From Antidepressant Tianeptine to Street Drug ZaZa: A Narrative Review

Wagner, Michael; Pergolizzi, Joseph V.; LeQuang, Jo Ann; Breve, Frank; Varrassi, Giustino

doi:10.7759/cureus.40688

Cited by 3 publications

(1 citation statement)

References 35 publications

(55 reference statements)

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“…The literature also underscores the need for increased regulatory oversight and public awareness regarding tianeptine. Given the rising number of cases of misuse and the significant health risks associated with its use, some states, including Michigan, Alabama, Ohio, Georgia, and Tennessee, have implemented bans on the sale of tianeptine [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Tianeptine’s Obscured Withdrawal, Presentation, and Treatment

Farsani,

Reyes

2024

Cureus

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The misuse of over-the-counter supplements containing the drug tianeptine poses significant public health concerns, as evidenced by a rise in Poison Control calls and social media discussions regarding its adverse effects. This case report highlights a 67-year-old Caucasian male presenting with symptoms suggestive of tianeptine withdrawal after consuming excessive doses of the supplements daily and their abrupt cessation 12 hours prior to arrival. Despite stable vitals, the patient exhibited anticholinergic toxidrome manifestations, necessitating supportive care and monitoring for acute intoxication. The patient's symptoms resolved, and he was discharged after two days in the hospital. Differential diagnosis complexities underscore the need for enhanced screening protocols and tailored treatment strategies. The discussion emphasizes the importance of prompt identification and management of tianeptine-related complications and calls for heightened awareness among healthcare providers.

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Section: Discussionmentioning

confidence: 99%

Tianeptine’s Obscured Withdrawal, Presentation, and Treatment

Farsani,

Reyes

2024

Cureus

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Navigating the Nomenclature of a Purported “Dietary Supplement”: A Cautionary Tale for Consumers and Practitioners Regarding Tianeptine or “Gas Station Heroin”

Martin

2023

Health

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Dietary supplement sales have surpassed $30 billion per year with their use becoming and remaining extremely popular amongst the general public. There are numerous bioactive components, both nutritive and non-nutritive, in dietary supplements with considerable efficacy in promoting health. However, there are many ways disallowed ingredients may enter the supplement pipeline with potentially toxic effects. Dietary supplements can be regulated (either pre-or post-market) as a drug, dietary supplement, a nutraceutical, new dietary ingredient (NDI), generally recognized as safe (GRAS) food ingredient, a food additive, or a food. A pharmaceutical drug (medication) is used to treat, cure, prevent, or diagnose a disease and is regulated by the FDA pre-market only and allowed by medical prescription, whereas the other labeling designations are largely regulated post-market. One such molecule with a labeling problem is tianeptine, which has global use as an efficacious, prescribed drug, while at the same time being considered a non-drug and potentially dangerous adulterant often referred to as gas station heroin. In this paper, we critically evaluate the use and labeling of this compound and attempt to clarify the conundrum surrounding its legal or illegal use. Tianeptine is effective and efficacious as an antidepressant in those responding poorly to selective serotonin reuptake inhibitors (SSRIs) and exhibits many medicinal characteristics of tricyclic antidepressants with fewer opioid-like side effects. As a result, sixty-six countries permit use of tianeptine as a prescription drug. At higher doses, tianeptine has recently been shown to exhibit significant potential for abuse and dependency along with toxicity. As such, the US does not recognize tianeptine as an FDA-approved drug or as a dietary supple-How to cite this paper: Martin, K.R.

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Nonhormonal Pharmacotherapies for the Treatment of Postmenopausal Vasomotor Symptoms

Witten,

Staszkiewicz,

Gold

et al. 2024

Cureus

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An average of 60-80% of all menopausal women experience bothersome vasomotor symptoms (VMSs), such as flushing and sweating, within the first seven years of onset. However, despite increasing prevalence, these hot flashes remain hard to treat and have a negative effect on the quality of life. Though hormone replacement therapy is commonly utilized as a standard treatment for VMSs, this therapy is not recommended for all women. Specifically, the oral form of hormone replacement therapy is associated with several contraindications, including a history of thromboembolic disease, migraine headache with aura, liver failure, heart disease, and hormone-dependent cancers. For women with these medical conditions, current literature indicates that nonhormonal therapies such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are suitable alternatives to reduce the frequency and intensity of VMSs. Currently, the only SSRI that is FDA-approved for the treatment of VMSs is paroxetine, but studies show that fluoxetine, citalopram, escitalopram, and sertraline are also proven to provide similar benefits. Similarly, the SNRI venlafaxine has also been well tolerated and has been shown to reduce the frequency and severity of hot flashes. The present investigation reviews the physiology of VMSs and examines the evidence for the use of nonhormonal pharmacologic therapies as treatment for women experiencing hot flashes. These interventions should be considered whenever hormone replacement therapy is contraindicated, with therapy individualized based on the severity of symptoms.

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From Antidepressant Tianeptine to Street Drug ZaZa: A Narrative Review

Cited by 3 publications

References 35 publications

Tianeptine’s Obscured Withdrawal, Presentation, and Treatment

Tianeptine’s Obscured Withdrawal, Presentation, and Treatment

Navigating the Nomenclature of a Purported “Dietary Supplement”: A Cautionary Tale for Consumers and Practitioners Regarding Tianeptine or “Gas Station Heroin”

Nonhormonal Pharmacotherapies for the Treatment of Postmenopausal Vasomotor Symptoms

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