Tianeptine Use in Dietary Supplements Linked to Neonatal Opioid Withdrawal Syndrome: Study

Researchers recommend doctors ask mothers about dietary supplement the are using, due to the risk of neonatal abstinence syndrome (NAS).

Tianeptine is often referred to as “gas station heroin”, and can be found as an ingredient in several over-the-counter dietary supplements, such as Neptune’s Fix and Tianna. However, new research suggests that use during pregnancy may cause infants to develop severe withdrawal symptoms after birth.

In findings published this month in the medical journal Pediatrics, researchers warn that tianeptine exposure in utero may cause symptoms similar to neonatal opioid withdrawal syndrome, also known by the clinical term neonatal abstinence syndrome, or NAS.

Tianeptine Pregnancy Exposure Risks

Tianeptine is an opioid receptor drug often prescribed in other countries as an antidepressant and sold under brand names like Stablon and Coaxil. In the United States, tianeptine is not approved for medical use by the U.S. Food and Drug Administration (FDA), but is commonly used in dietary supplements.

The drug is known to carry potential risks for abuse and addiction. However, side effects of exposure to tianeptine during pregnancy have not been widely studied.

Only one study from 2015 documented the possible side effects during pregnancy. The research reported a mother dependent on tianeptine with daily use. Her child was born with neonatal opioid withdrawal syndrome and needed treatment with morphine.

In this new study, conducted by researchers from the  University of South Alabama Children’s and Women’s Hospital, documented a case of chronic prenatal exposure due to the mother’s dependence on a dietary supplement containing tianeptine.

The infant developed signs of severe withdrawal shortly after birth. The symptoms were not reduced with phenobarbital, but the infant responded well to morphine therapy, a characteristic of opioid withdrawal syndrome.

Neonatal Opioid Withdrawal Syndrome

Infants suffering side effects of neonatal abstinence syndrome or neonatal opioid withdrawal can experience inconsolable crying, tremors, seizures, difficulty sleeping, irritability, tight muscle tone, hyperactive reflexes, and excessive sneezing or yawning. Doctors often treat infants with small doses of morphine, but other interventions can also help, such as skin-to-skin contact, low lighting, breastfeeding, and comforting actions.

The effects of neonatal opioid withdrawal syndrome can be long-lasting and may impact neurodevelopment, cause changes to cognition and school performance, impaired vision, behavior issues, and increased risk of early death.

There are increasing reports of consumers experiencing side effects from tianeptine, including seizures, agitation, confusion, sweating, rapid heartbeat, nausea, vomiting, hospitalizations, coma, and death.

Despite the potential risks, tianeptine products are sold over-the-counter and are easy to buy as dietary supplements at gas stations, delis, vape shops, convenience stores, and online under brand names like ZaZa and Tianna Red. Several states have banned the use of the drug and the FDA issued a warning in February 2022 about the risks of using dietary supplements containing tianeptine.

“For infants with clinical signs of opioid withdrawal without known etiology, we suggest that the maternal interview should inquire about the use of neurotropic over-the-counter drugs,” the researchers concluded.