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
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

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)
Adverse Effects
Frequency Not Defined
Anxiety
Diarrhea
Flatulence
Headache
Hypomania/mania
Nausea/vomiting
Warnings
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