SAME



University of Iowa Adult Outpatient Psychiatry Department 07/26/2000

(319) 353-6314. After hours: (319) 356-1616

S-ADENOSYL-L-METHIONINE (SAMe)

SAMe has been cited to alleviate depression2, reduce symptoms of fibromyalgia2, slow progress of osteoarthritis2, improve memory, reduce alcohol-induced liver damage2, and possibly reduce symptoms of attention deficit hyperactivity disorder1.

Dose: up to 2400 mg (800 mg TID)1

Minimum dosing for depression may be 1200-1600 mg/d5

Start with 1600 mg/day (800 BID), and gradually reduce to 800 or 400 mg/d2

Start with 200 BID X 2 days, 400 BID X 7 days, 400 TID X 10 days, then 400 QID.

S-adenosyl-L-Methionine is not effective with low B12 or folate levels2

Combine with conventional antidepressant for “jump start” commonly used in Europe2

Appears to increase serotonin turnover, inhibit reuptake of norepinephrine, augment dopaminergic activity, and increase folate5

Half-life of iv form is 80-100 minutes2

Not eliminated, but metabolized in many sites

Must use enteric oral form, as stomach digests it2

Proper use of this medication:

There is little information available on this medication in the English literature.

Because over-the-counter medications are poorly regulated in this country, the purity and potency of any given brand may vary, sometimes considerably.

S-adenosyl-L-Methionine should be taken on an empty stomach for better absorption. 2

There is no medical research concerning the method of changing from prescription antidepressants to SAMe

Consult with your physician before discontinuing any medication you are currently taking.

Do not start taking SAMe until you have been off your current antidepressant at least one week (2 weeks if you are taking Nardil/phenelzine or Parnate/tranylcypromine).

Commonly reported dose is 400 to 1600 mg daily2.

This medication is not addictive, and does not cause a high feeling.

When taken regularly, this medication may require 4-8 weeks before the full effects are noticed.

Do not drink alcohol while taking this medication.

If there is a possibility you may become pregnant or breast-feed while on this medication, first consult with your psychiatrist. This drug has not been tested in pregnancy, and it is unknown if it is excreted in breast milk.

This medication should not be abruptly discontinued.

Store this medication in a cool, safe place away from the reach of children.

This medication is usually very well tolerated, with few patients complaining of side effects. Side effects that do occur tend to be mild and transient (lasting a couple weeks). Reported possible side effects include:

Headache:1 This mild and responds to over-the-counter analgesics, such as acetaminophen (Tylenol) or aspirin.

Diarrhea or soft stool1: High-fiber diet and regular exercise may treat this uncommon side effect.

Increase dose to overcome gastroenterology side effects.

Nausea:1 Occurs at lower doses and disappears with higher doses. This usually goes away with continued use. Increase dose to overcome gastroenterology side effects.

Increased thirst1: Usually mild and transient.

Dry Mouth 4: Drink plenty of fluids. Chew sugarless gum or suck on sugarless candy.

Blurred vision:1 Unusual.

Restlessness, anxiety, &/or elation5: Report to your prescriber if you develop this side effect. 4

Symptoms of Parkinson’s Disease may become worse with S-adenosyl-L-Methionine treatment.

Patients with bipolar depression may switch to a manic state.4

Symptoms of toxicity may include: disorientation, vomiting, liver damage, shock2

No reported toxicity5

Parkinsonian symptoms have been reported with intravenous use3

Though there have been no significant drug interactions6 reported in the literature, the following other medications may require dosage adjustment while taking S-adenosyl-L-Methionine:

Antidepressants.

1. Shekim WO et al. (1990). S-Adenosyl-L-Methionine in Adults with ADHD, RS: Preliminary Results From an Open Trial. Psychopharmacology Bulletin. 26:2. 249-253.

2. Grazi S & Costa M. (1999). SAMe: The European Arthritis and Depression Breakthrough. Prima Health: Rocklin CA.

*3. Charlton CG & Crowell B. (1992). Parkinson’s Disease like Effects of S-Adenosyl-L-Methionine: Effects of L-Dopa. Pharmacology, Biochemistry, & Behavior. 43:2. 423-431.

4. Life Extension Report. (April 1997). S-adenosyl-L-Methionine part 2: Fast-Acting Natural Antidepressant.

5. Rosenbaum JF et al. (1990). The Antidepressant potential of oral S-adenosyl-L-Methionine. Acta Psychiatr Scand. 81:432-436.

6. Pettit JL. (2000). SAMe. Clinician Reviews. 10(5): 124-128. (Lit review).

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