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S-adenosylmethionine(trade name), (trade name)
Pregnancy Category: UK
Treatment of depressionHas also been used to manage:
- liver disease
- migraine headaches
May aid in the production, activation, and metabolism of various amines, phospholipids, hormones, and neurotransmitters. May stimulate articular cartilage growth and repair.
Anti-inflammatory and analgesic effects improve symptoms of osteoarthritis.
Absorption: Rapidly and extensively metabolized following oral administration.
Metabolism and Excretion: Actively metabolized by the liver.
Half-life: 100 min.
Time/action profile (antidepressant action)
|PO (depression)||1–2 wk||unknown||unknown|
|PO (osteoarthritis)||30 days||unknown||unknown|
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
- mild insomnia
- manic reactions (in patients with bipolar disorder)
InteractionsAvoid 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.
Tablets: 100 mg, 200 mg, 400 mgOTC
- 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 DiagnosesIneffective coping (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
- 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.
- 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.
- Decrease in symptoms of depression.
- Improvement in osteoarthritis symptoms.
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).