SAMe (Jarrow) Each box, either 30 tablets. Each enterically-coated tablet, 400 mg. derived from 800 mg tosylate disulfate. Suggested use is 400 to 800 mg/day. If taking 800 mg per day, take 2 tablets per day between meals. Clinical studies sometimes use a loading dose of 1,200 mg per day for three weeks and then a maintenance dosage of 400 to 600 mg per day.

SAMe is a compound of the amino acid methionine plus the cell's energy molecule, adenosine triphosphate (ATP). ATP is utilized in a wide range of reactions as a critical provider of the energy that drives many reactions. SAMe may be extremely helpful for liver function, while avoiding the iron-sequestering (and thus, damaging) effects of the free-form methionine. One placebo-controlled study showed improvement in bile flow, with reductions in bilirubin and alkaline phosphatase. Other studies showed improvements in fatty liver, the GGT level and reduced itching. It may have the added benefit of offsetting depression, which several studies have shown some benefit. Those with joint (arthritic) or bone problems may benefit from its anti-inflammatory properties. S-adenosylmethionine is an intermediate step along the pathway (or series of chemical reactions) transforming homocysteine into methionine, and from there to cysteine and taurine. Homocysteine in excess amounts can cause atherosclerosis, which can be offest by adequate intake of folic acid. Increased blood fats and other potential dangers to heart function are more commonly being seen in HIV+ people using protease inhibitors.

It is not clear whether using SAMe may help lower or might actually increase homocysteine levels (which would not be a good thing). This might happen if for some reason your body isn't converting the homocysteine to cysteine, which in this pathway are dependent on B12 and folic acid. (Another pathway using B6 converts the homocysteine to cystathionine.) See the entry also on TMG below.

It is a good idea to use SAMe with adequate levels of vitamins B6, B12, folic acid and, possibly, betaine (TMG). SAMe is probably the most active and efficient methyl-donor known. Vitamin B12 is another excellent one. Methyl groups are needed for the body to synthesize its own carnitine and various neurotransmitters (brain chemicals) like L-dopa, acetyl-L-carnitine, epinephrine and other compounds. Methylation of DNA can help protect and preserve it. It has been used to treat some inherited conditions that result in demyelination of nerves that causes neuropathy; whether this would help those with HIV- or HAART-related neuropathy is not known, although low levels of SAMe have been seen in people with HIV-related neuropathy. Reduced levels of SAMe are associated with fatty liver as well as other pathologies. In addition, since cotrimoxazole (Bactrim, Septra) can inhibit folate, this might be a good idea to use since it may be the Bactrim causing the observed increase in homocysteine. Studies report no side effects at all. However, there is a theoretical, but as yet unobserved, concern for people with bipolar manic/depressive disorder using SAMe. One case report of a woman receiving SAMe and clomipramine suggested a synergistic reaction that caused serious anxiety, heart dysregulation, confusion and stupor.

Store at room temperature. Do not store at extreme temperatures.