has said so directly and repeatedly, warning that these products are linked to serious harm, overdoses and death.

For most of its history the mechanism was described as something unusual and vaguely serotonergic. That description turned out to be incomplete in a way that matters enormously: tianeptine is a full agonist at the μ-opioid receptor. It is, pharmacologically, an opioid. Not opioid-like, not “acts on similar pathways” — the same receptor that heroin and oxycodone act on, engaged fully.

That is the fact the packaging does not tell you, and it is the reason this page exists.

What it actually does

At the amounts used in French clinical practice, tianeptine works as an antidepressant, and the opioid activity is modest enough that dependence in supervised prescribing is uncommon though not unknown.

At the amounts people take when it is sold over a counter with no prescriber, it is an opioid, and it does what opioids do: relief, warmth, an easing of physical and emotional pain, and for many people a distinct euphoria and lift in energy.

We are saying that plainly because the people at greatest risk from tianeptine are the ones who genuinely do not know what they are taking. Someone buying a mood supplement at a petrol station is not making a decision about opioid use. They are buying something they have been told is a supplement, it works noticeably well, and the whole framing of the purchase tells them this is not that kind of drug.

Its half-life is short. That single pharmacological detail drives most of what goes wrong, and it is covered below.

What the evidence actually shows

On its use as a medicine: decades of prescribing in France and elsewhere, with the usual body of trial evidence behind a licensed antidepressant. That evidence is about supervised use at therapeutic amounts, and it does not transfer to the products sold in American shops.

On misuse and dependence: a 2026 systematic review pulled together the published record on withdrawal, toxicity and clinical management, and the picture it describes is consistently an opioid one — tolerance, escalation, compulsive use, and a withdrawal that presents and is treated like opioid withdrawal.

On the scale of the problem: the clearest public data is the analysis of calls to US poison centres between 2000 and 2017, which found exposures rising sharply, concentrated in adults, and frequently involving serious outcomes. That analysis stops in 2017; the retail products largely arrived afterwards.

On overdose: case reports describe respiratory depression reversed by naloxone — the opioid antidote. That is about as direct a demonstration as pharmacology offers that this is an opioid. It also means naloxone works, which is worth knowing.

On pregnancy: there are published cases of neonatal withdrawal syndrome in babies born to mothers who used tianeptine, including cases where the mother had been using a product sold as a supplement. Reports appear across more than a decade⁴⁵, which suggests this is not a one-off.

On product contents: this is not merely an unregulated-supply problem. Products marketed as tianeptine have been recalled after being found to contain other drugs entirely, including synthetic cannabinoids, following clusters of seizures and loss of consciousness. Buying tianeptine in this market does not reliably get you tianeptine.

The risk profile

The evidence says don’t (5 of 5) — The known downside is severe enough that we will say it plainly rather than hedge.

What going wrong looks like from the inside

The deception is structural, and it does most of the work.

You buy something at a petrol station counter, next to the energy drinks, in packaging that looks like a supplement. It is legal where you bought it. It costs a few dollars. Everything about that transaction tells you it belongs to the same category as caffeine pills — and none of your ordinary caution about opioids is engaged, because as far as you know you are not near any.

Then it works, and it works well. Mood lifts. Energy improves. If you were depressed, it does something the last three things you tried did not.

The short half-life is what turns that into a trap. Because it clears quickly, the good feeling fades within hours, and what replaces it is not simply a return to baseline — it is early withdrawal, which feels like anxiety, aching, restlessness and low mood. The obvious response is to take more, and it works, because it is treating withdrawal. Within a remarkably short time people are taking it many times through the day, and they are doing it to hold off feeling ill rather than to feel good.

People commonly describe going through an entire large container far faster than they intended, spending far more than they meant to, and reorganising their day around a shop’s opening hours — while still, at that point, describing it to themselves as a supplement they got a bit carried away with. The word “opioid” often does not enter the picture until a doctor says it.

The recognisable signs, from inside: the gap between doses collapsing to a few hours. Feeling ill rather than merely flat when you are late. Buying out a shop’s stock because running out is now something you plan against. Any of those is the thing to act on, and now is much better than later.

If you take it while pregnant, tell the obstetric team. A baby withdrawing from an opioid nobody knew about is a genuine emergency, and it is entirely manageable if the team knows in advance.

Interactions and combinations

Treat this as an opioid, because it is one.

The dangerous combinations are other central nervous system depressants: alcohol, benzodiazepines, gabapentin or pregabalin, sedating antihistamines, and other opioids. That combination is what causes breathing to stop, and it is the mechanism behind most opioid deaths.

Naloxone can reverse a tianeptine overdose, and published cases describe exactly that. If you or someone in your household uses it, having naloxone nearby is a sensible precaution — it is available without prescription in every US state, free from many harm-reduction programmes, and it does no harm if given to someone who turns out not to need it. Two caveats that matter: it may take more than one dose, and it can wear off before the drug does, so call emergency services as well and do not leave the person alone even if they wake up and say they are fine.

Because tianeptine is also used as an antidepressant, there are real interactions with other psychiatric medication, particularly MAO inhibitors. If you take anything prescribed for mood, this needs a pharmacist’s input.

And because products sold as tianeptine have contained other drugs entirely, an unexpected reaction may not be a tianeptine reaction at all. If someone becomes acutely unwell, take the packaging with you.

If you’re already using it

The most useful thing on this page for you is probably this: what is happening to you is an opioid dependence, and that means the treatments that work for opioid dependence work for this. Buprenorphine and methadone are used for tianeptine dependence, and they work. That is a much better position to be in than most people fear when they realise what they have been taking.

Practical steps:

Tell a clinician the actual product name and that tianeptine is a μ-opioid agonist. Most American clinicians have not encountered it, and it will not appear on a standard urine drug screen. That sentence gives them everything they need.

Get naloxone, and make sure someone you live with knows where it is.

Do not simply stop if you have been using it heavily and often. Tianeptine withdrawal is not usually life-threatening in the way alcohol or phenibut withdrawal can be, but it is severe, and it is one of the harder opioid withdrawals people describe. There is medical treatment for it and there is no reason to do it unmedicated.

Stopping tianeptine covers what to expect and how to find treatment without insurance.

If you have been using this regularly and want to stop: read this first. Stopping abruptly is the part that goes wrong.

This page has not yet been reviewed by a clinician. It was written from the published literature and every claim is cited, but no named medical professional has checked it. We say so here rather than let a missing byline read as an implicit one.

Last reviewed 7 September 2026. Found something wrong? Corrections are published, not silently edited.