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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.

REMS

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 effects:

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

Pharmacokinetics ⬆ ⬇

Absorption: Rapidly and extensively metabolized following oral administration.

Distribution: Unknown.

Metabolism/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

Contraind./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).

Adv. Reactions/Side Effects ⬆ ⬇

GI: diarrhea, flatulence, vomiting

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

Interactions ⬆ ⬇

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.

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.

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.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇