Tianeptine as an opiate replacement in a patient on methadone treatment: A case report

Authors

DOI:

https://doi.org/10.5055/jom.0851

Keywords:

tianeptine, opioid use disorder, methadone, case report

Abstract

Tianeptine, an antidepressant and full μ-opioid receptor agonist, has increased in popularity and has been used as an over-the-counter supplement over the past decade. Due to its well-documented euphoric effects, there exists elevated risk for potential abuse. Buprenorphine–naloxone has been successfully utilized to treat opioid use disorder (OUD) in patients concurrently using tianeptine, limiting withdrawal symptoms and abstinence. However, there is limited evidence on the management of tianeptine use disorder, specifically methadone or naltrexone. The current opioid epidemic, the emerging use of tianeptine, and the lack of physician awareness have emphasized the need for further research on the role of tianeptine in medication-assisted treatment for OUD. This case report aims to demonstrate how medication-assisted therapy can be successfully utilized in a patient with opioid and severe other (tianeptine) drug use disorder.

Author Biographies

Vivek Velagapudi, BS

School of Medicine, University of Kansas Medical Center, Kansas City, Kansas

Jordan Calabrese, MD

Department of Psychiatry and Behavioral Sciences, University of Kansas Health System, Kansas City, Kansas

Roopa Sethi, MD

Department of Psychiatry and Behavioral Sciences, University of Kansas Health System, Kansas City, Kansas

References

Szczesniak L, Sullivan R: Microdose induction of buprenorphine in a patient using tianeptine. J Addict Med. 2022; 16(6): 736-738. DOI: 10.1097/ADM.0000000000001003. DOI: https://doi.org/10.1097/ADM.0000000000001003

National Center for Biotechnology Information: PubChem compound summary for CID 68870, tianeptine. Available at https://pubchem.ncbi.nlm.nih.gov/compound/Tianeptine. Accessed March 29, 2023.

Trowbridge P, Walley AY: Use of buprenorphine-naloxone in the treatment of tianeptine use disorder. J Addict Med. 2019; 13(4): 331-333. DOI: 10.1097/ADM.0000000000000490. DOI: https://doi.org/10.1097/ADM.0000000000000490

Baird TR, Akbarali HI, Dewey WL, et al.: Opioid-like adverse effects of tianeptine in male rats and mice. Psychopharmacology (Berl). 2022; 239(7): 2187-2199. DOI: 10.1007/s00213-022-06093-w. DOI: https://doi.org/10.1007/s00213-022-06093-w

Lauhan R, Hsu A, Alam A, et al.: Tianeptine abuse and dependence: Case report and literature review. Psychosomatics. 2018; 59(6): 547-553. DOI: 10.1016/j.psym.2018.07.006. DOI: https://doi.org/10.1016/j.psym.2018.07.006

Algera H, van der Schrier R, Cavalla D, et al.: Respiratory effects of the atypical tricyclic antidepressant tianeptine in human models of opioid-induced respiratory depression. Anesthesiology. 2022; 137(4): 446-458. DOI: 10.1097/ALN.0000000000004324. DOI: https://doi.org/10.1097/ALN.0000000000004324

Chu CC, Shieh JP, Shui HA, et al.: Tianeptine reduces morphine antinociceptive tolerance and physical dependence. Behav Pharmacol. 2010; 21(5-6): 523-529. DOI: 10.1097/FBP.0b013e32833db7d4. DOI: https://doi.org/10.1097/FBP.0b013e32833db7d4

Camenga DR, Colon-Rivera HA, Muvvala SB: Medications for maintenance treatment of opioid use disorder in adolescents: A narrative review and assessment of clinical benefits and potential risks. J Stud Alcohol Drugs. 2019; 80(4): 393-402. DOI: https://doi.org/10.15288/jsad.2019.80.393

Gagnier JJ, Kienle G, Altman DG, et al.: The CARE guidelines: Consensus-based clinical case reporting guideline development. Headache. 2013; 53(10): 1541-1547. DOI: 10.1111/head.12246. DOI: https://doi.org/10.1111/head.12246

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Association, 2013. DOI: https://doi.org/10.1176/appi.books.9780890425596

Wesson DR, Ling W: The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003; 35(2): 253-259. DOI: 10.1080/02791072.2003.10400007. DOI: https://doi.org/10.1080/02791072.2003.10400007

Vandel P, Regina W, Bonin B, et al.: Abuse of tianeptine. A case report. Encephale. 1999; 25(6): 672-673.

Khazaeli A, Jerry JM, Vazirian M: Treatment of kratom withdrawal and addiction with buprenorphine. J Addict Med. 2018; 12(6): 493-495. DOI: 10.1097/ADM.0000000000000435. DOI: https://doi.org/10.1097/ADM.0000000000000435

Published

02/08/2024

How to Cite

Velagapudi, V., J. Calabrese, and R. Sethi. “Tianeptine As an Opiate Replacement in a Patient on Methadone Treatment: A Case Report”. Journal of Opioid Management, vol. 20, no. 1, Feb. 2024, pp. 87-91, doi:10.5055/jom.0851.

Issue

Section

Clinical Report