SAMe: Benefits, Dosage, Contraindications
Other name(s)
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Scientific name(s)
S-adenosyl-L-methionine
Family or group:
Amino Acids
Indications
Rating methodology
EFSA approval.
Osteoarthritis ✪✪✪✪✪
Many clinical trials show that taking SAMe orally at doses of 400 to 1200 mg per day in 3 divided doses for up to 84 days is superior to placebo and comparable to NSAIDs (non-steroidal anti-inflammatory drugs) in reducing osteoarthritis symptoms. SAMe is associated with fewer adverse effects than NSAIDs and is comparable to NSAIDs in reducing pain and functional limitations. Significant symptom relief with SAMe may require up to 30 days of treatment compared to only 15 days with NSAIDs. Other preliminary evidence suggests that SAMe may stimulate the growth and repair of joint cartilage, particularly the synthesis and rate of proteoglycan proliferation in chondrocytes. A deficiency in SAMe in joint tissue leads to a loss of the gelatinous nature and shock-absorbing qualities of cartilage.
Posologie
Oral administration
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 multicentre study of the activity of S-adenosylmethionine in hip and knee osteoarthritis
Fibromyalgia ✪✪✪✪✪
Clinical research on SAMe has demonstrated modest improvement in certain symptoms of fibromyalgia compared to placebo, or compared to transcutaneous electrical nerve stimulation therapy. The doses used include 200 mg per day intramuscularly for 21 days, 800 mg per day orally in 2 divided doses for 6 weeks, or 400 mg per day orally in 2 divided doses for 6 weeks, plus 200 mg per day intramuscularly.
Posologie
Oral administration
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 suffering from depression show that taking SAMe as monotherapy at doses of 800 to 1600 mg per day in divided doses over 4 to 12 weeks is more effective than placebo and as effective as tricyclic antidepressants (TCAs). Preliminary clinical research in patients not responding to conventional antidepressants shows that taking oral SAMe at a dose of 1600 mg per day for 42 days does not improve depression symptoms compared to 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 administration
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 ✪✪✪✪✪
SAMe supplementation in patients with liver cirrhosis not only improves bile flow and clinical signs and symptoms but also enhances membrane function and increases glutathione levels. Glutathione plays a crucial role in detoxification and defense against various agents by directly combining with these toxic substances to eventually form water-soluble compounds. A double-blind randomized trial was conducted on patients with alcoholic cirrhosis, treated with SAMe (1200 mg/day, orally) or a placebo for 2 years. The results indicate that long-term treatment with SAMe can 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 daily or 400 mg three times daily for 1 month, or intravenously at 800 mg once daily or 250 to 600 mg twice per day for 3 to 30 days, improves liver function and pruritus in patients with chronic liver disease or liver cirrhosis.
Posologie
Orally
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 sulphur-containing amino acids in patients with liver cirrhosis
Biliary Disorders ✪✪✪✪✪
Oral intake of SAMe at 500 mg twice per day or 1600 mg per day for 2 to 8 weeks, or intravenously at 800 mg per day or 500 mg twice per day for 14 to 20 days, appears to be beneficial for treating cholestasis (reduced bile secretion) associated with acute or chronic liver diseases. Several clinical trials have shown that short-term SAMe treatment is superior to placebo in reducing pruritus, fatigue, alkaline phosphatase levels, and total and conjugated bilirubin in patients with cholestasis.
Posologie
Orally
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 SAMe intake at 1600 mg per day for 2 weeks, between peginterferon and ribavirin cures, appears to improve the early viral response in patients with hepatitis C who were previously non-responsive to conventional treatment. aIn other clinical research on patients with previously poor response to the same conventional treatment, the addition of SAMe 400 mg three times per day orally and 3 grams of betaine twice per day orally increased the percentage of patients with an early viral response from 14% to 59%. However, a sustained viral response was observed in only 10% of patients.
Posologie
Orally
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 levels, and enhances neurotransmitter binding to receptor sites, resulting in increased serotonin and dopamine activity and better membrane fluidity of brain cells, leading to 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 does not have effects on prostaglandins. SAMe may also protect against cytokine-induced cellular damage.
Usages associés
Hepato-protective
Individuals with acute or chronic liver disease lose the ability to synthesize SAMe from methionine, probably due to low activity of methionine adenosyltransferase (MAT), the enzyme that converts methionine to SAMe. This may lead to deficiencies in cysteine and choline. It can also result in 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 decreased bile flow, or cholestasis. SAMe is beneficial for a variety of liver disorders because of its ability to promote bile flow. Finally, SAMe allows for the inactivation of estrogens in the liver. In fact, clinical studies have shown it is useful for protecting the liver against damage and improving liver function in conditions associated with excess estrogens, namely the use of oral contraceptives, pregnancy, and premenstrual syndrome.
Usages associés
Safety dosage
Adult: 600 mg - 1600 mg
SAMe is perfectly suited for long-term use due to its excellent safety profile.
Interactions
Médicaments
Levodopa: moderate interaction
SAMe could reduce the effectiveness of levodopa.
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 lead to a switch to the manic phase in patients with bipolar disorder.
Parkinson's disease: avoid
SAMe methylates levodopa, which could theoretically worsen parkinsonian symptoms.
