S-adenosylmethionine


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SAMe

(sam-ee) ,

Ademetionine

(trade name),

S-adenosylmethionine

(trade name), (trade name)

Classification

Therapeutic: antidepressants
Pregnancy Category: UK
Treatment of depressionHas 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 and Excretion: Actively metabolized by the liver.
Half-life: 100 min.

Time/action profile (antidepressant action)

ROUTEONSETPEAKDURATION
PO (depression)1–2 wkunknownunknown
PO (osteoarthritis)30 daysunknownunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Bipolar disorder.
Use Cautiously in: Pregnancy, lactation, or children (safety not established); Bipolar disorder (can induce mania); Parkinson's disease (may worsen symptoms); Surgery (discontinue 2 weeks prior to elective procedures).

Adverse Reactions/Side Effects

Central nervous system

  • agitation
  • dizziness
  • mild insomnia
  • manic reactions (in patients with bipolar disorder)

Gastrointestinal

  • vomiting
  • diarrhea
  • flatulence

Interactions

Avoid use with antidepressants, meperidine, pentazocine, tramadol, and dextromethorphan (additive serotinergic 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.Avoid use with natural products that increase serotonin levels such as l-tryptophan and St. John's wort.
Oral (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 mg tid; Fibromyalgia—800 mg/day.

Availability

Tablets: 100 mg, 200 mg, 400 mgOTC

Nursing implications

Nursing 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.

Potential Nursing Diagnoses

Ineffective coping (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Oral: 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 wks depending on response and tolerance.

Patient/Family Teaching

  • Instruct patient to take SAMe as directed.
  • Advise patients to discontinue 2 weeks prior to elective surgical procedures.
  • Advise women to consult health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

  • Decrease in symptoms of depression.
  • Improvement in osteoarthritis symptoms.

S-adenosylmethionine

(ă-dĕn″ō-sĭl″mĕ-thī′ŭ-nēn″),

SAM-e

A compound that is synthesized naturally in the central nervous system when folate and vitamin B12 levels are adequate. It is involved in the methylation of neurotransmitters, amino acids, proteins, phospholipids, and other neurochemicals. The chemical is used as a treatment for depression, liver disease, and osteoarthritis. It is an active sulfonium form of methionine that acts as a methyl group donor in various reactions (such as the formation of epinephrine or creatine).

S-adenosylmethionine (es-a·deˈ·nō·sl·me·thīˑ·ō·nēn),

n a compound found in living cells that is involved in the synthesis of some amino acids. It has antiinflammatory properties and has been used to treat depression, Alzheimer's disease, osteoarthritis, fibromyalgia, liver disease, and migraines. Contraindicated for use by pregnant and lactating women, infants, children, and those with bipolar depression.
References in periodicals archive ?
S-adenosylmethionine (SAMe): Its role in the treatment of liver disorders.
Brain S-adenosylmethionine levels are severely decreased in Alzheimer's disease.
Folic acid supplementation may disturb the regulatory effect of S-adenosylmethionine on methylenetetrahydrofolatereductase activity [Abstract].
Likewise, betaine (trimethylglycine), which was also present at a relatively small dosage in this study, no doubt contributed to some formation of S-adenosylmethionine, but it has not produced lasting symptomatic improvement when used alone, in past anecdotal treatment experience.
Stability of plasma homocysteine, S-adenosylmethionine, and S-adenosylhomocysteine in EDTA, acidic citrate, and Primavett@TM collection tubes.
Hepatic concentrations of S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH) were measured using the high-performance liquid chromatography (HPLC) method of Herbig et al.
As can be seen from the table, the initial mean values of glutathione (GSH), oxidized glutathione (GSSG), S-adenosylmethionine (SAM), and four of the folate vitamers were significantly different from their laboratory reference values.
A landmark study funded by the National Institute of Mental Health revealed that the addition of S-adenosylmethionine or SAMe produces compelling results in major depression sufferers taking SSRIs, the majority of whom do not experience relief with prescription drugs alone.
Stable-isotope dilution liquid chromatography-electrospray injection tandem mass spectrometry method for fast, selective measurement of S-adenosylmethionine and S-adenosylhomocysteine in plasma.
Biochemicals, such as coenzyme Q10, S-adenosylmethionine (SAM), adenosine diphosphate (ADP) and nicotinamide adenine dinucleotide (NAD) and nutrients, i.
S-Adenosylmethionine as Adjunctive Treatment for Depression