SAMe: benefits, dosage, contraindications
Scientific name(s)
S-adenosyl-L-methionine
Family or group:
Amino acids
Indications
Scoring methodology
EFSA approval.
Osteoarthritis ✪✪✪✪✪
Numerous clinical trials show that oral administration of SAMe at 400 to 1200 mg per day in three divided doses for up to 84 days is superior to placebo and comparable to NSAIDs (nonsteroidal anti-inflammatory drugs) in reducing symptoms of osteoarthritis. SAMe is associated with fewer adverse effects than NSAIDs and is comparable to NSAIDs in reducing pain and functional limitation. Significant symptom relief with SAMe may require up to 30 days of treatment compared with only 15 days with NSAIDs. Other preliminary evidence suggests that SAMe may stimulate the growth and repair of articular cartilage, particularly the synthesis and proliferation rate of chondrocyte proteoglycans. A deficiency of SAMe in joint tissue leads to a loss of the gelatinous nature and shock-absorbing qualities of cartilage.
Posologie
Oral
400 - 1200 mg
84 - days
Adults
A long-term (two years) clinical trial with S-adenosylmethionine for the treatment of osteoarthritis
Safety and efficacy of S-adenosylmethionine (SAMe) for osteoarthritis
Double-blind clinical trial of S-adenosylmethionine versus ibuprofen in the treatment of osteoarthritis
S-Adenosyl-L-methionine (SAMe): from the bench to the bedside--molecular basis of a pleiotrophic molecule
Comparative clinical trial of S-adenosylmethionine versus nabumetone for the treatment of knee osteoarthritis: an 8-week, multicenter, randomized, double-blind, double-dummy, Phase IV study in Korean patients
A randomized, double blind, placebo controlled trial of intravenous loading with S-adenosylmethionine (SAM) followed by oral SAM therapy in patients with knee osteoarthritis
Double-blind multicenter study of the activity of S-adenosylmethionine in hip and knee osteoarthritis
Fibromyalgia ✪✪✪✪✪
A0Clinical research on SAMe has shown a modest improvement in some fibromyalgia symptoms compared with placebo, or compared with transcutaneous electrical nerve stimulation therapy. A0The doses used include 200 mg intramuscularly per day for 21 days, 800 mg per day orally in 2 divided doses for 6 weeks or 400 mg orally per day in 2 divided doses for 6 weeks, plus 200 mg per day intramuscularly.
Posologie
Oral
800 mg
6 - weeks
Adults
Clinical evaluation of S-adenosyl-L-methionine versus transcutaneous electrical nerve stimulation in primary fibromyalgia
Oral S-adenosylmethionine in primary fibromyalgia. Double-blind clinical evaluation
Oral S-adenosylmethionine in primary fibromyalgia. Double-blind clinical evaluation
Depression ✪✪✪✪✪
Several clinical studies in patients with depression show that taking SAMe as monotherapy at a dose of 800 to 1600 mg per day in divided doses for 4 to 12 weeks is more effective than placebo and as effective as tricyclic antidepressants (TCAs). Preliminary clinical research in patients who do not respond to conventional antidepressants shows that oral SAMe at a dose of 1600 mg per day for 42 days does not improve depressive symptoms compared with baseline in patients with major depressive disorder. However, higher-quality clinical evidence shows that adding SAMe at a dose of 400 to 800 mg twice daily to conventional treatment increases remission rates by about 14% after 6 weeks.
Posologie
Oral
800 - 1600 mg
12 - weeks
Adults
Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 5. Complementary and Alternative Medicine Treatments
S-adenosylmethionine blood levels in major depression: changes with drug treatment
PRACTICE GUIDELINE FOR THE Treatment of Patients With Major Depressive Disorder
S-adenosyl methionine (SAMe) augmentation of serotonin reuptake inhibitors for antidepressant nonresponders with major depressive disorder: a double-blind, randomized clinical trial
Oral S-adenosylmethionine in depression: a randomized, double-blind, placebo-controlled trial
Efficacy and tolerability of oral and intramuscular S-adenosyl-L-methionine 1,4-butanedisulfonate (SAMe) in the treatment of major depression: comparison with imipramine in 2 multicenter studies
An open-label pilot study of oral S-adenosyl-L-methionine in major depression: interim results
Double-blind, placebo-controlled study of S-adenosyl-L-methionine in depressed postmenopausal women
Cirrhosis ✪✪✪✪✪
Supplementation with SAMe in patients with liver cirrhosis not only improves bile flow and clinical signs and symptoms, but also improves membrane function and increases glutathione levels. Glutathione plays an essential role in detoxification as well as in defense against various agents by directly combining with these toxic substances to eventually form water-soluble compounds. A randomized, double-blind trial was conducted in patients with alcoholic cirrhosis, treated with SAMe (1200 mg/day, orally) or placebo for 2 years. The results indicate that long-term treatment with SAMe may improve survival or delay liver transplantation in patients with alcoholic liver cirrhosis, particularly in those with less advanced liver disease. Other preliminary clinical research shows that oral administration of SAMe at 600 mg per day or 400 mg three times a day for 1 month, or intravenous administration at 800 mg once a day or 250 to 600 mg twice a day for 3 to 30 days, improves liver function and pruritus in patients with chronic liver disease or liver cirrhosis.
Posologie
Oral
600 - 1200 mg
1 - month
Adults
Oral S-adenosyl-L-methionine (SAMe) administration enhances bile salt conjugation with taurine in patients with liver cirrhosis
Effect of S-adenosyl-L-methionine administration on plasma levels of sulfur-containing amino acids in patients with liver cirrhosis
Biliary disorders ✪✪✪✪✪
Oral administration of SAMe at 500 mg twice daily or 1600 mg daily for 2 to 8 weeks, or intravenous administration at 800 mg daily or 500 mg twice daily for 14 to 20 days, appears to be useful for treating cholestasis (decreased bile secretion) associated with acute or chronic liver disease. Several clinical trials have shown that short-term treatment with SAMe is superior to placebo in reducing pruritus, fatigue, alkaline phosphatase levels, and total and conjugated bilirubin in patients with cholestasis.
Posologie
Oral
1000 - 1600 mg
8 - weeks
Adults
Oral S-adenosylmethionine in the symptomatic treatment of intrahepatic cholestasis. A double-blind, placebo-controlled study
S-adenosylmethionine for the treatment of intrahepatic cholestasis of pregnancy. Results of a controlled clinical trial
A meta-analysis of therapeutic trials with ademetionine in the treatment of intrahepatic cholestasis
Hepatitis ✪✪✪✪✪
Oral administration of SAMe at 1600 mg per day for 2 weeks, between courses of peginterferon and ribavirin, appears to improve early virologic response in patients with hepatitis C who previously did not respond to conventional treatment. In other clinical research in patients with a previously poor response to the same conventional treatment, adding SAMe 400 mg three times daily orally and 3 grams of betaine twice daily orally increased the percentage of patients achieving an early virologic response from 14% to 59%. However, a sustained virologic response was observed in only 10% of patients.
Posologie
Oral
1600 mg
2 - weeks
Adults
Synergies
Properties
Antidepressant
SAMe is necessary for the synthesis of neurotransmitters and phospholipids such as phosphatidylcholine and phosphatidylserine. Adding SAMe to the diet of depressed patients increases serotonin levels, dopamine and phosphatidylserine and improves the binding of neurotransmitters to receptor sites, resulting in increased serotonin and dopamine activity and better fluidity of brain cell membranes, leading to a significant clinical improvement.
Usages associés
Anti-inflammatory
It has been shown that SAMe has anti-inflammatory and analgesic properties in animal models when administered orally and parenterally, but probably has no effects on prostaglandins. SAMe may also protect against cell damage induced by cytokines.
Usages associés
Hepatoprotective
People with acute or chronic liver disease lose the ability to synthesize SAMe from methionine, probably due to the low activity of methionine adenosyl transferase (MAP), the enzyme that converts methionine into SAMe. This can lead to cysteine and choline deficiencies. It can also lead to glutathione depletion, which plays a major role in liver detoxification and antioxidant reactions. On the other hand, one of the main causes of impaired liver function is reduced bile flow, or cholestasis. SAMe is beneficial for a variety of liver disorders because of its ability to promote bile flow. Finally, SAMe enables the inactivation of estrogens in the liver. Indeed, clinical studies have shown that it is useful for protecting the liver from damage and improving liver function in conditions associated with excess estrogens, namely the use of oral contraceptives, pregnancy, and premenstrual syndrome.
Usages associés
Safe dosage
Adults: 600 mg - 1600 mg
SAMe is perfectly suited for long-term use due to its excellent safety profile.
Interactions
Médicaments
Levodopa: moderate interaction
SAMe may reduce the effectiveness of levodopa.
Selective serotonin reuptake inhibitors: moderate interaction
Taking SAMe with serotonergic medications may increase the risk of serotonin syndrome and other serotonergic side effects.
Precautions
Pregnant women: avoid
Avoid use due to lack of reliable and sufficient information.
Breastfeeding women: avoid
Avoid use due to lack of reliable and sufficient information.
Bipolar disorder: avoid
The antidepressant activity of SAMe may trigger a switch to a manic phase in patients with bipolar disorder.
Parkinson's disease: avoid
SAMe methylates levodopa, which could theoretically worsen parkinsonian symptoms.
