Rankings / Mood, Anxiety & Stress
Tianeptine
Mood, Anxiety & Stress · Atypical antidepressant / mu-opioid agonist
Tier C-
High-risk evidence profile
Bottom line
Read Off Label grades Tianeptine as C- (4.3/10) based on moderate evidence, med benefit magnitude, and a high-risk safety profile.
Its high-risk evidence profile reflects a Safety score of 2/10; reported benefits and harms can differ by indication, dose, route, duration, and population.
Sold OTC as 'ZaZa', 'Tianaa', 'Neptune's Fix' in gas stations.
Studied, labeled, or reported-use context: 12. — Rx in EU/Asia; unscheduled US; not individualized guidance.
What the evidence says
Sold OTC as 'ZaZa', 'Tianaa', 'Neptune's Fix' in gas stations. CDC/FDA multiple safety alerts. Poison control calls and deaths rising steeply. Withdrawal resembles opioid withdrawal. Multiple US states (AL, FL, GA, IN, LA, KY, MI, MN, MS, NJ, OH, TN) have scheduled it. Recreational exposure is associated with opioid-type dependence, withdrawal, and overdose risk.
Mechanism
Originally classified as 'serotonin reuptake enhancer' but primary action is full mu-opioid receptor agonism at clinical doses; also glutamatergic modulation
Studied, labeled, or reported dose & route
12.5 mg 2-3x/day (therapeutic); abusers often ingest hundreds to thousands of mg/day
This records doses and routes described in studies, approved labeling, clinical practice, or documented use. It is not individualized guidance and does not establish safety; context changes with indication, formulation, health history, monitoring, and other medicines.
Citations
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Common questions
- What does the evidence show about Tianeptine's effects?
- Read Off Label rates the evidence for Tianeptine as Moderate and the benefit magnitude as med, producing an overall grade of C- (4.3/10). Sold OTC as 'ZaZa', 'Tianaa', 'Neptune's Fix' in gas stations.
- What safety findings are reported for Tianeptine?
- Tianeptine has a high risk profile in the database. HIGH (mu-opioid agonism = addiction, tolerance, withdrawal, overdose deaths; cardiotoxicity at high doses) Legal status: Rx in EU/Asia; unscheduled US (FDA warnings; state-level scheduling accelerating).
- What does the low Safety score for Tianeptine represent?
- The Safety score is 2/10. It records the substantial harms described for one or more use contexts; the Benefit score, indication, dose, route, duration, population, and legal status remain separate parts of the evidence profile.
- What doses or routes are reported for Tianeptine?
- 12.5 mg 2-3x/day (therapeutic); abusers often ingest hundreds to thousands of mg/day This is context from studies, approved labeling, clinical practice, or documented use; it is not individualized guidance and does not establish safety.
- How does Tianeptine work?
- Originally classified as 'serotonin reuptake enhancer' but primary action is full mu-opioid receptor agonism at clinical doses; also glutamatergic modulation
This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.