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.

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

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).

GI: diarrhea, flatulence, vomiting.

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

Natural-Drug Products:

• Avoid use with antidepressants, meperidine, tramadol, and dextromethorphan (additive serotonergic 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 Products:

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

• Tablets : 100 mg; 200 mg; 400 mg^OTC ;

• 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.

Ademetionine, S-adenosylmethionine

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

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

Therapeutic Classification: antidepressants

Absorption: Rapidly and extensively metabolized following oral administration.

Distribution: Unknown.

Metabolism/Excretion: Actively metabolized by the liver.

Half-life: 100 min.

(antidepressant action)

• 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.

SAM-ee