Tianeptine prior to general anesthesia

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Tianeptine (Stablon, Coaxil) is not available by prescription in the United States or regulated by the FDA. Therefore, it is not a commonly encountered pharmaceutical. Yet internationally it is a controlled substance. However, it is legally available for purchase online. The legality of this is another discussion; what I am interested in is the risk of a patient consuming tianeptine prior to undergoing general anesthesia.

Tianeptine should be discontinued 24-48 hrs prior to undergoing general anesthesia for elective surgery. However, in cases of emergency, surgery may be performed given increased perioperative monitoring.

Why is tianeptine required to be discontinued prior to general anesthesia?
 
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it's required to be discontinued? I don't even know what it is to require that it be discontinued! most of my patients show up on the day of surgery with little direct input from me on what to continue/discontinue; but if one of my pts showed up still on it I probably wouldn't cancel depending on the case.
 
SDN is not for medical advice.

You should discuss this with your anesthesiologist prior to surgery. Closing.

Edit - OP PM'd me and clarified that this is an academic, not personal question. Re-opening.
 
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I guess the concern is for serotonine syndrome with opioids administered in the context of general anesthesia.
 
I guess the concern is for serotonine syndrome with opioids administered in the context of general anesthesia.

Never heard of the drug, but looking it up that was my guess as well.

Though I've never told patients taking ANY TCA/SSRI/SNRI to stop prior to surgery.
 
Has anyone actually encountered serotonin syndrome from meds such as ssri, snri, tca, tramadol, meperidine? Or is this syndrome purely academic? We all know of the famous MAOi + meperidine combination that can be dangerous, but what about all these other serotonergic medications?
 
Tianeptine is an atypical opioid, so it probably can play a role is respiratory depression
 
Has anyone actually encountered serotonin syndrome from meds such as ssri, snri, tca, tramadol, meperidine? Or is this syndrome purely academic? We all know of the famous MAOi + meperidine combination that can be dangerous, but what about all these other serotonergic medications?

I've had a couple weird scenarios where I considered serotonin syndrome. In both cases I gave some flumazanil and patients snapped out of it. Figure some people just have a very paradoxical rxn to versed when too much is given. Very odd symptoms that kinda mimicked SS. Something to think about
 
Has anyone actually encountered serotonin syndrome from meds such as ssri, snri, tca, tramadol, meperidine? Or is this syndrome purely academic? We all know of the famous MAOi + meperidine combination that can be dangerous, but what about all these other serotonergic medications?

While I have never had a case of serotonin syndrome I did see a case of neuroleptic malignant syndrome as a resident. This guy came in with a case of uncomplicated diverticulitis and deteriorated over a couple days. He was on an antidepressant when he came in and then he was getting zyprexa for some agitation. He appeared septic but without a clear source and he was rigid, febrile, and delirious. I seem to recall asking neuro to look at him and we stopped the antidepressant and zyprexa. He began to normalize in 24 hours.
 
Has anyone actually encountered serotonin syndrome from meds such as ssri, snri, tca, tramadol, meperidine? Or is this syndrome purely academic? We all know of the famous MAOi + meperidine combination that can be dangerous, but what about all these other serotonergic medications?

Partner believed to have had one, patient on SSRI got methylene blue. Extremely high fever without hypercarbia/muscle rigidity. Sorry I don't have more details.
 
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