SAM-e, cautions

SAMe can increase the metabolism of certain drugs by facilitating their conjugation. However, the clinical significance of this observation is unknown.
 SAMe may lead to serotonin syndrome* if combined with antidepressants; do not use concurrently. Use of this supplement should be avoided if taking other supplements such as 5-HTP or St John’s wort because these products may also affect serotonin levels.
Patients on antidepressants or with bipolar disorder should avoid this supplement without the supervision of the treating physician due to case reports of mania, serotonin syndrome, or other side effects .

(Serotonin syndrome is a toxic reaction requiring immediate medical attention and is associated with too much serotonin. Symptoms may include anxiety, restlessness, confusion, weakness, tremor, muscle twitching or spasm, high fever, profuse sweating and rapid heart beat.)

Side effects may occur:

<ul>

<li>Insomnia</li>

<li>Anxiety</li>

<li>GI upset</li>

</ul>

<h2>Drug Interactions</h2>

Clomipramine: Serotonin syndrome was reported following concomitant administration of clomipramine and intramuscular S-adenosylmethionine .  <a href="http://www.ncbi.nlm.nih.gov/pubmed/8434674">Toxic interaction of S-adenosylmethionine and clomipramine</a>
Levodopa: There is concern that taking SAM-e over a period of time may decrease the effectiveness of L-dopa in Parkinson’s disease .  <a href="http://www.ncbi.nlm.nih.gov/pubmed/16340382" target="_blank">Levodopa intake increases plasma levels of S-adenosylmethionine in treated patients with Parkinson disease</a>
Antidepressants/anxiolytics (tricyclic antidepressants, MAOIs, and SSRIs): SAM-e may also raise serotonin levels, thereby increasing the risk of side effects or toxicities. A few case reports of mania and serotonin syndrome have been attributed to concomitant use of SAM-e.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/29950497">Possible SAMe-induced mania</a>

There is a theoretical concern that immunocompromised individuals may have an increased risk of Pneumocystis carinii infection with SAM-e.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/10809741" target="_blank">S-adenosylmethionine and</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/10809741">Pneumocystis carinii</a>.