SAMe

General

Complementary/Alternative Medicine:This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

Pronunciation:
sam-ee

Online audio

Trade Name(s)

• Ademetionine
• S-adenosylmethionine

Pregnancy Category
Category Unknown

Ther. Class.
antidepressants

Common Uses

• Treatment of depression
• Has also been used to manage:
  • osteoarthritis
  • fibromyalgia
  • liver disease
  • migraine headaches

Action

May aid in the production, activation, and metabolism of various amines, phospholipids, hormones, and neurotransmitters. May stimulate articular cartilage growth and repair.

Therapeutic Effect(s):

• Decreased depression.
• Anti-inflammatory and analgesic effects improve symptoms of osteoarthritis.

Pharmacokinetics

Absorption: Rapidly and extensively metabolized following oral administration.

Distribution: Unknown.

Metabolism and Excretion: Actively metabolized by the liver.

Half-life: 100 min.

TIME/ACTION PROFILE (antidepressant action)

ROUTE	ONSET	PEAK	DURATION
PO (depression)	1–2 wk	unknown	unknown
PO (osteoarthritis)	30 days	unknown	unknown

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity
• Bipolar disorder.

Use Cautiously in:

• Pregnancy, lactation, or children (safety not established)
• Bipolar disorder (can induce mania)
• Parkinson's disease (may worsen symptoms)
• Surgery (discontinue 2 weeks prior to elective procedures).

Adverse Reactions/Side Effects

CNS: agitation, dizziness, mild insomnia, manic reactions (in patients with bipolar disorder)

GI: vomiting, diarrhea, flatulence

* CAPITALS indicate life-threatening.
Italics indicate most frequent.

Interactions

natural drug interaction

• Avoid use with antidepressants, meperidine, pentazocine, tramadol, and dextromethorphan(additive serotinergic effects may occur).
• May ↓ effectiveness of levodopa and worsen Parkinsonian symptoms.
• Should not be used concurrently with MAO inhibitors. Avoid use of SAMe within 2 wk of using a MAO inhibitor.

natural natural interaction

Avoid use with natural products that increase serotonin levels such as l-tryptophan and St. John's wort.

Route/Dosage

PO: (Adults) Depression–200 mg once or twice daily, adjusted upward over 2 wk (range 400–1600 mg/day); Liver disorders–1200–1600 mg/day; Osteoarthritis–200 mg tid; Fibromyalgia–800 mg/day.

Availability

Tablets: 100 mg, 200 mg, 400 mg^OTC

Assessment

• Assess mental status for symptoms of depression prior to and periodically during therapy; advise patients with depression to be evaluated by a health care professional.
• Assess symptoms of pain and fatigue prior to and periodically during therapy.

Potential Diagnoses

• Ineffective coping (Indications)
• Deficient knowledge, related to medication regimen (Patient/Family/Teaching)

Implementation

PO: Administer on an empty stomach. Initial dose should be 200 mg once or twice daily to minimize GI disturbances. Dose may be adjusted upward over 1–2 wks depending on response and tolerance.

Patient/Family Teaching

• Instruct patient to take SAMe as directed.
• Advise patients to discontinue 2 weeks prior to elective surgical procedures.
• Advise women to consult health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

• Decrease in symptoms of depression.
• Improvement in osteoarthritis symptoms.