Drug Database - SAM-e

Other Name: S-Adenosyl Methionine

Brand Names: Gumbaral, Samyr, Adomet, Heptral and Admethionine

In the United States, SAM-e (pronounced "sam-ee") is sold as a nutritional supplement. Some research has indicated that taking SAM-e on a regular basis may help fight depression, liver disease, and the pain of osteoarthritis. Multiple clinical trials indicate benefits for depression, some liver conditions and osteoarthritis. All other indications are not yet proven.

Therapeutic use of SAM-e has increased as dietary supplements have gained in popularity, especially after the Dietary Supplement Health and Education Act was passed in 1994. This law allowed the distribution of SAM-e as dietary supplement, and therefore allowed it to bypass the regulatory requirements for drugs of the Food and Drug Administration (FDA).

S-adenosyl-L-methionine (SAM-e) is a dietary supplement often used to treat depression, although it can be used for other uses as well. In order to use SAM-e safely, you should talk with your healthcare provider prior to taking it if you have:

• Bipolar disorder, also known as manic depression
• Parkinson's disease
• Any allergies, including allergies to medications, foods, dyes, or preservatives.

Also, let your healthcare provider know if you are:

• Pregnant or thinking of becoming pregnant
• Breastfeeding

You should also be sure to tell your healthcare provider about all other medicines you are taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Warnings and precautions to be aware of concerning the safety of SAM-e include the following:

• Supplements (including SAM-e) are not regulated as closely as drugs. In the United States, supplements can be sold without ever having been shown to be safe or effective.


• Just like prescription antidepressants, SAM-e can cause mania in people with bipolar disorder. If you have this condition, do not take SAM-e without your healthcare provider's approval and supervision.


• Theoretically, SAM-e could make Parkinson's disease symptoms worse. However, this has not been demonstrated in humans. If you have Parkinson's disease, check with your healthcare provider before taking SAM-e.


• SAM-e supplements may interact with medications (see SAM-e Drug Interactions).


• It is not known whether SAM-e is safe for pregnant or breastfeeding women (see SAM-e and Pregnancy and SAM-e and Breastfeeding).


• If you decide to use supplements, be aware that what you see on the label may not reflect what is in the bottle. For example, some dietary supplements have been found to be contaminated with heavy metals or prescription drugs, and some have been found to have much more or much less of the featured ingredient than their label states. Therefore, make sure the manufacturer of your SAM-e product is trusted and reputable. It is a good sign if a manufacturer abides by the rules of Good Manufacturing Practices (GMP) for drugs. It is also a good sign if a product has the United States Pharmacopoeia (USP) seal, which means that it has been independently tested and shown to contain the correct ingredients in the amounts listed on the label. Your pharmacist is a good resource for information about which manufacturers are most reputable.

Once SAM-e donates its methyl group to choline, in the formation of creatine, carnitine, DNA, tRNA, norepinephrine, and other compounds, it is transformed into S-adenosyl-homocysteine, (SAH). Under normal circumstances, homocysteine, in the presence of vitamin B6, vitamin B12, and folic acid (SAM-e's main co-factors), will eventually be converted back into methionine, SAM-e, or cysteine, glutathione, and other useful substances. However, if adequate amounts of these vitamins are not present, SAM-e will not break down properly. As a consequence, the full benefits of SAM-e will not be obtained, and homocysteine may increase to unsafe levels.

High levels of homocysteine have been associated with atherosclerosis (hardening and narrowing of the arteries), as well as an increased risk of heart attacks, strokes, liver damage, and possibly Alzheimer's disease. Therefore, Vitamin B supplements are often taken along with SAM-e. These vitamins help metabolize the homocysteine into other useful compounds.

Another reported side effect of SAM-e is insomnia, therefore the supplement is often taken in the morning. Other reports of mild side effects include:

• lack of appetite
• constipation
• nausea
• dry mouth
• sweating
• anxiety/nervousness

But in placebo-controlled studies these side effects occur at about the SAM-e incidence in the placebo groups. Some users report increased anxiety with as little as 50 mg/day.

Therapeutic doses range from 400 mg/day to 1600 mg/day, although higher doses are used in some cases. Some physicians recommend even lower doses ranging from 50 to 200 mg/day to treat mild depression without triggering negative side effects. Consult with your physician before and during use.

Even though it is a "natural" product, SAM-e (S-adenosyl-L-methionine) can potentially interact with a number of medicines. Some of the medicines that can lead to SAM-e drug interactions include:

• Antidepressants
• Meperidine (Demerol®)
• Monoamine oxidase inhibitors (MAOIs), such as:
• Isocarboxazid (Marplan®)
• Phenelzine (Nardil®)
• Rasagiline (Azilect®)
• Selegiline (Eldepryl®, Emsam®, Zelapar®)
• Tranylcypromine (Parnate®)
• St. John's wort (Hypericum perforatum)
• Tramadol (Ultram®, Ultracet®)
• Triptans (certain migraine medications), such as:
• Almotriptan (Axert®)
• Eletriptan (Relpax®)
• Frovatriptan (Frova®)
• Naratriptan (Amerge®)
• Rizatriptan (Maxalt®)
• Sumatriptan (Imitrex®)
• Zolmitriptan (Zomig®)
• Tryptophan