Identification

Name
Tianeptine
Accession Number
DB09289
Type
Small Molecule
Groups
Investigational
Description

Tianeptine is a drug used primarily in the treatment of major depressive disorder and has been studied in the treatment of irritable bowel syndrome (IBS) [3]. Structurally, it is classified as a tricyclic antidepressant (TCA), however, it possesses different pharmacological properties than typical tricyclic antidepressants [1].

Tianeptine was discovered and patented by The French Society of Medical Research in the 1960s [29]. Currently, tianeptine is approved in France and manufactured and marketed by Laboratories Servier SA; it is also marketed in several other European countries under the trade name “Coaxil” as well as in Asia (including Singapore) and Latin America as “Stablon” and “Tatinol” but it is not available in Australia, Canada, New Zealand, the U.K. or the U.S.

Structure
Thumb
Synonyms
  • Tianeptina
Product Ingredients
IngredientUNIICASInChI Key
Tianeptine sodiumYG0E19592I30123-17-2ZLBSUOGMZDXYKE-UHFFFAOYSA-M
International/Other Brands
Coaxil / Neptine (Hanmi South Korea) / Salymbra / Stablon / Tatinol / Tianeurax / Zinosal
Categories
UNII
0T493YFU8O
CAS number
72797-41-2
Weight
Average: 436.952
Monoisotopic: 436.122355695
Chemical Formula
C21H25ClN2O4S
InChI Key
JICJBGPOMZQUBB-UHFFFAOYSA-N
InChI
InChI=1S/C21H25ClN2O4S/c1-24-18-9-6-5-8-16(18)21(23-13-7-3-2-4-10-20(25)26)17-12-11-15(22)14-19(17)29(24,27)28/h5-6,8-9,11-12,14,21,23H,2-4,7,10,13H2,1H3,(H,25,26)
IUPAC Name
7-({6-chloro-10-methyl-9,9-dioxo-9λ⁶-thia-10-azatricyclo[9.4.0.0³,⁸]pentadeca-1(15),3(8),4,6,11,13-hexaen-2-yl}amino)heptanoic acid
SMILES
CN1C2=CC=CC=C2C(NCCCCCCC(O)=O)C2=C(C=C(Cl)C=C2)S1(=O)=O

Pharmacology

Indication

Used primarily in the treatment of major depressive disorder and anxiety [1]. It is currently being studied for fibromyalgia pain treatment [23].

Pharmacodynamics

Analyses in large-scale epidemiologic surveys have shown that the anxiety disorders are widely comorbid with major depression. This makes antidepressant with anxiolytic properties particularly unique and attractive [2].

Tianeptine is effective in reducing depressive symptoms in mild to severe major depressive disorder and also alleviates anxious symptoms associated with depression without the need for coadministration of an anti-anxiety medication [2].

These findings, however, are met with controversial data. In a study of healthy volunteers, Tianeptine-treated subjects were less accurate at identifying facial expressions, suggesting a lack of improvement in the psychomotor symptoms of depression. The tianeptine group also showed reduced memory and reduced attentional vigilance to various stimuli [6].

Mechanism of action

Recent studies suggest that tianeptine acts as a full agonist at the mu-type opioid receptor (MOR) [13], [14]. The mu opioid receptors are currently being studied as effective targets for antidepressant therapies [30]. It is believed that the clinical effects of tianeptine are owed to its modulation of these receptors [13]. In addition to its actions on the opioid receptor, previous studies have owed its action to its effect on the serotonin receptor [15], [16], dopamine (D2/3) receptors [17], and glutamate receptors [11], [32], as discussed below:

Tianeptine has challenged the monoaminergic hypothesis of depression, as well as the widely supported monoaminergic mechanisms whereby the action of most known antidepressants have been explained [21]. Specifically, this drug is thought to persistently alter glutamate receptor bursting of the hippocampal CA3 commissural associational synapse [2]. Current research suggests that tianeptine produces its antidepressant effects through the modulation of glutamate receptor activity (for example, AMPA receptors and NMDA receptors) and affect the release of brain-derived neurotrophic factor (BDNF), which impacts neural plasticity [4]. More recent studies by support the role of tianeptine in the modulation of glutaminergic activity in the amygdala, the emotional region of the brain associated with memories [2].

Tianeptine reduces the hypothalamic-pituitary-adrenal response to stress, and thus prevents stress-related behavioral issues [4, 5]. In rodents, the stress of acute restraint increases extracellular levels of glutamate in the basolateral amygdala an effect that was inhibited by tianeptine [2]. Interestingly, the SSRI fluoxetine increased extracellular glutamate levels in the basolateral amygdala regardless of stress conditions. These data demonstrate that the mechanism of action of tianeptine is distinct from SSRIs and support the hypothesis that the mechanism of action of tianeptine relates to alteration of glutaminergic activity in the amygdala and the hippocampus [2, 4].

In addition to the above mechanisms, tianeptine is a unique antidepressant and anxiolytic medication that stimulates the uptake of serotonin (5-hydroxytryptamine; 5-HT), and 5-hydroxyindoleacetic acid (5-HIAA) in brain tissue [2].

Although the monoaminergic neurotransmitters serotonin (5-HT), noradrenaline (NA) and dopamine (DA) are proven to be related to the occurrence of depressive disorders, it is now recognized that monoamine deficits are not sufficient to explain the mechanism of action of antidepressant medications [2].

TargetActionsOrganism
UGlutamate receptor 1
modulator
Human
AMu-type opioid receptor
agonist
Human
U5-hydroxytryptamine receptor 1A
inhibitor
Human
UD(3) dopamine receptor
agonist
Human
Absorption

Well absorbed, approximately 99% bioavailability [9].

Volume of distribution

0.8 L/kg (0.77 +/- 0.31 L/kg) [12]

Protein binding

95% bound to plasma protein [25].

Metabolism

Tianeptine is metabolized primarily by beta-oxidation of its heptanoic side chain [7]. The metabolism of tianeptine was studied after a one-time oral administration of radioisotopically (14C) labeled compound to healthy male volunteers. After 1 week, approximately 66% of the dose was eliminated by the kidneys (55% elimination during the first 24 hr). After 24h, unchanged drug 3% of the drug was found unchanged in the urine. Three major metabolites result from beta-oxidation of Tianeptine. The metabolite profiles of tianeptine in feces and plasma were found to be qualitatively similar to that in urine [8].

Route of elimination

Eliminated with bile as glucuronide and glutamine conjugates [10].

Half life

Approximately 2.5 h [12]

Clearance

Rapidly cleared by the kidneys [25].

Toxicity

There are several published case reports of tianeptine intoxication and death [28]. An overdose of tianeptine can lead to opiod-like effects and lead to respiratory failure and death, due to its direct effect on the mu opioid receptor [28]. In addition, cardiotoxicity can result from an overdose of this medication [28].

Affected organisms
  • Humans
Pathways
Not Available
Pharmacogenomic Effects/ADRs
Not Available

Interactions

Drug Interactions
DrugInteraction
(R)-warfarinThe metabolism of Tianeptine can be decreased when combined with (R)-warfarin.
(S)-WarfarinThe metabolism of Tianeptine can be decreased when combined with (S)-Warfarin.
2,4-thiazolidinedioneTianeptine may decrease the hypoglycemic activities of 2,4-thiazolidinedione.
2,5-Dimethoxy-4-ethylamphetamineThe risk or severity of serotonin syndrome can be increased when 2,5-Dimethoxy-4-ethylamphetamine is combined with Tianeptine.
2,5-Dimethoxy-4-ethylthioamphetamineThe risk or severity of serotonin syndrome can be increased when Tianeptine is combined with 2,5-Dimethoxy-4-ethylthioamphetamine.
3,4-MethylenedioxyamphetamineThe risk or severity of serotonin syndrome can be increased when 3,4-Methylenedioxyamphetamine is combined with Tianeptine.
3,5-diiodothyropropionic acidThe metabolism of Tianeptine can be decreased when combined with 3,5-diiodothyropropionic acid.
4-Bromo-2,5-dimethoxyamphetamineThe risk or severity of serotonin syndrome can be increased when 4-Bromo-2,5-dimethoxyamphetamine is combined with Tianeptine.
4-hydroxycoumarinThe metabolism of Tianeptine can be decreased when combined with 4-hydroxycoumarin.
4-MethoxyamphetamineTianeptine may increase the vasopressor activities of 4-Methoxyamphetamine.
Food Interactions
Not Available

References

General References
  1. Wilde MI, Benfield P: Tianeptine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depression and coexisting anxiety and depression. Drugs. 1995 Mar;49(3):411-39. [PubMed:7774514]
  2. Kole MH, Swan L, Fuchs E: The antidepressant tianeptine persistently modulates glutamate receptor currents of the hippocampal CA3 commissural associational synapse in chronically stressed rats. Eur J Neurosci. 2002 Sep;16(5):807-16. [PubMed:12372016]
  3. Sohn W, Lee OY, Kwon JG, Park KS, Lim YJ, Kim TH, Jung SW, Kim JI: Tianeptine vs amitriptyline for the treatment of irritable bowel syndrome with diarrhea: a multicenter, open-label, non-inferiority, randomized controlled study. Neurogastroenterol Motil. 2012 Sep;24(9):860-e398. doi: 10.1111/j.1365-2982.2012.01945.x. Epub 2012 Jun 11. [PubMed:22679908]
  4. Reagan LP, Hendry RM, Reznikov LR, Piroli GG, Wood GE, McEwen BS, Grillo CA: Tianeptine increases brain-derived neurotrophic factor expression in the rat amygdala. Eur J Pharmacol. 2007 Jun 22;565(1-3):68-75. doi: 10.1016/j.ejphar.2007.02.023. Epub 2007 Feb 20. [PubMed:17368617]
  5. Delbende C, Contesse V, Mocaer E, Kamoun A, Vaudry H: The novel antidepressant, tianeptine, reduces stress-evoked stimulation of the hypothalamo-pituitary-adrenal axis. Eur J Pharmacol. 1991 Sep 24;202(3):391-6. [PubMed:1660816]
  6. Cooper CM, Whiting DA, Cowen PJ, Harmer CJ: Tianeptine in an experimental medicine model of antidepressant action. J Psychopharmacol. 2015 May;29(5):582-90. doi: 10.1177/0269881115573810. Epub 2015 Mar 10. [PubMed:25759404]
  7. Fromenty B, Freneaux E, Labbe G, Deschamps D, Larrey D, Letteron P, Pessayre D: Tianeptine, a new tricyclic antidepressant metabolized by beta-oxidation of its heptanoic side chain, inhibits the mitochondrial oxidation of medium and short chain fatty acids in mice. Biochem Pharmacol. 1989 Nov 1;38(21):3743-51. [PubMed:2597170]
  8. Grislain L, Gele P, Bertrand M, Luijten W, Bromet N, Salvadori C, Kamoun A: The metabolic pathways of tianeptine, a new antidepressant, in healthy volunteers. Drug Metab Dispos. 1990 Sep-Oct;18(5):804-8. [PubMed:1981739]
  9. Salvadori C, Ward C, Defrance R, Hopkins R: The pharmacokinetics of the antidepressant tianeptine and its main metabolite in healthy humans--influence of alcohol co-administration. Fundam Clin Pharmacol. 1990;4(1):115-25. [PubMed:2341111]
  10. Szafarz M, Wencel A, Pociecha K, Fedak FA, Wlaz P, Wyska E: Pharmacokinetic study of tianeptine and its active metabolite MC5 in rats following different routes of administration using a novel liquid chromatography tandem mass spectrometry analytical method. Naunyn Schmiedebergs Arch Pharmacol. 2018 Feb;391(2):185-196. doi: 10.1007/s00210-017-1448-2. Epub 2017 Dec 12. [PubMed:29230490]
  11. McEwen BS, Chattarji S, Diamond DM, Jay TM, Reagan LP, Svenningsson P, Fuchs E: The neurobiological properties of tianeptine (Stablon): from monoamine hypothesis to glutamatergic modulation. Mol Psychiatry. 2010 Mar;15(3):237-49. doi: 10.1038/mp.2009.80. Epub 2009 Aug 25. [PubMed:19704408]
  12. Royer RJ, Albin H, Barrucand D, Salvadori-Failler C, Kamoun A: Pharmacokinetic and metabolic parameters of tianeptine in healthy volunteers and in populations with risk factors. Clin Neuropharmacol. 1988;11 Suppl 2:S90-6. [PubMed:3180120]
  13. Gassaway MM, Rives ML, Kruegel AC, Javitch JA, Sames D: The atypical antidepressant and neurorestorative agent tianeptine is a mu-opioid receptor agonist. Transl Psychiatry. 2014 Jul 15;4:e411. doi: 10.1038/tp.2014.30. [PubMed:25026323]
  14. Samuels BA, Nautiyal KM, Kruegel AC, Levinstein MR, Magalong VM, Gassaway MM, Grinnell SG, Han J, Ansonoff MA, Pintar JE, Javitch JA, Sames D, Hen R: The Behavioral Effects of the Antidepressant Tianeptine Require the Mu-Opioid Receptor. Neuropsychopharmacology. 2017 Sep;42(10):2052-2063. doi: 10.1038/npp.2017.60. Epub 2017 Mar 17. [PubMed:28303899]
  15. Datla KP, Curzon G: Behavioural and neurochemical evidence for the decrease of brain extracellular 5-HT by the antidepressant drug tianeptine. Neuropharmacology. 1993 Sep;32(9):839-45. [PubMed:7694170]
  16. Sonawalla S, Chakraborty N, Parikh R: Treatment of major depression and anxiety with the selective serotonin re-uptake enhancer tianeptine in the outpatient psychiatric care setting of India. J Indian Med Assoc. 2003 Feb;101(2):116-7, 124. [PubMed:12841497]
  17. Dziedzicka-Wasylewska M, Rogoz Z, Skuza G, Dlaboga D, Maj J: Effect of repeated treatment with tianeptine and fluoxetine on central dopamine D(2) /D(3) receptors. Behav Pharmacol. 2002 Mar;13(2):127-38. [PubMed:11981225]
  18. Tianeptine [Link]
  19. Tianeptine [Link]
  20. Tianeptine properties [Link]
  21. The neurobiological properties of Tianeptine (Stablon): from monoamine hypothesis to glutamatergic modulation [Link]
  22. Pharmacokinetic study of tianeptine and its active metabolite MC5 in rats following different routes of administration using a novel liquid chromatography tandem mass spectrometry analytical method [Link]
  23. Effects of tianeptine on symptoms of fibromyalgia via BDNF signaling in a fibromyalgia animal model [Link]
  24. Anxiety- rather than depression-like behavior is associated with adult neurogenesis in a female mouse model of higher trait anxiety- and comorbid depression-like behavior [Link]
  25. Antidepressants: Past, Present and Future [Link]
  26. TIANEPTINE DRUG INFORMATION [Link]
  27. Acute Toxicity From Intravenous Use of the Tricyclic Antidepressant Tianeptine [Link]
  28. Management of Respiratory Depression from Tianeptine Overdose with Naloxone [Link]
  29. HMDB, Tianeptine Metabocard [Link]
  30. Targeting opioid receptor signalling in depression: do we need selective kappa opioid receptor antagonists? [Link]
  31. The kappa opioid receptor: from addiction to depression, and back [Link]
  32. The antidepressant tianeptine persistently modulates glutamate receptor currents of the hippocampal CA3 commissural-associational synapse in chronically stressed rats [File]
External Links
Human Metabolome Database
HMDB0042038
KEGG Drug
D02575
PubChem Compound
68870
PubChem Substance
310265181
ChemSpider
62102
ChEBI
91749
ChEMBL
CHEMBL1289110
Wikipedia
Tianeptine
ATC Codes
N06AX14 — Tianeptine

Clinical Trials

Clinical Trials
PhaseStatusPurposeConditionsCount
3Unknown StatusTreatmentBipolar Disorder (BD)1
4CompletedTreatmentMajor Depressive Disorder (MDD)1

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage forms
Not Available
Prices
Not Available
Patents
Not Available

Properties

State
Solid
Experimental Properties
PropertyValueSource
melting point (°C)148L1413
boiling point (°C)609.2L1413
Predicted Properties
PropertyValueSource
Water Solubility0.00413 mg/mLALOGPS
logP2.07ALOGPS
logP1.53ChemAxon
logS-5ALOGPS
pKa (Strongest Acidic)4.22ChemAxon
pKa (Strongest Basic)8.1ChemAxon
Physiological Charge0ChemAxon
Hydrogen Acceptor Count5ChemAxon
Hydrogen Donor Count2ChemAxon
Polar Surface Area86.71 Å2ChemAxon
Rotatable Bond Count8ChemAxon
Refractivity113.41 m3·mol-1ChemAxon
Polarizability45.73 Å3ChemAxon
Number of Rings3ChemAxon
Bioavailability1ChemAxon
Rule of FiveYesChemAxon
Ghose FilterYesChemAxon
Veber's RuleNoChemAxon
MDDR-like RuleYesChemAxon
Predicted ADMET features
Not Available

Spectra

Mass Spec (NIST)
Not Available
Spectra
SpectrumSpectrum TypeSplash Key
Predicted GC-MS Spectrum - GC-MSPredicted GC-MSNot Available
Predicted MS/MS Spectrum - 10V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 10V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Negative (Annotated)Predicted LC-MS/MSNot Available

Taxonomy

Description
This compound belongs to the class of organic compounds known as medium-chain fatty acids. These are fatty acids with an aliphatic tail that contains between 4 and 12 carbon atoms.
Kingdom
Organic compounds
Super Class
Lipids and lipid-like molecules
Class
Fatty Acyls
Sub Class
Fatty acids and conjugates
Direct Parent
Medium-chain fatty acids
Alternative Parents
Aralkylamines / Halogenated fatty acids / Heterocyclic fatty acids / Organosulfonamides / Aryl chlorides / Benzenoids / Amino acids / Dialkylamines / Carboxylic acids / Azacyclic compounds
show 6 more
Substituents
Medium-chain fatty acid / Halogenated fatty acid / Heterocyclic fatty acid / Aralkylamine / Aryl chloride / Aryl halide / Benzenoid / Organosulfonic acid amide / Organic sulfonic acid or derivatives / Organosulfonic acid or derivatives
show 21 more
Molecular Framework
Aromatic heteropolycyclic compounds
External Descriptors
Not Available

Targets

Kind
Protein
Organism
Human
Pharmacological action
Unknown
Actions
Modulator
General Function
Pdz domain binding
Specific Function
Ionotropic glutamate receptor. L-glutamate acts as an excitatory neurotransmitter at many synapses in the central nervous system. Binding of the excitatory neurotransmitter L-glutamate induces a co...
Gene Name
GRIA1
Uniprot ID
P42261
Uniprot Name
Glutamate receptor 1
Molecular Weight
101505.245 Da
References
  1. McEwen BS, Chattarji S, Diamond DM, Jay TM, Reagan LP, Svenningsson P, Fuchs E: The neurobiological properties of tianeptine (Stablon): from monoamine hypothesis to glutamatergic modulation. Mol Psychiatry. 2010 Mar;15(3):237-49. doi: 10.1038/mp.2009.80. Epub 2009 Aug 25. [PubMed:19704408]
  2. The antidepressant tianeptine persistently modulates glutamate receptor currents of the hippocampal CA3 commissural-associational synapse in chronically stressed rats [File]
Kind
Protein
Organism
Human
Pharmacological action
Yes
Actions
Agonist
General Function
Voltage-gated calcium channel activity
Specific Function
Receptor for endogenous opioids such as beta-endorphin and endomorphin. Receptor for natural and synthetic opioids including morphine, heroin, DAMGO, fentanyl, etorphine, buprenorphin and methadone...
Gene Name
OPRM1
Uniprot ID
P35372
Uniprot Name
Mu-type opioid receptor
Molecular Weight
44778.855 Da
References
  1. Gassaway MM, Rives ML, Kruegel AC, Javitch JA, Sames D: The atypical antidepressant and neurorestorative agent tianeptine is a mu-opioid receptor agonist. Transl Psychiatry. 2014 Jul 15;4:e411. doi: 10.1038/tp.2014.30. [PubMed:25026323]
  2. Samuels BA, Nautiyal KM, Kruegel AC, Levinstein MR, Magalong VM, Gassaway MM, Grinnell SG, Han J, Ansonoff MA, Pintar JE, Javitch JA, Sames D, Hen R: The Behavioral Effects of the Antidepressant Tianeptine Require the Mu-Opioid Receptor. Neuropsychopharmacology. 2017 Sep;42(10):2052-2063. doi: 10.1038/npp.2017.60. Epub 2017 Mar 17. [PubMed:28303899]
  3. Possible Involvement of µ Opioid Receptor in the Antidepressant-Like Effect of Shuyu Formula in Restraint Stress-Induced Depression-Like Rats [Link]
Kind
Protein
Organism
Human
Pharmacological action
Unknown
Actions
Inhibitor
General Function
Serotonin receptor activity
Specific Function
G-protein coupled receptor for 5-hydroxytryptamine (serotonin). Also functions as a receptor for various drugs and psychoactive substances. Ligand binding causes a conformation change that triggers...
Gene Name
HTR1A
Uniprot ID
P08908
Uniprot Name
5-hydroxytryptamine receptor 1A
Molecular Weight
46106.335 Da
References
  1. Datla KP, Curzon G: Behavioural and neurochemical evidence for the decrease of brain extracellular 5-HT by the antidepressant drug tianeptine. Neuropharmacology. 1993 Sep;32(9):839-45. [PubMed:7694170]
  2. Sonawalla S, Chakraborty N, Parikh R: Treatment of major depression and anxiety with the selective serotonin re-uptake enhancer tianeptine in the outpatient psychiatric care setting of India. J Indian Med Assoc. 2003 Feb;101(2):116-7, 124. [PubMed:12841497]
  3. Tianeptine: A review of its use in depressive disorders. [Link]
Kind
Protein
Organism
Human
Pharmacological action
Unknown
Actions
Agonist
General Function
G-protein coupled amine receptor activity
Specific Function
Dopamine receptor whose activity is mediated by G proteins which inhibit adenylyl cyclase. Promotes cell proliferation.
Gene Name
DRD3
Uniprot ID
P35462
Uniprot Name
D(3) dopamine receptor
Molecular Weight
44224.335 Da
References
  1. Dziedzicka-Wasylewska M, Rogoz Z, Skuza G, Dlaboga D, Maj J: Effect of repeated treatment with tianeptine and fluoxetine on central dopamine D(2) /D(3) receptors. Behav Pharmacol. 2002 Mar;13(2):127-38. [PubMed:11981225]

Enzymes

Kind
Protein
Organism
Human
Pharmacological action
No
Actions
Substrate
General Function
Vitamin d3 25-hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It performs a variety of oxidation react...
Gene Name
CYP3A4
Uniprot ID
P08684
Uniprot Name
Cytochrome P450 3A4
Molecular Weight
57342.67 Da
References
  1. Preskorn SH: Tianeptine: a facilitator of the reuptake of serotonin and norepinephrine as an antidepressant? J Psychiatr Pract. 2004 Sep;10(5):323-30. [PubMed:15361747]
  2. Larrey D. and Ripault M. (2013). Drug-induced liver disease (3rd ed.). Academic Press.

Drug created on October 29, 2015 13:44 / Updated on November 05, 2018 17:49