Herb & supplement monograph

Tianeptine Drug Interactions, Uses, Effectiveness, Safety & More

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS ·Updated July 2026

What is this page for?

First and foremost: how Tianeptine interacts with medications. The heart of this page is the interaction list — every drug Tianeptine is known to interact with, and how serious each one is.

But these pages have grown well beyond that into a full monograph — what Tianeptine is, what people use it for and how strong the evidence is, its safety and side effects, and answers to the questions we’re asked most — written and reviewed by the clinical staff at HelloPharmacist. It’s educational information from our licensed clinical databases, not medical advice, and we don’t sell or endorse products. Our editorial policy

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Tianeptine Drug Interactions: The Bottom Line

From the HelloPharmacist Editorial Team · Updated July 2026

Based on the available evidence, the overall risk of a clinically significant Tianeptine drug interaction is moderate for most people, and a small number of combinations can be dangerous. Nearly all of the listed interactions are rated moderate, but a handful are major, and none are minor.

Interactions deserving the most attention

The most serious concern is combining tianeptine with MAOIs, where human-supported evidence suggests a risk of severe reactions including dangerous blood pressure changes, fever, seizures, and even death. CNS depressants such as benzodiazepines also deserve caution, since higher doses of tianeptine have opioid-like sedative effects, and one reported case involved slowed breathing when it was taken with alprazolam. Human research also shows alcohol works the other way, lowering tianeptine levels and possibly weakening its effects.

What the rest of the list means

A long interaction list does not mean every combination is harmful. Most entries are moderate rather than severe, and some rest on limited evidence, such as the aspirin interaction, which comes from lab research showing the two drugs compete for the same carrier proteins in the blood rather than from proven effects in people.

Check your medications against Tianeptine

Based on HelloPharmacist’s Tianeptine interaction data and reviewed under our editorial standards.

Interaction report

Drugs that interact with Tianeptine

277 medications have a known interaction with Tianeptine, graded by severity. Select any drug for the full evidence-based detail.

9 major interactions. These combinations can be clinically significant — best avoided, or used only with close professional supervision. Always check with your pharmacist before combining them with Tianeptine.

Don’t want to scroll the list? Just ask.

Tell us the medications you take and we’ll check each one against Tianeptine using our pharmacist-reviewed interaction data.

AI summaries are generated from our Tianeptine interaction data for education only — always confirm with your pharmacist. How we use AI

2,830 drugs

Read The List Like a Pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
Probable. Interaction 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.
Possible. 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
Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
Each drug listed above links to the full report for that exact Tianeptine combination — clinical detail, likelihood, evidence level, and citations.
Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

The big picture

The kinds of drugs Tianeptine affects

Every type of medication (drug category) Tianeptine is known to interact with. Open any category for the detail — or search your exact drug in the checker above.

All 4 drug categories Tianeptine interacts with

Monoamine Oxidase Inhibitors (maois)Alcohol (ethanol)AspirinCns Depressants

Monoamine Oxidase Inhibitors (Maois)

Tianeptine may increase the toxicity of MAOIs.
Concomitant use of tianeptine and non-selective MAOIs might increase the risk of cardiovascular collapse, hypertension, fever, convulsions, and death.

Likelihood Probable Evidence C

Alcohol (Ethanol)

Alcohol increases the clearance and might reduce the levels and clinical effects of tianeptine.
Clinical research shows that alcohol decreases tianeptine absorption rate and lowers tianeptine plasma levels by about 30%. Furthermore, an analysis of alcohol blood levels in 112 patients suggests that alcohol use disorder is associated with a 124% increase in clearance of tianeptine.

Likelihood Probable Evidence B

Aspirin

Chronic use of aspirin might increase the levels and clinical effects of tianeptine.
Aspirin is converted to salicylic acid in the body. In vitro research shows that salicylic acid binds to the same protein sites as tianeptine, displacing protein-bound tianeptine and leading to higher levels of tianeptine in the blood.

Likelihood Possible Evidence D

Cns Depressants

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.

Likelihood Possible Evidence D

Monograph

Tianeptine: Uses, Safety & Side Effects

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS · Reviewed July 2026 ·

The bottom line

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.

Part used: Synthetic chemical compound (not a plant)
Common forms: Tablets, capsules, powders, and liquid 'gas station' products

People commonly use it for

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

Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.

Safety at a glance

OverallBest avoided

Tianeptine sold in supplements carries serious risks of addiction, overdose, and death, and is not FDA-approved in the U.S.

PregnancyPossibly 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...

Read the full pregnancy detail

BreastfeedingInsufficient reliable information

There is insufficient reliable information available about the use tianeptine during lactation. However, tianeptine is a tricyclic antidepressant, and...

Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

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Overview

Tianeptine is a man-made (synthetic) drug, not an herb or plant. It was originally developed decades ago as a prescription antidepressant and is approved for that use in some countries in Europe, Asia, and Latin America under brand names like Stablon and Coaxil.

In the United States, tianeptine is not approved by the FDA for any medical use. Despite this, it is sold illegally in some dietary supplements, powders, and 'gas station' pills, often marketed for mood, energy, focus, or pain. The FDA has warned the public about these products. Because tianeptine can act like an opioid at higher doses, it has been nicknamed 'gas station heroin.'

How it works

Tianeptine affects several brain systems. At normal therapeutic doses, it influences glutamate signaling and may affect serotonin in ways that differ from typical antidepressants. Researchers think this may help with mood.

Importantly, tianeptine also activates the body's mu-opioid receptors — the same receptors that opioid drugs like morphine act on. This opioid-like activity becomes much stronger at the high doses found in some abused products, which is why it can cause euphoria, dependence, and dangerous withdrawal. Much of what we understand about its receptor effects comes from laboratory and animal research.

Effectiveness

Does Tianeptine work?

Here’s what the research actually shows for each use — graded by Natural Medicines and reviewed by Dr. Brian Staiger, PharmD.

Evidence overview · 7 uses evaluated

1 Possibly effective 6 Insufficient evidence

How to read these evidence grades

Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.

1EffectiveStrong, consistent evidence it works.

2Likely EffectiveGood evidence, though not yet conclusive.

3Possibly EffectiveSome evidence suggests a benefit.

4Possibly IneffectiveSome evidence it may not help.

5Likely IneffectiveFairly strong evidence it doesn’t help.

6IneffectiveStrong evidence it doesn’t work.

7Insufficient Reliable Evidence to RateToo little research to say either way.

Possibly Effective Depression