Characteristics of Tianeptine Exposures Reported to the National Poison Data System — United States, 2000–2017

Abstract

Background: Tianeptine is an atypical tricyclic drug that is used as an antidepressant in Europe, Asia, and Latin America. Although it is not approved for medical use by the U.S. Food and Drug Administration (FDA), tianeptine is available for purchase online. Animal and human studies showed that tianeptine is an opioid receptor agonist. Several published cases of tianeptine poisoning describe various adverse effects from recreational abuse. Our study objective is to characterize calls about tianeptine exposures reported to the National Poison Data System (NPDS) between 2000 and 2017. Method(s): We reviewed all calls reporting tianeptine exposure in NPDS during January 2000-December 2017. Call counts were analyzed by year, region (U.S. census regions), demographics, exposure reason, exposure route, and co-exposures. We analyzed single tianeptine exposure calls (excluding withdrawal-associated calls) to characterize clinical effects, therapies, medical outcome, and level of care. We calculated frequencies of categorical variables and means of continuous variables using SAS 9.3. The SAS procedure, GENMOD, was used to test for trend significance in exposure calls from 2014 to 2017. We used Fisher's exact test to test for associations between outcome severity and multiple versus single exposures, age groups, and gender. Statistical significance was defined as <0.05. Result(s): During the study period, NPDS received 218 tianeptine exposure-related calls. Of those, 114 (52%) were single substance exposures to tianeptine, excluding withdrawal-associated calls (n=29). The increasing yearly trend was statistically significant (p