Case Report: Combined Kratom and Tianeptine Overdose Causes Severe Respiratory Failure, Encephalopathy

Why it matters

This peer-reviewed case report documents the serious dangers of combining kratom with tianeptine — a drug sometimes sold as a dietary supplement — and highlights the limitations of naloxone as a treatment, offering critical guidance for emergency clinicians.

The big picture

Tianeptine is an atypical antidepressant with opioid agonist effects that is widely available in the US as a supplement despite its abuse potential. Kratom's opioid-like properties combined with tianeptine's potent opioid receptor activity creates a particularly dangerous polydrug combination. As both substances gain popularity in unregulated supplement markets, emergency physicians and pharmacists are encountering these polysubstance cases with increasing frequency.

Key findings

• A middle-aged man with polysubstance abuse history developed acute hypoxemic respiratory failure after ingesting kratom and tianeptine together
• Patient presented with significant respiratory depression, hypoxia, bilateral pulmonary infiltrates, and acute encephalopathy
• Naloxone was administered as part of symptomatic management alongside ICU-level supportive care
• The patient gradually improved with ICU support, though the case underscores the severity of combined kratom-tianeptine toxicity
• Both kratom and tianeptine act on opioid receptors; combined use creates compounding opioid-like respiratory suppression

What they say

The authors concluded that this "case highlights the potential for severe respiratory and neurological compromise with combined kratom and tianeptine toxicity," underscoring the need for clinician awareness of this dangerous drug combination.

Bottom line

**Combining kratom with tianeptine — both opioid-acting supplements sold legally in much of the US — can produce life-threatening respiratory failure requiring intensive care, a risk clinicians and patients urgently need to understand.**