Question - What drug, not currently approved by the U.S FDA, is an atypical tricyclic drug used as an antidepressant in Europe, Asia, and Latin America that has opioid receptor agonist activity and has recently been reported to cause severe adverse effects including death from recreational abuse?
Answer - The cited reference notes “Tianeptine (marketed as Coaxil or Stablon) is an atypical tricyclic drug used as an antidepressant in Europe, Asia, and Latin America. In the United States, tianeptine is not approved by the Food and Drug Administration (FDA) for medical use and is an unscheduled pharmaceutical agent. Animal and human studies show that tianeptine is an opioid receptor agonist. Several case studies have reported severe adverse effects and even death from recreational abuse of tianeptine.” (El Zahran T, et al. Characteristics of tianeptine exposures reported to the National Poison Data System- United States, 2000-2017, MMWR Morb Mortal Wkly Rep 2018; 67:815-818)