S-Adenosyl-L-methionine

S-Adenosyl-L-methionine

• S-Adenosyl-L-methionine (SAMe) is a compound found in the human body. It works by donating a methyl group, contributing multiple different reactions to metabolize hormones, neurotransmitters, and proteins. It was discovered in Italy by Cantoni.

Dosage:

• For adults with osteoarthritis, 400-1200 mg daily in up to three divided doses for up to 84 day has been studied. One study looked at intravenous loading dose of SAMe 400 mg daily for 5 days, then switching to oral can improve symptoms as quickly as 14 days.

• For cholestasis in liver disease, studies have looked at SAMe 500 BID orally or 1600 mg orally once a day for 2-8 weeks, or IV 800 mg daily or IV 500 mg BID for 2-3 weeks.

• SAMe for depression has been studied at doses of total 800-1600 mg orally for 4-12 weeks and IV/IM at 200-400 mg 1-4 weeks. Oral formulations should be taken with food. The main uses studied include:

• Osteoarthritis (knee and hip): Older studies from the 1980s and 1990s compared SAMe at doses above to placebo and other NSAIDs, showing that SAME can be as effective as NSAIDs in improving osteoarthritis symptoms.

• It may require up to 30 days to get the full effect of SAMe treatment. IV treatment can take 14 days to experience the full effect. A Cochrane review from 2009 did say this treatment for osteoarthritis is inconclusive but more data is needed to prove this treatment is clinically effective.

• Major depression: Studies have shown mixed results when SAMe is used alone when compared to placebo, TCAs, and escitalopram.

• However, when used in combination with traditional treatment in patients not responding to their current treatment, it can improve remission rates. IV/IM formulations have been shown to be better than placebo and as good as TCAs when used at the doses above.

• Cholestasis: When compared to placebo, some studies stated that SAMe at the doses above can improve patient symptoms such as pruritus and fatigue as well as markers of disease including alkaline phosphatase levels.

• Some studies were conducted looking at SAMe for intrahepatic cholestasis of pregnancy, but the results were mixed.

Safety:

• Well tolerated at the doses above but at higher doses can cause Gl distress, nausea, vomiting, sweating, and insomnia.

Medication Interactions:

• Levodopa, Serotonergic drugs as SAMe has some serotonergic properties.