II. Indications

III. Physiology

  1. Endogenous compound synthesized in liver from Methionine
  2. Increases chondrocytes and decreases their Cytokine-induced damage
  3. Increases cartilage thickness

IV. Efficacy

  1. Symptom improvement does not occur for weeks after starting treatment
  2. Comparable to NSAIDs for Osteoarthritis pain
  3. Although Celebrex was more effective in the first month, no difference at 3 months
  4. References
    1. Muller-Fassbender (1987) Am J Med 83:81-3 [PubMed]
    2. Najm (2004) BMC Musculoskelet Disord 5:6 [PubMed]

V. Adverse Effects

  1. May be better tolerated than NSAIDs
  2. Serotonergic effects
    1. Anxiety
    2. Headache
    3. Mania
    4. Risk of Serotonin Syndrome

VI. Dosing

  1. SAMe 200 mg orally three times daily

VII. Disadvantages

  1. Very expensive
  2. Short and unpredictable shelf life
    1. Butanedisulfonate salt formulation appears to be most stable of available preparations

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