Meta Information
ID:sam-e
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/class/serotonergic-agents
Target name:
Serotonergic Medications (SSRIs, SNRIs, TCAs, Triptans)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
SAM-e can increase serotonin levels, and combining it with other serotonergic drugs creates a high risk of serotonin syndrome, a potentially life-threatening condition caused by excessive serotonin activity.
Actionable advice:
Avoid combining SAM-e with these medications unless under the strict guidance of your prescribing physician.
Target id:
/class/maois
Target name:
Monoamine Oxidase Inhibitors (MAOIs)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
The combination of SAM-e with MAOIs poses a very high risk of severe serotonin syndrome and/or hypertensive crisis due to a massive increase in available monoamines like serotonin and norepinephrine.
Actionable advice:
This combination is contraindicated; never take SAM-e with MAOIs.
Target id:
/condition/bipolar-disorder
Target name:
Bipolar Disorder
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
The antidepressant effects of SAM-e can trigger a switch from a depressive episode into a manic or hypomanic state in individuals with bipolar disorder.
Actionable advice:
Do not use SAM-e if you have bipolar disorder, except under the direct supervision of a psychiatrist.
Target id:
/dietary/meal
Target name:
Any Caloric Food or Meal
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
1
Hours after target:
2
Description:
Food, particularly protein, can significantly interfere with the absorption of SAM-e in the gut, reducing its bioavailability and effectiveness.
Actionable advice:
Take SAM-e on an empty stomach, at least 1 hour before or 2 hours after eating.
Target id:
/intervention/folate
Target name:
Folate (Vitamin B9)
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
null
Description:
Folate is an essential cofactor for the metabolic pathway that recycles homocysteine, a potentially harmful byproduct of SAM-e's activity. Inadequate folate can lead to elevated homocysteine levels.
Actionable advice:
Ensure adequate folate intake, ideally as L-methylfolate, when supplementing with SAM-e.
Target id:
/intervention/vitamin-b12
Target name:
Vitamin B12
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
null
Description:
Vitamin B12 is a critical cofactor for the enzyme methionine synthase, which is necessary for converting homocysteine back to methionine as part of the SAM-e cycle.
Actionable advice:
Ensure adequate Vitamin B12 intake when supplementing with SAM-e to support healthy homocysteine metabolism.
Target id:
/intervention/levodopa
Target name:
Levodopa
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
SAM-e is a methyl donor that can increase the peripheral breakdown of levodopa, potentially reducing its effectiveness for treating Parkinson's disease symptoms.
Actionable advice:
Consult your neurologist before combining SAM-e with levodopa.
Target id:
/class/antidiabetic-medications
Target name:
Diabetes Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
SAM-e may have a mild glucose-lowering effect, which can be additive with diabetes medications, potentially increasing the risk of hypoglycemia (low blood sugar).
Actionable advice:
Monitor blood glucose levels closely if combining SAM-e with diabetes medications and consult your doctor.
Target id:
/biomarker/homocysteine
Target name:
Homocysteine
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
SAM-e is metabolized into homocysteine; without sufficient B-vitamin cofactors (B6, B9, B12) for recycling, homocysteine levels can rise, which is a risk factor for cardiovascular disease.
Actionable advice:
Periodically monitor homocysteine levels and ensure adequate B-vitamin intake when using SAM-e.
Target id:
/intervention/saint-johns-wort
Target name:
Saint John's Wort
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Both SAM-e and St. John's Wort increase serotonin levels, and their combined use significantly elevates the risk of developing potentially fatal serotonin syndrome.
Actionable advice:
Do not take SAM-e and St. John's Wort together.
Target id:
/intervention/dextromethorphan
Target name:
Dextromethorphan (Cough Suppressant)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Dextromethorphan has serotonergic properties and, when combined with SAM-e, can contribute to an increased risk of serotonin syndrome.
Actionable advice:
Avoid using dextromethorphan-containing cough and cold remedies while taking SAM-e.
Target id:
/intervention/tramadol
Target name:
Tramadol
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Tramadol is an opioid analgesic with strong serotonergic activity. Combining it with SAM-e creates a high risk of serotonin syndrome.
Actionable advice:
Do not take SAM-e and tramadol together.
Target id:
/intervention/vitamin-b6
Target name:
Vitamin B6
Severity:
moderate
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
null
Description:
Vitamin B6 is a required cofactor for the enzyme that converts homocysteine to cysteine, providing an alternative pathway for its clearance and preventing its accumulation.
Actionable advice:
Ensure adequate Vitamin B6 intake when supplementing with SAM-e.
Target id:
/class/anticoagulants-antiplatelets
Target name:
Anticoagulants and Antiplatelets
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
There is a theoretical concern that SAM-e could affect platelet function, potentially increasing the risk of bleeding when combined with blood-thinning medications, although clinical evidence is limited.
Actionable advice:
Use with caution and inform your doctor if you are taking blood-thinning medications.
Target id:
/circadian/sleep
Target name:
Going to Sleep
Severity:
minor
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
6
Hours after target:
null
Description:
SAM-e can have a mild stimulating or energizing effect in some individuals, which may cause anxiety or interfere with sleep if taken too close to bedtime.
Actionable advice:
Take SAM-e doses in the morning or early afternoon to avoid potential sleep disturbances.
Target id:
/intervention/creatine_systemic_healthspan
Target name:
Creatine
Severity:
minor
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
null
Description:
A large portion of the body's SAM-e is used to synthesize creatine. Supplementing with creatine can reduce this metabolic demand, potentially 'sparing' SAM-e for other essential methylation reactions.
Actionable advice:
Consider taking creatine to reduce the metabolic burden on the body's SAM-e supply.
Target id:
/intervention/betaine
Target name:
Betaine (TMG)
Severity:
minor
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
null
Description:
Betaine (TMG) supports an alternative metabolic pathway for recycling homocysteine back to methionine, complementing the folate/B12-dependent pathway and further protecting against homocysteine buildup.
Actionable advice:
Consider taking Betaine (TMG) alongside SAM-e to provide comprehensive support for homocysteine metabolism.
Target id:
/condition/lesch-nyhan-syndrome
Target name:
Lesch-Nyhan Syndrome
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
In this rare genetic disorder of purine metabolism, SAM-e administration can exacerbate the overproduction of uric acid, worsening the condition's symptoms.
Actionable advice:
SAM-e is contraindicated and should not be used by individuals with Lesch-Nyhan syndrome.