MAJOR — Use With Caution
Tianeptine and Opioids — CONTRAINDICATED (Additive Opioid Respiratory Depression)
Evidence level: MODERATE
DANGEROUS COMBINATION. Tianeptine acts on the same brain receptors as opioid painkillers. Taking both is like taking a double dose of opioids, which can cause your breathing to stop and potentially kill you.
Tianeptine is a mu-opioid receptor agonist in addition to its antidepressant properties. Combining with exogenous opioids produces additive mu-opioid receptor activation, leading to enhanced respiratory depression, excessive sedation, and significantly elevated overdose risk. Tianeptine abuse at supratherapeutic doses already causes opioid-like toxicity.
NEVER combine tianeptine with opioid medications. Tianeptine itself has opioid properties. If you are prescribed opioid painkillers, discontinue tianeptine and inform your doctor. Keep naloxone (Narcan) available if using either substance.
Take Hydrocodone as prescribed. Tianeptine can typically be taken with a meal, spaced 1-2 hours from the medication for clean absorption. Discuss this combination with your pharmacist for personalized guidance.
Higher risk for: elderly, opioid-naive patients, those with sleep apnea, respiratory conditions, concurrent CNS depressants (benzodiazepines, alcohol), liver impairment, or history of substance use disorder.
Extreme drowsiness, pinpoint pupils, slow/shallow/stopped breathing, blue lips, loss of consciousness, cold clammy skin. Call 911 immediately.
Disclose tianeptine use. Explain that tianeptine has mu-opioid agonist activity and is used recreationally as an opioid. Discuss safe alternatives for both pain management and mood support.
Opioid combinations carry serious risks including respiratory depression. Talk to your pain management specialist about non-opioid alternatives: physical therapy, NSAIDs (if appropriate), nerve blocks, or non-sedating supplements like PEA (palmitoylethanolamide) or curcumin for inflammation.
DANGEROUS COMBINATION. Tianeptine acts on the same brain receptors as opioid painkillers. Taking both is like taking a double dose of opioids, which can cause your breathing to stop and potentially kill you.
Take Hydrocodone as prescribed. Tianeptine can typically be taken with a meal, spaced 1-2 hours from the medication for clean absorption. Discuss this combination with your pharmacist for personalized guidance.
Extreme drowsiness, pinpoint pupils, slow/shallow/stopped breathing, blue lips, loss of consciousness, cold clammy skin. Call 911 immediately.
Opioid combinations carry serious risks including respiratory depression. Talk to your pain management specialist about non-opioid alternatives: physical therapy, NSAIDs (if appropriate), nerve blocks, or non-sedating supplements like PEA (palmitoylethanolamide) or curcumin for inflammation.
Disclose tianeptine use. Explain that tianeptine has mu-opioid agonist activity and is used recreationally as an opioid. Discuss safe alternatives for both pain management and mood support.
Or browse the full interaction database (121,000+ pairs).