Natural Products

SAM-e

S-adenosyl-L-methionine

Efficacy

• Indications with proven efficacy:
  Depression
  Osteoarthritis
• Indications with possible, but poorly documented efficacy - the use of this product cannot be recommended:
  AIDS-related myelopathy
  Intrahepatic cholestasis
  Liver disease
• Also used for these other indications, but with no proof of efficacy:
  Chronic backache
  Chronic lead poisoning
  Dementia and Alzheimer's disease
  Enhancement of intellectual performances
  Fibromyalgia
  Migraine
  Multiple sclerosis
  Parkinson's disease
  Seizures
  To delay aging

Security

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

What is it?

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.

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) or homeopathic medicine number (DIN-HM) 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 plants content varies 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 http://www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php.

Does it work?

There is evidence that SAM-e is effective in depression and osteoarthritis. It is also used to treat certain conditions in which it could be of some benefits:

• Depression:
  Its action on neurotransmitters may be responsible for its antidepressant activity. Typically, oral doses vary between 400 and 1600 mg daily and intravenous or intramuscular doses vary between 200 and 400 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 is comparable to NSAIDs in the treatment of osteoarthritis. A typical oral dose is 200 mg three times a day or 600 to 1200 mg daily for 2 weeks followed by 400 mg daily. Intravenously 400 mg daily is used.
• Intrahepatic cholestasis:
  SAM-e may decrease pruritus, fatigue, alkaline phosphatase levels and bilirubin. The usual oral dose is 800 mg twice daily or an intravenous dose of 800 mg per day. For intrahepatic cholestasis of pregnancy, the intravenous dose has been used.
• Liver disease :
  SAM-e may increase liver enzyme activity. People with cirrhosis or chronic liver disease due to medications, alcoholism or lead poisoning use this product to normalize liver enzyme and decrease bilirubin. The usual oral dose is 1200 to 1600 mg per day.
• AIDS-related myelopathy :
  People with AIDS have been shown to have reduced CNS SAM-e levels, which may explain why repair mechanisms for myelin are impaired. SAM-e supplements may protect against AIDS-related myelopathy. The usual dose is 800 mg per day for 14 days, intravenously.

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

Is it safe?

• SAM-e is not associated with any specific toxicity. No toxicity has been reported in the 22 000 patients who participated in clinical studies lasting up to 2 years. When taken orally, SAM-e may cause mild digestive troubles, headaches, and anxiety in people with depression and hypomania in people with bipolar disorder.
• SAM-e is possibly safe when used intravenously short-term during the third trimester of pregnancy for intrahepatic cholestasis, but large-scale trials are needed to confirm this information. 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.
• No drug interactions are known. It may however enhance the effects of antidepressants. Before taking SAM-e, check with your pharmacist to make sure that there are no drug interactions with your regular medication

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.

References

1. Natural Medicines Comprehensive Database, Therapeutic Research Faculty, 2007
2. Natural Therapeutics Pocket Guide 2000-2001 (Lexicomp)
3. Passeportsanté.net. SAM-e. http://www.passeportsante.net
4. Rotblatt M. et Ziment I. Evidence-Based Herbal Medicine, Hanley & Belfus, 2002