Interactions with Drugs
SAMe may affect bleeding risk when taken with drugs that may affect bleeding risk. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
SAMe may affect blood pressure. Caution is advised in people taking drugs that affect blood pressure.
SAMe may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be increased in the blood and may cause increased effects or potentially serious adverse reactions. People using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
SAMe may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
SAMe may also interact with agents that may affect the nervous system, agents that may be toxic to the liver, agents that may treat psychiatric disorders, alcohol, antidepressants (monoamine oxidase inhibitors [MAOIs] and selective serotonin reuptake inhibitors [SSRIs]), anti-inflammatory agents, cholesterol-lowering agents, clomipramine, ear agents, estrogens, eye agents, levodopa, methotrexate, pain relievers, skin agents, stomach agents, tolcapone, and tricyclic antidepressant drugs (TCAs).
Interactions with Herbs and Dietary Supplements
SAMe may affect bleeding risk when taken with herbs and supplements that are believed to affect bleeding risk. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
SAMe may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
SAMe may affect blood pressure. Caution is advised in people taking herbs or supplements that affect blood pressure.
SAMe may also interact with alcohol, antidepressants (monoamine oxidase inhibitors [MAOIs] and selective serotonin reuptake inhibitors [SSRIs]), anti-inflammatory herbs and supplements, antioxidants, cholesterol-lowering herbs and supplements, choline, docosahexaenoic acid (DHA), folic acid, herbs and supplements that may affect the nervous system, herbs and supplements that may be toxic to the liver, herbs and supplements that may treat psychiatric disorders, hormonal herbs and supplements, methionine, minerals, pain relievers, stomach agents, vitamins, vitamin B6, and vitamin B12.
This evidence-based monograph was prepared by The Natural Standard Research Collaboration