The opioid crisis in the United States continues, with most people aware of the dangers of prescription opioid abuse, heroin, and fentanyl.
However, a new risk has emerged—tianeptine.
Tianeptine is being used as an opioid substitute. The U.S. Food and Drug Administration (FDA) has warned consumers that this unapproved drug, often found in dietary supplements, is not a safe alternative to opioids.
What Tianeptin? (The Zaza drug)
Tianeptine is an antidepressant used in some countries to treat depression and anxiety.
Often sold under names like “Zaza Red” or “Tianna,” tianeptine has gained attention due to its opioid-like effects and potential for abuse.
Foreign brand names for Tianeptine include:
- Coaxil
- Tatinol
- Stablon
- Neluptin
- Neptika
- Tialera
- Aneptinex
- Lyxit
Why is tianeptine called “the Zaza drug”?
Tianeptine has become widely known as “Zaza” due to its branding in unregulated supplements sold at gas stations, vape shops, and online. People use it for its supposed mood-boosting and opioid-like effects.
Tianeptine side effects
When taken in high doses, tianeptine can lead to serious health complications. Side effects of Zaza include:
- Dependence: Regular use at high doses increases the likelihood of addiction.
- Withdrawal symptoms: Stopping tianeptine after heavy use can cause severe withdrawal effects.
- Toxicity: Excessive consumption can lead to harmful effects on the body.
- Respiratory depression: High doses can slow breathing, posing a life-threatening risk.
- Mortality: Severe cases of misuse have resulted in fatal overdoses.
- Moderate or major health effects: Many single-substance exposures reported to U.S. poison centers indicate serious complications.
Tianeptine withdrawal symptoms
Stopping tianeptine, especially after prolonged use, can lead to withdrawal symptoms similar to opioid withdrawal. These symptoms include:
- Agitation: Users may feel restless, irritable, or highly anxious.
- Nausea and vomiting: Digestive distress is common during withdrawal.
- Tachycardia (rapid heart rate): The heart rate may increase significantly.
- Hypertension (high blood pressure): Elevated blood pressure can cause additional health risks.
- Diarrhea: Gastrointestinal issues often occur when stopping use.
- Tremors: Shaking or muscle spasms may develop.
- Excessive sweating: Increased perspiration is frequently reported.
- Constipation and urinary retention: Some individuals may experience difficulty with bowel movements or urination.
- Chest pain and shortness of breath: Cardiovascular symptoms can arise in severe cases.
- Palpitations: Users may experience an irregular or racing heartbeat.
- Headaches and blurry vision: Neurological effects can include migraines or vision disturbances.
- Fevers and chills: Body temperature fluctuations are common.
- Anorexia: Appetite loss may occur, leading to weight loss.
Are Zaza pills (Tianeptine) illegal?
The legality of tianeptine in the United States depends on where you live. Some states have banned it, while others still allow its sale.
Federal status of tianeptine
At the federal level, tianeptine is not currently classified as a controlled substance under the U.S. Controlled Substances Act. However:
- A bill was introduced in January 2024 to classify tianeptine as a Schedule III controlled substance.
- The FDA has not approved tianeptine for medical use in the U.S., meaning doctors cannot prescribe it.
State-level restrictions
Some states have taken action to ban or regulate tianeptine due to safety concerns. Examples include:
- Tennessee: Classified as a Schedule II controlled substance since July 1, 2022.
- Alabama: Regulated as a controlled substance since 2021.
- Michigan, Ohio, and Georgia: Tianeptine is banned in these states due to concerns about misuse and public health risks.
If you're struggling with Tianeptine addiction, reach out to our Counselors for support.
How tianeptine leads to addiction
Tianeptine works in a way that makes addiction more likely. This happens due to:
- Withdrawal symptoms: When someone stops using tianeptine, they may experience difficulty breathing, agitation, and vomiting, making it hard to quit.
- Opioid-like effects: Tianeptine activates opioid receptors, creating a feeling of euphoria. This can make people want to use it repeatedly.
- Rapid tolerance: Over time, users need higher doses to feel the same effects, leading to increased use.
- Short-lasting effects: The euphoric effects wear off quickly, causing users to take tianeptine multiple times a day.
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Tianeptine case study reports showing dangerous reactions
A CNN report from 2018 detailed a case study of a 42-year-old man found unresponsive by his wife after using tianeptine.
Emergency responders administered naloxone, which revived him. At the hospital, he admitted to taking more tianeptine than usual to manage chronic back pain.
Another study examined poison control calls related to tianeptine from January 1, 2015, to March 15, 2020.
Out of 48 reviewed cases, 37 occurred between May 2019 and March 2020. More than half required hospitalization, with 17 patients needing intensive care. Naloxone was used in four cases to reverse symptoms.
A CDC report from 2018 documented the death of a 24-year-old California man who had a two-year history of tianeptine misuse. He was found unresponsive on October 10, 2017, and remained in a coma after being transported to the hospital.
A blood sample taken that day showed a tianeptine level of 3,000 ng/mL, far exceeding the therapeutic range of 278–366 ng/mL. An MRI confirmed toxic leukoencephalopathy, a severe brain condition linked to substance use. The man died 19 days later.
Another case report described two fatal tianeptine overdoses in Texas. A 28-year-old man and a 30-year-old man were both found unresponsive in their homes. Investigators found drug paraphernalia and bags labeled as tianeptine at both scenes, linking their deaths to the substance.
Tianeptine overdose: what to do
A tianeptine overdose can be life-threatening. If you or someone else has taken too much, act fast.
When to call 911
Call 911 immediately if you notice:
- Slow or stopped breathing
- Severe confusion or unconsciousness
- Seizures or shaking
- Extreme drowsiness
Naloxone may help. If available, give Naloxone and wait for emergency responders.
While waiting for help
If the person is awake but showing signs of overdose:
- Avoid giving food or water since they may have trouble swallowing.
- Keep them awake by talking to them.
- Watch their breathing and check if it slows down.
- Don’t let them lie on their back to prevent choking.
Treatment for tianeptine addiction
If you are struggling with tianeptine addiction, taking the right steps can help you stop safely and avoid severe withdrawal symptoms. Quitting suddenly can be dangerous, so follow these guidelines for a safer recovery.
What to do if you want to quit
- Do not stop suddenly if you have been using tianeptine for a long time or at high doses. This can cause severe withdrawal symptoms.
- Talk to a doctor about a plan to taper off slowly, reducing your dose over time to lessen withdrawal effects.
- Stay hydrated and eat regularly to help your body recover.
Managing withdrawal symptoms
Tianeptine withdrawal can feel similar to opioid withdrawal. To manage symptoms:
- Use over-the-counter medications for nausea, headaches, or diarrhea.
- Get plenty of rest and allow your body time to adjust.
- Consider professional help if symptoms become too difficult to handle alone.
Comprehensive treatment tailored to you
Online treatment for substance abuse
If you’re struggling with tianeptine addiction and need a flexible, private way to get help, online rehab can provide the support you need.
Whether you’re continuing treatment or looking for an alternative to in-person rehab, Modern Recovery’s virtual program makes high-quality addiction care more accessible.
- Continue working or attending school: Get treatment without disrupting your responsibilities.
- Stay connected to recovery support: Engage in therapy and counseling from the comfort of home.
- Flexible scheduling: Choose session times that fit your lifestyle.
- Private and confidential: Access professional care discreetly, with no need for in-person visits.
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Our online rehab program includes:
- One-on-one therapy: Personalized sessions with licensed professionals who understand substance abuse and tianeptine addiction.
- Online group therapy: Connect with others in recovery for support and accountability.
- Family counseling: Strengthen relationships and improve communication with loved ones.
- Cognitive behavioral therapy (CBT): Learn coping skills to prevent relapse and manage cravings.
- Case management support: Get guidance on long-term recovery planning to stay on track.
Recovery from tianeptine addiction is possible. With the right help, you can take back control of your life.
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Sources
1. Wagner ML, Pergolizzi J Jr, LeQuang JA, Breve F, Varrassi G. From antidepressant tianeptine to street drug ZaZa: a narrative review. Cureus. 2023 Jun 20;15(6):e40688.
2. Quadir M, Rine NI, Badeti J, Hays HL, Michaels NL, Yang J, et al. Tianeptine Exposures Reported to United States Poison Centers, 2015–2023. J Med Toxicol. 2025;21:30–41.
3. Hershey HL, Onyango EM, Durst K, Korona-Bailey J, Mukhopadhyay S. Tianeptine-involved emergency department visits, fatal overdoses, and substance seizures in Tennessee, 2021–2023. Drug Alcohol Depend Rep. 2024 Aug 14;12:100272.
4. Farsani A, Reyes C. Tianeptine’s Obscured Withdrawal, Presentation, and Treatment. Cureus. 2024 Jun 17;16(6):e62554.