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


Trade Name(s)

  • Ademetionine
  • S-adenosylmethionine

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)

ROUTEONSETPEAKDURATION
PO (depression)1–2 wkunknownunknown
PO (osteoarthritis)30 daysunknownunknown

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity;
  • Bipolar disorder;
  • Lactation.

Use Cautiously in:

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

Adverse Reactions/Side Effects

GI: vomiting, diarrhea, flatulence

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

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

Interactions

Natural Drug Interaction

Natural-Natural:

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– 200–400 mg three times daily;  Fibromyalgia– 800 mg/day.

Availability

Tablets: 100 mg, 200 mg, 400 mgOTC

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

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 wk depending on response and tolerance.

Patient/Family Teaching

  • Instruct patient to take SAMe as directed.
  • Advise patients to discontinue 2 wk prior to elective surgical procedures.
  • Advise females of reproductive potential 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.
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