SAMe (S-adenosyl-L-methionine)
- SAME is een molecuul en essentiële methyldonor voor meer dan 100 biochemische reacties in het lichaam.
- Het molecuul wordt door het lichaam gevormd uit homocysteïne en 5-MTHF (actief folaat).
- Hormonen, neurotransmitters, nucleïnezuren, eiwitten, fosfolipiden en sommige geneesmiddelen zijn afhankelijk van een toereikende SAMe huishouding.
- SAMe concentraties nemen af met het vorderen van de leeftijd. Ook bij o.a. depressie en levercirrose zijn de concentraties vaak verlaagd.
- SAMe kan worden ingezet zijn o.a.: depressie, artrose, levercirrose, fibromyalgie en veroudering.
In het kort
- SAME is een molecuul en essentiële methyldonor voor meer dan 100 biochemische reacties in het lichaam.
- Het molecuul wordt door het lichaam gevormd uit homocysteïne en 5-MTHF (actief folaat).
- Hormonen, neurotransmitters, nucleïnezuren, eiwitten, fosfolipiden en sommige geneesmiddelen zijn afhankelijk van een toereikende SAMe huishouding.
- SAMe concentraties nemen af met het vorderen van de leeftijd. Ook bij o.a. depressie en levercirrose zijn de concentraties vaak verlaagd.
- SAMe kan worden ingezet zijn o.a.: depressie, artrose, levercirrose, fibromyalgie en veroudering.
Wat is SAMe (S-adenosyl-L-methionine)?
SAMe is een molecuul dat van nature in het lichaam wordt gevormd uit homocysteïne en 5-methyleentetrahydrofolaat17490. Om tot SAMe te komen gebruikt het lichaam het aminozuur methionine en ATP. Het molecuul wordt door vrijwel alle lichaamsweefsels en vloeistoffen verdeeld5231. Concentraties zijn het hoogst tijdens de kindertijd en nemen af met de leeftijd9114.
SAMe speelt een essentiële rol in meer dan 100 biochemische reacties waarbij enzymatische transmethylering betrokken is. SAMe functioneert als primaire methylgroepdonor bij verschillende reacties in het lichaam. Het draagt bij aan de synthese, activering en/of het metabolisme van hormonen, neurotransmitters, nucleïnezuren, eiwitten, fosfolipiden en sommige geneesmiddelen5231,5232,9110,95076.
SAMe wordt endogeen geproduceerd uit homocysteïne en 5-methyleentetrahydrofolaat17490. De synthese is nauw verbonden met het metabolisme van vitamine B12 en foliumzuur (B11 of B11)5231. Tekorten aan deze vitamines kunnen resulteren in verlaagde SAMe-concentraties in het centrale zenuwstelsel5231.
Gebruik
SAMe wordt oraal gebruikt voor depressie, angst, hartziekte, fibromyalgie, buikpijn, osteoartritis, bursitis, tendinitis, lage rugpijn, dementie, de ziekte van Alzheimer, veroudering, chronisch vermoeidheidssyndroom (CVS), verbetering van intellectuele prestaties, leverziekte, cholestase en de ziekte van Parkinson. Andere toepassingen zijn onder meer premenstrueel syndroom (PMS), premenstruele dysfore stoornis (PMDD), opvliegers, aandachtstekortstoornis met hyperactiviteit (ADHD), multiple sclerose, ruggenmergletsel, toevallen, migraine, chronische loodvergiftiging, stoornissen van porfyrine en bilirubine metabolisme.
SAMe wordt ook intraveneus toegepast voor de behandeling van depressie, osteoartritis, aan HIV / AIDS gerelateerde myelopathie, fibromyalgie, leverziekte, cirrose en cholestase.
Intramusculaire toepassingen zijn fibromyalgie, depressie en de ziekte van Alzheimer.
Veiligheid
Indien oraal, intraveneus of intramusculair en op de juiste manier gebruikt. Ernstige toxiciteit is niet gemeld in meerdere klinische onderzoeken met meer dan 22.000 patiënten die enkele dagen tot twee jaar aanhielden5189,5201,5202,5209,5219,5231,5232,12231,14840,17490,95075,95076.
Kinderen
Bij kortstondig oraal of intraveneus gebruik bij kinderen werd 75-1,400 mg SAMe per dag met schijnbare veiligheid tot 30 dagen gebruikt bij kinderen met hepatitis, cholestase of functionele buikpijn20206,20456,20457,20458,90105.
Zwangerschap
Bij kortdurend intraveneus gebruik tijdens het derde trimester van de zwangerschap. In twee kleinschalige onderzoeken werd SAMe 800 mg dagelijks gedurende 14-20 dagen intraveneus gebruikt tijdens het derde trimester van de zwangerschap voor cholestase. Er werden geen nadelige effecten bij de moeder of de foetus waargenomen5219,5231,5240. Er zijn grootschalige onderzoeken nodig om de veiligheid van SAMe-gebruik tijdens de zwangerschap te bevestigen. Gebruik van SAMe tijdens de zwangerschap mag alleen worden overwogen als de voordelen duidelijk opwegen tegen de mogelijke risico’s. Er is onvoldoende betrouwbare informatie beschikbaar over het gebruik van SAMe bij hogere doses, gedurende langere tijd of tijdens het eerdere trimester van de zwangerschap.
Lactatie
Er is onvoldoende betrouwbare informatie beschikbaar.
Effectiviteit
Artrose
Meerdere klinische onderzoeken tonen aan dat het oraal innemen van SAMe superieur is aan placebo en vergelijkbaar is met NSAID’s voor het verminderen van symptomen die verband houden met osteoartritis. SAMe gaat gepaard met minder bijwerkingen dan NSAID’s, is vergelijkbaar wat betreft het verminderen van pijn en het verbeteren van functionele beperkingen (5188,5199,5203,5204,5205,5206,5207,5208,5209,5215)9108,9111,12054,20201,20202,20203. Aanzienlijke symptoomverlichting met SAMe kan tot 30 dagen behandeling vereisen, vergeleken met slechts 15 dagen met NSAID’s. Er zijn aanwijzingen dat intraveneuze oplaaddoses SAMe gedurende vijf dagen, gevolgd door orale behandeling, de symptoomverlichting kunnen versnellen tot 14 dagen5188.
Cholestasis
Het oraal of intraveneus toedienen van SAMe lijkt nuttig te zijn voor de behandeling van cholestase geassocieerd met acute of chronische leverziekte en zwangerschap. Meerdere klinische onderzoeken hebben aangetoond dat SAMe-therapie op korte termijn superieur is aan placebo wat betreft afnemende pruritus, vermoeidheid, alkalische fosfatasespiegels en totaal en geconjugeerd bilirubine bij patiënten met cholestase5219,5238,5239,5240,9108,20204,20206,20213, 20229. Ander voorlopig onderzoek toont aan dat SAMe het aantal vroeggeboorten vermindert in vergelijking met een controle van bèta-mimetica bij zwangere vrouwen met cholestase20212.
Cirrose
Voorlopig klinisch onderzoek toont aan dat het oraal of intraveneus toedienen van SAMe de leverfunctieparameters en pruritus verbetert bij patiënten met chronische leverziekte of levercirrose20214,20451,20455,20459,20460,20462. Ander voorlopig bewijs toont aan dat SAMe de protrombinetijd, het serumalbumine en de mate van lipideninfiltratie verbetert bij patiënten met levercirrose20453.
Depressie
Veel klinische onderzoeken tonen aan dat het gebruik van SAMe als monotherapie voor depressie effectiever is dan placebo en even effectief als tricyclische antidepressiva (TCA’s) in onderzoeken die tot 42 dagen duren2082,2083,5189,5190,5192,5195,5196,9108, 9109.Uit een analyse van klinisch onderzoek uit 2016 blijkt echter dat het nemen van SAMe als monotherapie voor depressie niet effectiever is dan placebo, hoewel het even effectief lijkt te zijn als TCA’s en escitalopram95075. Klinisch bewijs van hogere kwaliteit toont echter dat het toevoegen van SAMe 400-800 mg tweemaal daags aan conventionele behandeling de remissiepercentages na 6 weken aanzienlijk met ongeveer 14 procent verhoogt17490.
Het intraveneus of intramusculair toedienen van SAMe, op korte termijn, lijkt de symptomen van ernstige depressie te verbeteren. Verschillende klinische onderzoeken hebben aangetoond dat parenteraal toegediende SAMe superieur is aan placebo en mogelijk even effectief als intraveneuze of orale tricyclische antidepressiva in onderzoeken die tot 30 dagen duren2082,3562,5184,5189,5200, 5231,9109,20220,20222. In sommige onderzoeken trad het antidepressieve effect snel op, binnen 1-2 weken na aanvang van de behandeling5200. Dit voordeel is waarschijnlijk het gevolg van de parenterale toedieningsweg3562. Parenterale SAMe is ook met succes gebruikt in combinatie met een oraal tricyclisch antidepressivum om het begin van antidepressieve werking te versnellen5193.
Over het algemeen kan SAMe als monotherapiebehandeling voor depressieve stoornis nuttig zijn. Praktische richtlijnen van de American Psychiatric Association geven aan dat S-adenosylmethionine (SAMe) kan worden overwogen bij patiënten met depressie die de voorkeur geven aan complementaire en alternatieve therapieën17491. Er is iets sterker bewijs dat SAMe baat kan hebben bij patiënten met een depressieve stoornis bij gebruik in combinatie met conventionele antidepressiva. Momenteel beveelt het Canadian Network for Mood and Anxiety Treatments (CANMAT) SAMe aan als een tweedelijns, aanvullende behandeling voor gebruik bij milde tot matige depressieve stoornis95691.
Fibromyalgie
Het oraal innemen van SAMe kan mogelijk de symptomen van fibromyalgie verbeteren. Klinische onderzoeken toonden een bescheiden verbetering van de symptomen van fibromyalgie aan in vergelijking met placebo of vergeleken met transcutane elektrische zenuwstimulatie (TENS) -therapie5211,5241,20228. Het toedienen van 400 mg SAMe, 1 x daags gedurende 15 dagen, vermindert significant de pijn van de bekende tenderpoints evenals de depressieve gevoelens bij fibromyalgie20227.
Hiv / aids-gerelateerde myelopathie
Het intraveneus toedienen van SAMe lijkt de myelopathie bij patiënten met aids te verbeteren. SAMe heeft de status van weesgeneesmiddel in onderzoek voor dit gebruik1691,5217,5218.
Seksuele disfunctie
SAMe kan seksuele disfunctie bij mannen met een depressie verbeteren. Een klinische studie meldt dat het nemen van een getitreerde orale dosis SAMe 1600 mg per dag naast bepaalde antidepressiva gedurende 6 weken de subjectieve symptomen van seksuele opwinding en disfunctie verbetert in vergelijking met placebo bij mannen met depressieve stoornis20470.
Bijwerkingen
Oraal wordt SAMe over het algemeen goed verdragen. Bijwerkingen komen vaker voor bij hogere doses en omvatten winderigheid, misselijkheid, braken, diarree, obstipatie, droge mond, hoofdpijn, milde slapeloosheid, anorexia, zweten, duizeligheid en nervositeit5231,9113,12231,14840,17123.
Angst en vermoeidheid zijn opgetreden bij mensen met een depressie5231,14841 en hypomanie bij mensen met een bipolaire stoornis5231. Een geval van manie met is ook gemeld bij een verder gezonde patiënt12231.
Interacties
Medicatie
Levo-dopa
SAMe methyleert levodopa, wat de symptomen van Parkinson kan verergeren. Theoretisch zou SAMe de effectiviteit van levodopa bij de ziekte van Parkinson LE kunnen verminderen10466.
Serotonerge medicijnen
Vermijd de combinatie met medicijnen die werking hebben op het serotonine gehalte vanwege de versterkende effecten. SAMe heeft serotonerge effecten3521,5196,5232,5193. Theoretisch zou het combineren van serotonerge geneesmiddelen met SAMe het risico op serotonerge bijwerkingen kunnen verhogen, waaronder het serotoninesyndroom en cerebrale vasoconstrictieve aandoeningen8056.
Serotonerge geneesmiddelen omvatten selectieve serotonineheropnameremmers (SSRI’s) zoals fluoxetine (Prozac), paroxetine (Paxil) en sertraline (Zoloft); tricyclische en atypische antidepressiva zoals amitriptyline (Elavil), clomipramine (Anafranil) en imipramine (Tofranil); triptanen zoals sumatriptan (Imitrex), zolmitriptan (Zomig) en rizatriptan (Maxalt); opioïden zoals methadon (Dolophine) en tramadol (Ultram); en vele andere medicijnen.
Kruiden en supplementen
Kruiden en supplementen met serotonergische eigenschappen
Theoretisch zou SAMe de effecten en nadelige effecten kunnen versterken van producten die de serotoninespiegel verhogen. Deze producten omvatten 5-HTP, Hawaiian baby woodrose, L-tryptofaan en sint-janskruid3521, 5193).
Ziekte
Bipolaire stoornis
Het gebruik van SAMe kan ertoe leiden dat patiënten van een depressieve toestand naar een hypomanische of manische toestand gaan3523,5216,12231.
Lesch-Nyhan-syndroom
Bij Lesch-Nyhan-patiënten die werden behandeld met allopurinol, resulteerde SAMe 400 mg-1600 mg per dag, toenemend gedurende 8 weken, in verslechtering van het gedrag bij de meerderheid van de patiënten. De maximale dosis van 1600 mg per dag werd bereikt bij 4 van de 14 deelnemers90108.
Ziekte van parkinson
SAMe methyleert levodopa, wat theoretisch de symptomen van Parkinson zou kunnen verergeren. Dit is echter niet gemeld bij mensen10466.
Operatie
SAMe kan de serotoninespiegel beïnvloeden. Theoretisch kan SAMe interfereren met chirurgische procedures vanwege serotonerge effecten op het centrale zenuwstelsel of serotonerge effecten op het vasculaire systeem. Vertel patiënten om SAMe ten minste 2 weken vóór electieve chirurgische ingrepen te staken.
Dosering
Oraal:
SAMe wordt gewoonlijk ingenomen in doseringen van 400-1600 mg per dag gedurende 2-12 weken. De dagelijkse dosering kan worden verdeeld over 3 innamemomenten. Lage doses worden soms gedurende enkele weken opgehoogd. SAMe moet op een lege maag worden ingenomen, 30-60 minuten voor de maaltijd of twee uur na de maaltijd.
Intraveneus/intramusculair:
Intraveneus is SAMe toegediend in 200-1200 mg per dag als eenmalige dosis of verdeeld over 2 innamemomenten. Intramusculair is SAMe 200-400 mg eenmaal daags gedurende 1-4 weken toegediend.
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