S-adenosyl methionine

(SAM-e)

Description: SAM-e is an amino acid. It is the most active methyl-donor in your

body, meaning it donates methyl groups to other chemical compounds in your
body including neurotransmitters.

Therapeutic indications are summarized as follows

• Osteoarthritis
• Fatty liver
• Depression

Dose: 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.

Usage: SAMe is best absorbed on an empty stomach. Enteric-coated tablets

packaged in foil or foil blister packs increase stability and improve absorption.
SAMe should be stored in a cool, dry place to prevent deterioration.

Availability: In the United States, SAM is sold as a nutritional supplement under

the marketing name SAM-e. SAM is also marketed under the Gumbaral, Samyr,
Adomet, Heptral and Admethionine brand names as a prescription drug
approved in Russia, Italy, and Germany. In India it is being marketed by
wochhard with brand name SAMMY 200/400 Tablet for osteoarthritis.

Regulatory status: Prescription drug and Nutraceuticals

Oral SAMe achieves peak plasma concentrations 3 to 5 hours after ingestion of

an enteric-coated tablet (400 – 1000 mg). The half-life is about 100 minutes. It
may require up to one month for it to reach full effectiveness in treating
osteoarthritis. Because of structural instability, stable salt forms of SAM are
required for its use as an oral drug.

Therapeutic use of SAM 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 as dietary supplement,
and therefore allowed it to bypass the regulatory requirements for drugs of the
Food and Drug Administration (FDA).

For depression, SAMe was shown to be as good as standard antidepressant

therapy.
For liver disease, SAMe improved intrahepatic cholestasis (cholesterol deposits
in the liver, including intrahepatic cholestasis of pregnancy) and reduced serum
bilirubin levels, itching associated with intrahepatic cholestasis and jaundice.

For osteoarthritis, SAMe was shown as effective at relieving joint pain as

NSAIDs. SAM-e plays an important role in cartilage formation and repair. In in-
vitro studies, SAM-e has been shown to increase the blood levels of
proteoglycans - the starting point of cartilage formation. It increases synovial fluid
and reduces stiffness, soreness and pain.

Side Effects: Oral supplementation of SAM-e can cause nausea and vomiting in
some people, so it is recommended that supplementation be graduated. Start
with one 200mg tablet per day. That may be enough. After a couple days,
increase to 200mg twice a day, and if needed, you can increase to 400mg twice
a day on the 5th or 6th day. Only increase to 400mg three times a day after
about 2 weeks and finally, 400mg four times a day after about 3 weeks. People
suffering from bipolar disorder should not take SAM-e, as its rapid antidepressant
effects can lead to manic episodes! Also, see the precautionary note below
regarding homocysteine. It is recommended that people taking SAM-e also take
a B-vitamin complex.

Developed by

Dr.Mohammad Shahbaz Alam- 0091-9818131498

Meher Pharma International, New Delhi, India
Email:meher_pharma@rediffmail.com