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Case Reports
. 2023 Aug 1:11:162-164.
doi: 10.1016/j.toxrep.2023.07.006. eCollection 2023 Dec.

"Tianeptine abuse via novel, extended-release, star-shaped, drug delivery device"

Henrik Galust  1 , Justin A Seltzer  1 , Jeremy R Hardin  1 , Nathan A Friedman  1 , Alicia Minns  1
Affiliations
Case Reports

"Tianeptine abuse via novel, extended-release, star-shaped, drug delivery device"

Henrik Galust et al. Toxicol Rep. .

Abstract

We report a rare domestic case of exposure to tianeptine and use of a novel, extended-release, six-armed, star-shaped, drug delivery capsule. A 40-year-old male with a history of depression, anxiety, ethanol, opioid, cannabis, and tobacco use disorders presented to the emergency department (ED) from a substance abuse residential recovery treatment program after developing hypertension, tachycardia, and tremor for two day. He used an extended-release, six-armed, star-shaped, drug delivery device he purchased online, filling each arm with 15 mg of tianeptine (90 mg total). His intention was to mitigate the symptoms of kratom/opioid withdrawal through this extended-release method while simultaneously undergoing formal treatment for ethanol withdrawal. Tianeptine is an atypical tricyclic antidepressant that exerts complex mechanisms of action including serotonin (5-HT) neuromodulation as well as full μ-opioid and ∂-opioid receptor agonism. The capsule itself is made of caprolactone, which is a bioabsorbable material similar to absorbable sutures, initially developed as a long-term enteral antimalarial delivery method and is not FDA approved for human use. Over the course of the patients two day hospitalization course he developed symptoms consistent with uncomplicated ethanol withdrawal, which were treated with as-needed phenobarbital. No clinical manifestations of opioid or serotonin toxicity developed. Serial EKGs and telemetry monitoring remained unchanged. The patient was then medically cleared and discharged back to the residential recovery treatment program.

Keywords: Coaxil; Delayed-release Capsule; Stablon; Tatinol; Tianeptine.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

ga1
Graphical abstract
Image 1
Image 1
Star-shaped, polyester-based, delayed drug release capsule. Representative image courtesy of Robert Langer; Langer Labs MIT.
Image 2
Image 2
Structural similarity shared by tianeptine and tricyclic antidepressant amitriptyline.
See this image and copyright information in PMC

References

    1. Gupta S., Wallace R., Sloshower J. Online sales of unscheduled pharmaceutical agents: a case report of tianeptine use in the United States. J. Addict. Med. 2017;11(5):411–412. doi: 10.1097/adm.0000000000000342. PMID: 28742625. - DOI - PubMed
    1. Guelfi J.D., Dulcire C., Le Moine P., Tafani A. Clinical safety and efficacy of tianeptine in 1,858 depressed patients treated in general practice. Neuropsychobiology. 1992;25(3):140–148. doi: 10.1159/000118824. - DOI - PubMed
    1. Guelfi J.D. Efficacy of tianeptine in comparative trials versus reference antidepressants. An overview. Br. J. Psychiatry Suppl. 1992;15:72–75. - PubMed
    1. Wagstaff A.J., Ormrod D., Spencer C.M. Tianeptine: a review of its use in depressive disorders. CNS Drugs. 2001;15(3):231–259. doi: 10.2165/00023210-200115030-00006. - DOI - PubMed
    1. Nickel T., Sonntag A., Schill J., et al. Clinical and neurobiological effects of tianeptine and paroxetine in major depression. J. Clin. Psychopharmacol. 2003;23(2):155–168. doi: 10.1097/00004714-200304000-00008. - DOI - PubMed

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