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).
References in periodicals archive ?
S-adenosylmethionine decarboxylase: structure, function and regulation by polyamines.
Changes in the expression of methionine adenosyltransferase genes and S-adenosylmethionine homeostasis during hepatic stellate cell activation.
Cerebrospinal fluid S-adenosylmethionine in depression and dementia: effects of treatment with parenteral and oral S adenosylmethionine.
S-adenosylmethionine concentrations in diagnosis of Pneumocystis carinii pneumonia.
Therefore, clinicians have tried to administer precursors of cysteine (see figure 4), such as the compound acetylcysteine or the molecule S-adenosylmethionine (SAMe) (discussed in the following section), which can reach the cells and be converted to cysteine there.
S-adenosylmethionine (SAMe) is a compound synthesized from the amino acid methionine, which is involved in CNS methylation reactions.
Methionine is the precursor of S-adenosylmethionine, the primary donor for the methylation of neurotransmitters and DNA [35-37] Significantly lower levels of S-adenosylmethionine, involved in choline synthesis, have been found in the cerebro-spinal fluid of patients with Alzheimer's disease [38].
One of the last steps in the synthesis of JH is catalyzed by farnesoic acid O-methyltransferase (MeT), which transfers a methyl group from S-adenosylmethionine to either farnesoic acid (FA) or JH acid (2).
Double-blind controlled clinical trial of oral S-adenosylmethionine versus piroxicam in knee osteoarthritis.
Using supplements donated by the Life Extension Foundation, researchers revealed in Advances in Integrative Medicine that the addition of the nutritional supplement S-adenosylmethionine (SAMe) to selective serotonin reuptake inhibitor (SSRI) therapy improved symptoms in adults who failed to optimally respond to drugs.
9,120,820, claims detection analyte probes based on a natural product mimic of the methyltransferase cofactor S-adenosylmethionine (SAM).
Vitamin B12 is involved in DNA synthesis, red blood cell formation, homocysteine metabolism, and synthesis of S-adenosylmethionine, and is essential for the normal functioning of the nervous system and immune system.