SAM-e

S-adenosyl-L-methionine

Efficacy

• Indications with possible efficacy:
  Depression
  Osteoarthritis
• Indications with possible, but poorly documented efficacy:
  Fibromyalgia
  Intrahepatic cholestasis
  Liver disease
• Other indications with no proof of efficacy:
  Anxiety
  Cardiovascular disease
  Chronic backache
  Dementia and Alzheimer's disease
  Enhancement of intellectual performances
  Migraine
  Multiple sclerosis
  To delay aging

Security

• Risk of Drug Interactions: Moderate
• Adverse Effects: Not frequent

Description

SAM-e is a naturally occurring molecule found in almost all tissues. It plays an essential role in the production and activation of proteins, hormones and neurotransmitters. SAM-e administration is associated with increased CNS serotonine, dopamine and norepinephrine levels. It appears to have analgesic and anti-inflammatory properties and seems to stimulate cartilage growth and repair. Oral SAM-e is weakly absorbed. Peak levels are reached 3 to 5 hours after ingestion of an enteric-coated tablet.

Direction of use

• Depression:
  Its action on neurotransmitters may be responsible for its antidepressant activity.

  Usual doses:
  Between 400 and 1600 mg daily in 2 or 3 doses.

• Fibromyalgia:
  Usual doses: 800 mg daily

• Osteoarthritis:
  Because of its analgesic and anti-inflammatory effects as well as its capacity to stimulate cartilage growth and repair, SAM-e efficiency seems comparable to NSAIDs in the treatment of osteoarthritis.

  Usual doses:
  Loading dose of 600 to 1200 mg daily (in 3 doses) for 2 to 3 weeks followed by 200 mg twice daily.

• Intrahepatic cholestasis:
  SAM-e may decrease pruritus, fatigue, alkaline phosphatase levels and bilirubin.

  Usual doses: 800 mg twice daily

There is insufficient reliable information to conclude that SAM-e is effective in any other indication.

Precautions

• Side effects
  SAM-e is not associated with any specific toxicity. SAM-e may cause mild digestive troubles, dry mouth, insomnia and dizziness.
• Contraindications
  People with bipolar disorder or Parkinson's disease should avoid SAM-e.
• Interactions
  It may modify the effects of antidepressants and levodopa. Before taking SAM-e, check with your pharmacist to make sure that there are no drug interactions with your regular medication
• Pregnancy and breastfeeding
  It should only be considered when benefits clearly outweigh the risks. Since there is no safety data available concerning its use during breast-feeding, lactating women should not take SAM-e.

Clinical notes

• SAM-e is an interesting molecule but its therapeutic value remains to be clearly established. It does not appear to be associated with any severe toxicity.

Warning

In 2004, Canada adopted new regulations that control the manufacturing, packaging, labeling and importing of natural health products. The new regulations also include an adverse reaction reporting system. Products that conform to the regulation's criteria are identified with a natural product number (NPN) and can be legally sold in Canada. This number indicates that the product meets specific criteria for safety and purity, not that it is effective for any indication.

Medicinal plant contents vary naturally from plant to plant - just as fruits from the same package may vary in taste and texture. There is no standard to measure the active content of each plant. Thus, efficacy of natural products should be expected to vary from brand to brand as well as from bottle to bottle of the same brand.

For more information about the Natural Health Products Regulations, or to check if a product has been assessed, visit the Health Canada website at www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php.

References

1. Natural Medicines Comprehensive Database, Therapeutic Research Faculty, 2010
2. Natural Therapeutics Pocket Guide 2000-2001 (Lexicomp)
3. Passeportsanté.net. SAM-e. www.passeportsante.net
4. Rotblatt M. et Ziment I. Evidence-Based Herbal Medicine, Hanley & Belfus, 2002
5. The Review of Natural Products, 6th Edition, 2010