From Antidepressant Tianeptine to Street Drug ZaZa: A Narrative Review

The confusion surrounding tianeptine must be cleared up: it is not a nootropic or harmless drug that can safely be sold over the counter or online without a prescription. The drug offers an initial and highly pleasurable euphoria, and this psychoactive effect makes it appealing to drug abusers who may combine it with other drugs in a “stack” for polysubstance abuse. Dependency is the expected result of prolonged exposure to supratherapeutic doses of tianeptine, triggering withdrawal symptoms if the drug is stopped abruptly or drastically reduced. Greater awareness is needed by the public who see this drug merely as a harmless over-the-counter cognitive enhancer; greater awareness is needed by merchants who sell this drug believing it is benign; and greater awareness is needed among clinicians in terms of discussing this drug with patients. Guidance as to how to treat tianeptine toxicity and rehabilitation are needed as well. Tianeptine represents a new and slow-moving public health crisis that must be efficiently and immediately addressed.

Tianeptine, ZaZa
What is tianeptine? Lawmakers sound the alarm on 'gas station heroin'

A bipartisan group of lawmakers is asking federal regulators to take action on an over-the-counter substance known as "gas station heroin."

Tianeptine is a tricyclic antidepressant used in some parts of Europe, Asia and South America, but the U.S. Food and Drug Administration has not approved its use in the United States. Sold at gas stations across the country under names like "ZaZa Red" and "Neptune’s Elixir," tianeptine use can lead to serious health complications and even death, according to the New Jersey Poison Center. 

People with an opioid use disorder may be more likely to use tianeptine, the New Jersey Poison Center explains, "as it is inaccurately marketed as a safer alternative to opioids and can have  opioid-like effects," the New Jersey Poison Center explains in a bulletin on its website. 

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