| Alternative Medicine. Author/s: Jeremy L. Pettit
Issue: May, 2000 Interest in alternative therapies has exploded among Americans during recent decades, and researchers have responded with studies and reports about the efficacy and safety of these treatments. Practitioners need to stay abreast of this emerging information so they can guide their patients in making informed decisions about using such alternative therapies as herbal medicine, acupuncture, homeopathy, and energy healing. To help PAs and NPs sort through the barrage of available information, each month the "Alternative Medicine" feature presents an up-to-date and scientific view of a specific therapy. SAMe Description Neither a drug nor a hormone, SAMe (S-adenosylmethionine) is a popular supplement now being marketed to relieve conditions including osteoarthritis (OA), depression, fibromyalgia, and certain liver disorders. SAMe is synthesized from the amino acid methionine and is found throughout the body. Pharmacology SAMe is a methyl donor that works within the cell to convert raw materials into bioactive agents; it is then converted to homocysteine, a contributing link to various diseases. [1-3] However, this need not be a reason for concern: results of in vivo studies suggest that SAMe may actually offer protection against the development of heart disease. [4] Additionally, folate and vitamin [B.sub.12] have been shown to reduce levels of homocysteine. [3,5] As for its apparent benefit to the joints, SAMe appears to protect the chondrocytes (cells that manufacture the main components of cartilage: chon-droitin sulfate, collagen, and proteoglycans) against physical stress that causes wear and tear on the joints. As production of proteoglycans improves, healthy cartilage can be better maintained and aging or damaged cartilage repaired. [6-8] Use Most research conducted on SAMe has addressed OA--a condition not satisfactorily treated by currently available medications. The use of nonsteroidal anti-inflammatory drugs (NSAIDs), for example, is diminishing with the acknowledgement that they improve joint pain and function only modestly--by 30% and 15%, respectively. [9] An awareness of NSAIDs' adverse effects, especially gastrointestinal pain and bleeding, has also reduced their use. Researchers have estimated that 16,500 deaths among arthritis sufferers each year are attributable to NSAID use. [10] Not only do aspirin, NSAIDs, and steroids appear to have a destructive effect on cartilage, [11-15] but NSAIDs may accelerate the breakdown of damaged cartilage because it absorbs greater amounts of the drugs. [16] The longest study ever conducted on the use of SAMe for OA was a 24-month, multicenter, open-label trial involving 10 general practitioners and 108 patients with OA of the knee, hip, or spine. Patients received 600 mg/d (200 mg tid) for two weeks, then 400 mg/d (200 mg bid) until study's end. Improvement of clinical symptoms among patients taking SAMe was evident beginning after two weeks of treatment. Despite nonspecific, transient adverse effects in 20 patients, none required discontinuation of therapy. No adverse effects were recorded during the last six months of treatment. [17] | |
The largest such trial of SAMe involved 20,641 patients with OA of the knee, hip, or spine, or osteoarthritic polyarthritis of the fingers. Patients received ademethionine (another name for SAMe) in a fixed dosage schedule for eight weeks with no other analgesics or antirheumatic treatment. Efficacy was described as very good or good by 71% of patients, as was tolerance by 87%. The trial by Berger and Nowak was discontinued early because of unspecified symptoms of intolerance in 5% of the patients; only 2.3% of patients reported lack of efficacy. [18] In other trials addressing its use to treat OA, SAMe had efficacy comparable with that of naproxen, [19,20] ibuprofen, [21] and indomethacin, [22] but produced fewer adverse reactions. As for SAMe's effectiveness in treating clinical depression, Bell and colleagues [23,24] have reported faster and more significant improvements in patients taking SAMe than in those given common antidepressants. By the end of the second week in one small trial, 66% of SAMe patients versus 22% of imipramine patients experienced significant improvement in symptoms of major depression. [23] In a second small study, 62% of patients given SAMe and 50% of patients receiving desipramine for major depression had significant improvement over four weeks; further, plasma SAMe levels were directly correlated with the degree of clinical improvement in patients who took it. [24] Other researchers suggest that SAMe may be an appropriate alternative for patients who cannot tolerate tricyclic] antidepressants. [25] Vahora and Malek-Ahmadi [26] reported fewer adverse effects with SAMe use than are associated with conventional antidepressants. Contraindications No studies have yet revealed contraindications for use of SAMe in normal daily doses. Drug Interactions No recent studies have addressed possible interactions between SAMe supplements and other drugs. Adverse Effects As mentioned above, Berger and Nowak [18] reported that 5% of patients complained of intolerance of SAMe, but precise effects were not specified. In comparison with other common therapies for OA, SAMe appears to have a limited adverse-effects profile. No reports of adverse effects, contraindications, drug interactions, or warnings have emerged from studies of patients who received SAMe for treatment of depression. Dose Regimen In the studies addressing SAMe and OA cited here, daily dosing ranged from 600 to 1,200 mg. [17-22] Murray [27] suggests an initial daily dosage of 1,200 to 1,600 mg, divided. After 21 days on this regimen, patients may reduce intake to a maintenance daily dosage of 400 mg. Cost Among the products currently available, package prices range from $27 to $55, with contents sufficient for approximately 10 days' recommended use. As continued research supports the beneficial effects of SAMe, it is hoped that competition among manufacturers will lead to lower prices. |
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