Drug & supplement interaction

Tianeptine + Azithromycin

Azithromycin brand names: Zithromax, Zmax, Azasite.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 13, 2026
The bottom line No known interaction

We found no known interaction between Tianeptine and Azithromycin in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

Know someone taking this? Share
Facebook Post Reddit Email
On this page
Interaction report

Tianeptine and Azithromycin

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Azithromycin and Tianeptine in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Tianeptine safety at a glance

Tianeptine overall Avoid Tianeptine sold in supplements carries serious risks of addiction, overdose, and death, and is not FDA-approved in the U.S.
Pregnancy Possibly Unsafe When used orally. Although tianeptine is approved as a prescription drug in certain countries and has been used during pregnancy under the guidance of a healthc... Read the full pregnancy detail
Breastfeeding Avoid Safety while breastfeeding is unknown, and opioid-like effects make it unsafe to use.

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center) — the full detail is in the Special populations card below. Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Azithromycin and Tianeptine? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Azithromycin

Interactions in our licensed database are recorded against drug classes, not just single drug names. Azithromycin is filed under 7 classifications — including macrolide antibiotics, qt interval-prolonging drugs, antibiotic drugs. Tianeptine has documented interactions with 4 drug classes — the most serious being monoamine oxidase inhibitors (maois) (major), alcohol (ethanol) (moderate) and aspirin (moderate) — and none of Azithromycin’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Tianeptine Does Interact With Other Medications

Tianeptine has 9 major, 268 moderate known drug interactions in our database — Azithromycin isn’t one of them. If you take anything else, check it against the full list below.

Major 9 Moderate 268 No known interaction 2,553 (incl. Azithromycin)
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.

What to actually watch for

No Interaction Found — But Data Suggests Tianeptine and Azithromycin May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do. 3 of them are worth acting on rather than waiting out — marked below.

  • Seizures Worth acting on Additional detail

    Tianeptine

    “Orally, tianeptine can cause insomnia, drowsiness, dizziness, and headache when used in prescription doses (25-37.5 mg daily). Orally, recreational use of tianeptine has been associated with agitation, anxiety, confusion, drowsiness, and seizures. In one case, tianeptine misuse was linked to toxic leukoencephalopathy.”

    Tianeptine · Natural Medicines adverse-effect record, reported in anxiety.

    5 sources cited
    1. 100831. Summary of Product Characteristics Stablo: Tianeptine. 2008. Available at: https://www.servier.com.ve/sites/default/files/spc-pil/spc-stablon.pdf
    2. 111549. García-Alberca JM, Gris E, de la Guía P, Mendoza S. Effects of Tianeptine Treatment on Depression and Cognitive Function in Patients with Alzheimer's Disease: A 12-Month Retrospective Observational Study. J Alzheimers Dis 2022;88(2):707-720. PubMed
    3. 100790. Goodnough R, Li K, Fouladkou F, et al. Notes from the Field: Toxic Leukoencephalopathy Associated with Tianeptine Misuse - California, 2017. MMWR Morb Mortal Wkly Rep. 2018;67(27):769-770.
    4. 115958. AQuadir M, Rine NI, Badeti J, et al. Tianeptine Exposures Reported to United States Poison Centers, 2015-2023. J Med Toxicol 2025;21(1):30-41. PubMed
    5. 116138. Hershey HL, Onyango EM, Durst K, Korona-Bailey J, Mukhopadhyay S. Tianeptine-involved emergency department visits, fatal overdoses, and substance seizures in Tennessee, 2021-2023. Drug Alcohol Depend Rep 2024;12:100272. PubMed

    Azithromycin

    Listed in the ADVERSE REACTIONS section of the FDA label for Azithromycin. Read the label on DailyMed ›

  • Liver problems Worth acting on Additional detail

    Tianeptine

    “Orally, tianeptine has been linked to cases of acute allergic hepatitis. It has also been associated with cholestatic or hepatocellular liver damage, occurring after 6 days to 8 weeks of tianeptine use.”

    Tianeptine · Natural Medicines adverse-effect record, reported in hepatitis.

    2 sources cited
    1. 100797. Le Bricquir Y, Larrey D, Blanc P, Pageaux GP, Michel H. Tianeptine--an instance of drug-induced hepatotoxicity predicted by prospective experimental studies. J Hepatol. 1994;21(5):771-3. PubMed
    2. 100807. Voican CS, Corruble E, Naveau S, Perlemuter G. Antidepressant-induced liver injury: a review for clinicians. Am J Psychiatry. 2014;171(4):404-15. PubMed

    Azithromycin

    Listed in the ADVERSE REACTIONS section of the FDA label for Azithromycin. Read the label on DailyMed ›

  • A higher chance of infection Worth acting on reported in 5.4% of FDA reports for Azithromycin Additional detail

    Tianeptine

    “Orally, tianeptine has been associated with aspiration pneumonia. In a case report, a 42-year-old male presented with respiratory depression and aspiration pneumonia due to concomitant use of high-dose tianeptine and alprazolam. His respiration improved after administration of naloxone, and he recovered with supportive care.”

    Tianeptine · Natural Medicines adverse-effect record, reported in depression.

    1 source cited
    1. 100799. Lucaj S, Leo RJ. Tianeptine Sodium: A Nootropic With Potentially Lethal Consequences. Prim Care Companion CNS Disord. 2018;20(4).

    Azithromycin

    Listed in the ADVERSE REACTIONS section of the FDA label for Azithromycin, and in voluntary FDA adverse-event reports. Read the label on DailyMed ›

  • A fast or pounding heartbeat Additional detail

    Tianeptine

    “Orally, prescription or recreational use of tianeptine has been associated with cardiovascular effects such as tachycardia and high blood pressure.”

    Tianeptine · Natural Medicines adverse-effect record, reported in hypertension.

    3 sources cited
    1. 100789. El Zahran T, Schier J, Glidden E, et al. Characteristics of Tianeptine Exposures Reported to the National Poison Data System - United States, 2000-2017. MMWR Morb Mortal Wkly Rep. 2018;67(30):815-818. PubMed
    2. 100831. Summary of Product Characteristics Stablo: Tianeptine. 2008. Available at: https://www.servier.com.ve/sites/default/files/spc-pil/spc-stablon.pdf
    3. 115958. AQuadir M, Rine NI, Badeti J, et al. Tianeptine Exposures Reported to United States Poison Centers, 2015-2023. J Med Toxicol 2025;21(1):30-41. PubMed

    Azithromycin

    Listed in the ADVERSE REACTIONS section of the FDA label for Azithromycin. Read the label on DailyMed ›

  • Drowsiness / Anxiety or restlessness / Trouble sleeping Additional detail

    Tianeptine

    Recorded for Tianeptine in the same Natural Medicines adverse-effect record shown under Liver problems above.

    Azithromycin

    Listed in the ADVERSE REACTIONS section of the FDA label for Azithromycin. Read the label on DailyMed ›

  • Constipation / Diarrhea reported in 4.9% of FDA reports for Azithromycin Additional detail

    Tianeptine

    “Orally, prescription or recreational use of tianeptine has been associated with nausea, vomiting, diarrhea, and constipation.”

    Tianeptine · Natural Medicines adverse-effect record, reported in constipation.

    6 sources cited
    1. 100789. El Zahran T, Schier J, Glidden E, et al. Characteristics of Tianeptine Exposures Reported to the National Poison Data System - United States, 2000-2017. MMWR Morb Mortal Wkly Rep. 2018;67(30):815-818. PubMed
    2. 100792. Guelfi JD, Dulcire C, Le Moine P, Tafani A. Clinical safety and efficacy of tianeptine in 1,858 depressed patients treated in general practice. Neuropsychobiology. 1992;25(3):140-8. PubMed
    3. 100831. Summary of Product Characteristics Stablo: Tianeptine. 2008. Available at: https://www.servier.com.ve/sites/default/files/spc-pil/spc-stablon.pdf
    4. 111549. García-Alberca JM, Gris E, de la Guía P, Mendoza S. Effects of Tianeptine Treatment on Depression and Cognitive Function in Patients with Alzheimer's Disease: A 12-Month Retrospective Observational Study. J Alzheimers Dis 2022;88(2):707-720. PubMed
    5. 115958. AQuadir M, Rine NI, Badeti J, et al. Tianeptine Exposures Reported to United States Poison Centers, 2015-2023. J Med Toxicol 2025;21(1):30-41. PubMed
    6. 116138. Hershey HL, Onyango EM, Durst K, Korona-Bailey J, Mukhopadhyay S. Tianeptine-involved emergency department visits, fatal overdoses, and substance seizures in Tennessee, 2021-2023. Drug Alcohol Depend Rep 2024;12:100272. PubMed

    Azithromycin

    Listed in the ADVERSE REACTIONS section of the FDA label for Azithromycin, and in voluntary FDA adverse-event reports. Read the label on DailyMed ›

  • Tiredness Additional detail

    Tianeptine

    “Orally, tianeptine used in prescription doses (25-37.5 mg daily) may cause asthenia, tremor, and muscle pain. Withdrawal symptoms have occurred after therapeutic doses and may include myalgias, tremors, and myoclonic jerking.”

    Tianeptine · Natural Medicines adverse-effect record, reported in myasthenia gravis.

    2 sources cited
    1. 100831. Summary of Product Characteristics Stablo: Tianeptine. 2008. Available at: https://www.servier.com.ve/sites/default/files/spc-pil/spc-stablon.pdf
    2. 106881. Rushton W, Whitworth B, Brown J, Kurz M, Rivera J. Characteristics of tianeptine effects reported to a poison control center: a growing threat to public health. J. Clin Toxicol (Phila). 2021;59(2):152-7. PubMed

    Azithromycin

    Listed in the ADVERSE REACTIONS section of the FDA label for Azithromycin. Read the label on DailyMed ›

Showing the 10 most notable of 14 shared effects — ranked by how unusual each one is, not just whether both lists mention it.

Reported for Tianeptine but not commonly for Azithromycin: dependence or withdrawal symptoms, raised blood pressure, muscle pain and confusion.

Effects for Azithromycin come from the ADVERSE REACTIONS section of its FDA label; effects for Tianeptine come from the Natural Medicines adverse-effect record, quoted above. Where a percentage is shown, it is the share of 59,712 voluntary FDA FAERS reports for Azithromycin that mention that effect — a reporting proportion, not an incidence rate and not evidence the drug caused it. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

Special populations

Tianeptine in Pregnancy & Breastfeeding

Pregnancy Possibly Unsafe

When used orally. Although tianeptine is approved as a prescription drug in certain countries and has been used during pregnancy under the guidance of a healthcare provider when medically necessary, its use is discouraged. Tianeptine use can lead to neonatal abstinence syndrome (NAS), especially when used recreationally, throughout pregnancy. In case reports, babies born to mothers taking high doses of tianeptine (e.g. 650 mg or more daily) during pregnancy presented with NAS. Symptoms included diarrhea, fever, frequent yawning and sneezing, global hypertonia, high-pitched crying, jitteriness, poor feeding, sweating, undisturbed tremors, vomiting, and weak or excessive sucking. This tianeptine-induced NAS mimicked opiate-induced NAS and was treated successfully with morphine.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.© 2026 Therapeutic Research Center

From our Q&A

Questions About Tianeptine or Azithromycin

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Tianeptine or Azithromycin, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Azithromycin

This page covers Tianeptine only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Azithromycin page lists 92 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), Arsenic (major), Cesium (major) and Ephedra (major).

By severity: 8 major · 71 moderate · 13 minor.

From our pharmacist’s overview on the Azithromycin page

“A five-day Z-Pak for a sinus or chest infection seems too brief to fuss over, but azithromycin (Zithromax, Zmax) deserves genuine caution around supplements, and the eight major-rated entries on this list are the ones to understand first. Most of those involve the heart.”

Reviewed by 2 · Jul 18, 2026

Open the Azithromycin interaction page

How much people look this up

Where Tianeptine and Azithromycin 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

#1,047 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Azithromycin
Top 5%

#60 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.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Tianeptine reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 13, 2026. The Tianeptine and Azithromycin records this page draws on were last updated July 11, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
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.

Synthetic chemical compound (not a plant) · Tablets, capsules, powders, and liquid 'gas station' products

An interaction check asks whether these two react with each other — it does not ask whether Tianeptine is a good idea for someone in your situation. Here is what our Tianeptine record says about it on its own.

Tianeptine: dosing

There is no safe, established over-the-counter dose of tianeptine, and we do not recommend self-dosing with these products. In countries where it is a prescription antidepressant, a doctor sets the dose and monitors the patient closely.The amounts found in U.S. 'supplement' products are often unlabeled, inconsistent, or far higher than any medical dose — which is part of why they are so dangerous.

From our Tianeptine monograph — the full record covers uses, side effects and every documented interaction.

Read the full Tianeptine monograph & all interactions
Medication

About Azithromycin

What Is Azithromycin Used For?

Brand names: Zithromax, Zmax, Azasite

  • Azithromycin is used to treat certain bacterial infections, such as bronchitis; pneumonia; sexually transmitted diseases (STD); and infections of the ears, lungs, sinuses, skin, throat, and reproductive organs. Azithromycin also is used to treat or prevent disseminated Mycobacterium avium complex (MAC) infection [a type of lung infection that often affects people with human immunodeficiency virus (HIV)]. Azithromycin is in a class of medications called macrolide antibiotics. It works by stopping the growth of bacteria.

  • Antibiotics such as azithromycin will not work for colds, flu, or other viral infections. Using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

Most-Reported Side Effects for Azithromycin

From FAERS, the FDA’s public side-effect reporting system (59,712 reports, all brands). Reports are voluntary and are not proof the drug caused the effect.

Dyspnea 4,651 reports
Nausea 3,461 reports
Pneumonia 3,225 reports
Cough 3,120 reports
Drug hypersensitivity 2,991 reports
See full Azithromycin drug information
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
268Moderate
0Minor
2,552No known interaction
9 Major 268 Moderate 2,552 No interaction
Major

9 interactions

Moderate

268 interactions

Showing 60 of 268 moderate interactions — see all 268 on the Tianeptine page.

No interaction 2,552 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 2,552 medications checked with no known interaction — see the full Tianeptine list.

See the full Tianeptine interactions page
See every supplement checked against Azithromycin, ranked by severity
Evidence & sources

Tianeptine References

The 18 references that drive our Tianeptine monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Bence C, Bonord A, Rebillard C, et al. Neonatal Abstinence Syndrome Following Tianeptine Dependence During Pregnancy. Pediatrics. 2016;137(1). PubMed
  2. El Zahran T, Schier J, Glidden E, et al. Characteristics of Tianeptine Exposures Reported to the National Poison Data System - United States, 2000-2017. MMWR Morb Mortal Wkly Rep. 2018;67(30):815-818. PubMed
  3. Goodnough R, Li K, Fouladkou F, et al. Notes from the Field: Toxic Leukoencephalopathy Associated with Tianeptine Misuse - California, 2017. MMWR Morb Mortal Wkly Rep. 2018;67(27):769-770.
  4. Grasela TH, Fiedler-Kelly JB, Salvadori C, Marey C, Jochemsen R. Development of a population pharmacokinetic database for tianeptine. Eur J Clin Pharmacol. 1993;45(2):173-9. PubMed
  5. Guelfi JD, Dulcire C, Le Moine P, Tafani A. Clinical safety and efficacy of tianeptine in 1,858 depressed patients treated in general practice. Neuropsychobiology. 1992;25(3):140-8. PubMed
  6. Lauhan R, Hsu A, Alam A, Beizai K. Tianeptine Abuse and Dependence: Case Report and Literature Review. Psychosomatics. 2018;59(6):547-553. PubMed
  7. Le Bricquir Y, Larrey D, Blanc P, Pageaux GP, Michel H. Tianeptine--an instance of drug-induced hepatotoxicity predicted by prospective experimental studies. J Hepatol. 1994;21(5):771-3. PubMed
  8. Lucaj S, Leo RJ. Tianeptine Sodium: A Nootropic With Potentially Lethal Consequences. Prim Care Companion CNS Disord. 2018;20(4).
  9. Salvadori C, Ward C, Defrance R, Hopkins R. The pharmacokinetics of the antidepressant tianeptine and its main metabolite in healthy humans--influence of alcohol co-administration. Fundam Clin Pharmacol. 1990;4(1):115-25. PubMed
  10. 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
  11. Voican CS, Corruble E, Naveau S, Perlemuter G. Antidepressant-induced liver injury: a review for clinicians. Am J Psychiatry. 2014;171(4):404-15. PubMed
  12. Zini R, Morin D, Salvadori C, Tillement JP. The influence of various drugs on the binding of tianeptine to human plasma proteins. Int J Clin Pharmacol Ther Toxicol. 1991;29(2):64-6.
  13. Summary of Product Characteristics Stablo: Tianeptine. 2008. Available at: https://www.servier.com.ve/sites/default/files/spc-pil/spc-stablon.pdf
  14. Rushton W, Whitworth B, Brown J, Kurz M, Rivera J. Characteristics of tianeptine effects reported to a poison control center: a growing threat to public health. J. Clin Toxicol (Phila). 2021;59(2):152-7. PubMed
  15. García-Alberca JM, Gris E, de la Guía P, Mendoza S. Effects of Tianeptine Treatment on Depression and Cognitive Function in Patients with Alzheimer's Disease: A 12-Month Retrospective Observational Study. J Alzheimers Dis 2022;88(2):707-720. PubMed

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking Tianeptine and Azithromycin Together: Common Questions

Is it safe to take Tianeptine with Azithromycin?
We do not list a known interaction between Tianeptine and Azithromycin. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
Do Tianeptine and Azithromycin have any of the same side effects?
Yes — our sources link each of them separately to 10 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.
How was the Tianeptine and Azithromycin combination checked?
Interactions in our licensed database are recorded against drug classes. Azithromycin is filed under 7 classifications, and Tianeptine has documented interactions with 4 drug classes — none of Azithromycin's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does Tianeptine interact with any other medications?
Yes. Tianeptine has 277 documented drug interactions in our database — Azithromycin is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Azithromycin interact with any supplements?
Yes. Azithromycin has documented interactions with 92 supplements in our database — Tianeptine is not one of them. The Azithromycin interaction page linked on this page lists every one, ranked by severity.

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

Where next

Keep Exploring

Tianeptine monograph Uses, safety profile, and every drug interaction in one place Azithromycin drug information The full plain-English guide to this medication Azithromycin supplement interactions Every supplement checked against Azithromycin, 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 References The 18 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Azithromycin 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.