Drug & supplement interaction

Tianeptine + Acetaminophen, Codeine, Doxylamine

Acetaminophen, Codeine, Doxylamine brand name: Mersyndol.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Tianeptine has a moderate interaction with Acetaminophen, Codeine, Doxylamine. Tianeptine has sedative effects; high doses may have additive effects with other CNS depressants.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
Know someone taking this? Share
Facebook Post Reddit Email
On this page
Interaction report

Tianeptine and Acetaminophen, Codeine, Doxylamine

Here is the interaction we found between these two, with the evidence behind it.

Moderate

CNS DEPRESSANTS

Why this applies to Acetaminophen, Codeine, Doxylamine

Acetaminophen, Codeine, Doxylamine falls under CNS DEPRESSANTS — the group Tianeptine interacts with.

Tianeptine has sedative effects; high doses may have additive effects with other CNS depressants.
Higher doses of tianeptine have opioid like effects and may have additive effects with other sedative drugs. In one case report, a 42-year-old male presented with respiratory depression and aspiration pneumonia due to concomitant use of high-dose tianeptine and alprazolam.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the concern with combining tianeptine and a product like Mersyndol. That tablet already carries two ingredients that calm the nervous system: codeine, an opioid pain reliever, and doxylamine, a sedating antihistamine. Tianeptine, especially at the high doses found in those gas station products, behaves much like an opioid itself. Stacking these together can pile on the sedation, so you could feel unusually drowsy, foggy, or dizzy. In a worst case, breathing can slow down dangerously, which is the real risk with opioids on board.

This is graded as a theoretical, pharmacology-based interaction, but a real case report linked high-dose tianeptine plus a sedative to serious breathing trouble. Please don't mix these without talking to your doctor or pharmacist first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Lauhan R, Hsu A, Alam A, Beizai K. Tianeptine Abuse and Dependence: Case Report and Literature Review. Psychosomatics. 2018;59(6):547-553. PubMed
  2. Lucaj S, Leo RJ. Tianeptine Sodium: A Nootropic With Potentially Lethal Consequences. Prim Care Companion CNS Disord. 2018;20(4).
  3. Samuels BA, Nautiyal KM, Kruegel AC, et al. The Behavioral Effects of the Antidepressant Tianeptine Require the Mu-Opioid Receptor. Neuropsychopharmacology. 2017;42(10):2052-2063. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Tianeptine Also Interacts With Other Medications

Tianeptine has 9 major, 267 moderate known drug interactions in our database — the Acetaminophen, Codeine, Doxylamine one above is one of them. If you take anything else, check it against the full list below.

Major 9 Moderate 267 No known interaction 2,554 (incl. Acetaminophen, Codeine, Doxylamine)
Taking anything else?

Check Another of Your Medications Against Tianeptine

Covers the 2,830 medications we’ve checked against Tianeptine. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Acetaminophen, Codeine, Doxylamine

This page covers Tianeptine only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Codeine, Doxylamine page lists 261 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: 1,4-butanediol (major), Activated Charcoal (major), Asarabacca (major), Beer (major) and Gamma-hydroxybutyrate (ghb) (major).

By severity: 11 major · 208 moderate · 42 minor.

From our pharmacist’s overview on the Acetaminophen, Codeine, Doxylamine page

“Mersyndol pairs acetaminophen with codeine and doxylamine, two sedating drugs in one tablet, so I read its interaction list with genuine vigilance. Of the 261 supplements and herbs on file, the biggest hazard is anything else that slows the brain: 78 ingredients add sedation, and that group holds several of the 11 major-rated entries,…”

Reviewed by 2 · Jul 18, 2026

Open the Acetaminophen, Codeine, Doxylamine interaction page

How much people look this up

Where Tianeptine and Acetaminophen, Codeine, Doxylamine Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Tianeptine
Steady interest

#1,063 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Acetaminophen, Codeine, Doxylamine
Steady interest

#1,584 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Tianeptine

What is Tianeptine?

  • Depression (prescription use in some countries)
  • Anxiety
  • Mood enhancement
  • Pain relief
  • Self-treatment of opioid withdrawal
  • Recreational euphoria

Tianeptine is a prescription antidepressant in some countries, but it is NOT approved by the FDA in the United States and is illegally sold in dietary supplements and 'gas station' products. At high doses it acts like an opioid and carries serious risks of addiction, overdose, and dangerous withdrawal. We strongly advise against using over-the-counter tianeptine products and urge anyone considering it to talk with a doctor or pharmacist first.

Read the full Tianeptine monograph & all interactions
Keep checking

Other Drugs & Tianeptine

Browse every other medication we’ve checked against Tianeptine — both the ones with a known interaction and the ones without. Select any drug for the full detail.

9Major
267Moderate
0Minor
2,553No known interaction
9 Major 267 Moderate 2,553 No interaction
Major

9 interactions

Moderate

267 interactions

Showing 60 of 267 moderate interactions — see all 267 on the Tianeptine page.

No interaction 2,553 drugs checked — show the list

We also checked Tianeptine against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,553 medications checked with no known interaction — see the full Tianeptine list.

See the full Tianeptine interactions page
See every supplement checked against Acetaminophen, Codeine, Doxylamine, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Tianeptine monograph › Uses, safety, and every drug interaction in one place Acetaminophen, Codeine, Doxylamine supplement interactions › Every supplement checked against Acetaminophen, Codeine, Doxylamine, ranked by severity Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Tianeptine and Acetaminophen, Codeine, Doxylamine Together: Common Questions

Can you take Tianeptine with Acetaminophen, Codeine, Doxylamine?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Tianeptine and Acetaminophen, Codeine, Doxylamine interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Acetaminophen, Codeine, Doxylamine and Tianeptine?

Our pharmacists answer your medication & supplement questions — free.

Ask a pharmacist

This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.