Indication-specific dosing for (SAMe), frequency-based adverse effects, comprehensive interactions, contraindications, pregnancy & lactation schedules, and cost information.

Sections

Sections Same
Suggested Dosing
Suggested Uses
Interactions
Adverse Effects
Warnings
Pregnancy
Pharmacology

Suggested Dosing

Depression

Oral: 400-1600 mg PO qDay

IM/IV: 200-400 mg/day

Osteoarthritis

Oral: 200 mg PO TID

IV: 400 mg/day IV

Liver Disease, Alcohol Related

Oral: 1200-1600 mg PO qDay; no more than 24 months

IV: 200-2000 mg/day IV x 15-30 days

IM: 200 mg/day IM x 30 days

Intrahepatic Cholestasis

Oral: 800 mg PO BID

Fibromyalgia

800 mg PO qDay

AIDS-related Myelopathy (Orphan)

800 mg/day IV x 14 days

Orphan indication sponsor

Genopia USA, Inc; 90 Gold Street, 6N; New York, NY 10038

Suggested Uses

AIDS-related myelopathy, Alzheimer's disease, bursitis/tendinitis, depression, fibromyalgia, heart disease, intrahepatic cholestasis, liver disease, migraine headache, osteoarthritis

Efficacy

Several studies showed comparable effectiveness to TCAs

Standardization of product not as good in US as in Europe

Oral form has poor bioavailability; pos. studies used parenteral SAMe

Mult clinical trials showed comparable effectiveness to NSAIDS, with fewer side effects

Studies showed possibly effective for the treatment of AIDS-related myelopathy, fibromyalgia,& intrahepatic cholestasis

Interaction Checker

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No Interactions Found

Interactions Found

Contraindicated

Serious - Use Alternative

Significant - Monitor Closely

Minor

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Contraindicated (0)

Serious - Use Alternative (7)

desvenlafaxine
SAMe and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
isocarboxazid
isocarboxazid and SAMe both increase serotonin levels. Avoid or Use Alternate Drug.
linezolid
linezolid and SAMe both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.
methylene blue
methylene blue and SAMe both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
phenelzine
phenelzine and SAMe both increase serotonin levels. Avoid or Use Alternate Drug.
procarbazine
procarbazine and SAMe both increase serotonin levels. Avoid or Use Alternate Drug.
tranylcypromine
tranylcypromine and SAMe both increase serotonin levels. Avoid or Use Alternate Drug.

Monitor Closely (54)

5-HTP
5-HTP and SAMe both increase serotonin levels. Use Caution/Monitor.
almotriptan
almotriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
amitriptyline
amitriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
amoxapine
amoxapine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
buspirone
buspirone and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
citalopram
citalopram and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
clomipramine
clomipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
cocaine topical
cocaine topical and SAMe both increase serotonin levels. Use Caution/Monitor.
desipramine
desipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
dexfenfluramine
dexfenfluramine and SAMe both increase serotonin levels. Use Caution/Monitor.
dextroamphetamine
dextroamphetamine and SAMe both increase serotonin levels. Use Caution/Monitor.
dextromethorphan
dextromethorphan and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
dihydroergotamine
dihydroergotamine and SAMe both increase serotonin levels. Use Caution/Monitor.
dihydroergotamine intranasal
dihydroergotamine intranasal and SAMe both increase serotonin levels. Use Caution/Monitor.
doxepin
doxepin and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
duloxetine
duloxetine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
eletriptan
eletriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
ergotamine
ergotamine and SAMe both increase serotonin levels. Use Caution/Monitor.
escitalopram
escitalopram and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
fenfluramine
fenfluramine and SAMe both increase serotonin levels. Use Caution/Monitor.
fluoxetine
fluoxetine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
fluvoxamine
fluvoxamine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
frovatriptan
frovatriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
imipramine
imipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
isoniazid
isoniazid and SAMe both increase serotonin levels. Use Caution/Monitor.
L-tryptophan
L-tryptophan and SAMe both increase serotonin levels. Use Caution/Monitor.
levomilnacipran
levomilnacipran and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
lithium
lithium and SAMe both increase serotonin levels. Use Caution/Monitor.
lofepramine
lofepramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
lsd
lsd and SAMe both increase serotonin levels. Use Caution/Monitor.
maprotiline
maprotiline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
meperidine
meperidine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
milnacipran
milnacipran and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
mirtazapine
mirtazapine and SAMe both increase serotonin levels. Use Caution/Monitor.
morphine
morphine and SAMe both increase serotonin levels. Use Caution/Monitor.
naratriptan
naratriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
nefazodone
nefazodone and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
nortriptyline
nortriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
paroxetine
paroxetine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
pentazocine
pentazocine and SAMe both increase serotonin levels. Use Caution/Monitor.
protriptyline
protriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
rasagiline
rasagiline and SAMe both increase serotonin levels. Use Caution/Monitor.
rizatriptan
rizatriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
selegiline
selegiline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely. Routine addition of SAM-e to other conventional antidepressant medications, especially MAOIs is not recommended.
selegiline transdermal
selegiline transdermal and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
sertraline
sertraline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
St John's Wort
SAMe and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.
sumatriptan
sumatriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
sumatriptan intranasal
sumatriptan intranasal and SAMe both increase serotonin levels. Use Caution/Monitor.
tramadol
SAMe and tramadol both increase serotonin levels. Use Caution/Monitor.
trazodone
trazodone and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
trimipramine
trimipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
venlafaxine
venlafaxine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
zolmitriptan
zolmitriptan and SAMe both increase serotonin levels. Use Caution/Monitor.

Minor (0)

5-HTP
Monitor Closely (1)5-HTP and SAMe both increase serotonin levels. Use Caution/Monitor.
almotriptan
Monitor Closely (1)almotriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
amitriptyline
Monitor Closely (1)amitriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
amoxapine
Monitor Closely (1)amoxapine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
buspirone
Monitor Closely (1)buspirone and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
citalopram
Monitor Closely (1)citalopram and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
clomipramine
Monitor Closely (1)clomipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
cocaine topical
Monitor Closely (1)cocaine topical and SAMe both increase serotonin levels. Use Caution/Monitor.
desipramine
Monitor Closely (1)desipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
desvenlafaxine
Serious - Use Alternative (1)SAMe and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
dexfenfluramine
Monitor Closely (1)dexfenfluramine and SAMe both increase serotonin levels. Use Caution/Monitor.
dextroamphetamine
Monitor Closely (1)dextroamphetamine and SAMe both increase serotonin levels. Use Caution/Monitor.
dextromethorphan
Monitor Closely (1)dextromethorphan and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
dihydroergotamine
Monitor Closely (1)dihydroergotamine and SAMe both increase serotonin levels. Use Caution/Monitor.
dihydroergotamine intranasal
Monitor Closely (1)dihydroergotamine intranasal and SAMe both increase serotonin levels. Use Caution/Monitor.
doxepin
Monitor Closely (1)doxepin and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
duloxetine
Monitor Closely (1)duloxetine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
eletriptan
Monitor Closely (1)eletriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
ergotamine
Monitor Closely (1)ergotamine and SAMe both increase serotonin levels. Use Caution/Monitor.
escitalopram
Monitor Closely (1)escitalopram and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
fenfluramine
Monitor Closely (1)fenfluramine and SAMe both increase serotonin levels. Use Caution/Monitor.
fluoxetine
Monitor Closely (1)fluoxetine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
fluvoxamine
Monitor Closely (1)fluvoxamine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
frovatriptan
Monitor Closely (1)frovatriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
imipramine
Monitor Closely (1)imipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
isocarboxazid
Serious - Use Alternative (1)isocarboxazid and SAMe both increase serotonin levels. Avoid or Use Alternate Drug.
isoniazid
Monitor Closely (1)isoniazid and SAMe both increase serotonin levels. Use Caution/Monitor.
L-tryptophan
Monitor Closely (1)L-tryptophan and SAMe both increase serotonin levels. Use Caution/Monitor.
levomilnacipran
Monitor Closely (1)levomilnacipran and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
linezolid
Serious - Use Alternative (1)linezolid and SAMe both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.
lithium
Monitor Closely (1)lithium and SAMe both increase serotonin levels. Use Caution/Monitor.
lofepramine
Monitor Closely (1)lofepramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
lsd
Monitor Closely (1)lsd and SAMe both increase serotonin levels. Use Caution/Monitor.
maprotiline
Monitor Closely (1)maprotiline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
meperidine
Monitor Closely (1)meperidine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
methylene blue
Serious - Use Alternative (1)methylene blue and SAMe both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
milnacipran
Monitor Closely (1)milnacipran and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
mirtazapine
Monitor Closely (1)mirtazapine and SAMe both increase serotonin levels. Use Caution/Monitor.
morphine
Monitor Closely (1)morphine and SAMe both increase serotonin levels. Use Caution/Monitor.
naratriptan
Monitor Closely (1)naratriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
nefazodone
Monitor Closely (1)nefazodone and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
nortriptyline
Monitor Closely (1)nortriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
paroxetine
Monitor Closely (1)paroxetine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
pentazocine
Monitor Closely (1)pentazocine and SAMe both increase serotonin levels. Use Caution/Monitor.
phenelzine
Serious - Use Alternative (1)phenelzine and SAMe both increase serotonin levels. Avoid or Use Alternate Drug.
procarbazine
Serious - Use Alternative (1)procarbazine and SAMe both increase serotonin levels. Avoid or Use Alternate Drug.
protriptyline
Monitor Closely (1)protriptyline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
rasagiline
Monitor Closely (1)rasagiline and SAMe both increase serotonin levels. Use Caution/Monitor.
rizatriptan
Monitor Closely (1)rizatriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
selegiline
Monitor Closely (1)selegiline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely. Routine addition of SAM-e to other conventional antidepressant medications, especially MAOIs is not recommended.
selegiline transdermal
Monitor Closely (1)selegiline transdermal and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
sertraline
Monitor Closely (1)sertraline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
St John's Wort
Monitor Closely (1)SAMe and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.
sumatriptan
Monitor Closely (1)sumatriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
sumatriptan intranasal
Monitor Closely (1)sumatriptan intranasal and SAMe both increase serotonin levels. Use Caution/Monitor.
tramadol
Monitor Closely (1)SAMe and tramadol both increase serotonin levels. Use Caution/Monitor.
tranylcypromine
Serious - Use Alternative (1)tranylcypromine and SAMe both increase serotonin levels. Avoid or Use Alternate Drug.
trazodone
Monitor Closely (1)trazodone and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
trimipramine
Monitor Closely (1)trimipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
venlafaxine
Monitor Closely (1)venlafaxine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
zolmitriptan
Monitor Closely (1)zolmitriptan and SAMe both increase serotonin levels. Use Caution/Monitor.

Frequency Not Defined

Anxiety

Diarrhea

Flatulence

Headache

Hypomania/mania

Nausea/vomiting

Contraindications

MAO inhibitor use within 14 day

Cautions

Bipolar disorder

Pregnancy & Lactation

Pregnancy Category: N/A

Lactation: N/A

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Pharmacology

Metabolism: N/A

Excretion: N/A

Mechanism of Action

Methyl donor in many metabolic reactions

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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Sections Same
Suggested Dosing
Suggested Uses
Interactions
Adverse Effects
Warnings
Pregnancy
Pharmacology

Same (Herb/Suppl)