Ademetionine (SAMe)
SAM-e, S-adenosylmethionine, S-adenosyl-L-methionine, AdoMet, Heptral, Transmetil, Samyr
Forms: Enteric-coated tablets; in countries where it is a medicine, also an injectable form used in hospitals. Supplement products differ in content and stability.
The body's main methyl donor and a glutathione precursor, made mainly in the liver. A licensed medicine in some countries (for intrahepatic cholestasis, in some also depression), a dietary supplement in others.
Legal status: A licensed medicine in some countries (for example Italy, for intrahepatic cholestasis); sold as a dietary supplement in the US. Varies by country.
What it gives
What people use it for and what the sources report. Strength is a general category from the literature: mild, clear or strong.
Purpose
Taken as 'liver support' while using oral steroids, because their typical liver injury is cholestasis (blocked bile flow). No trial has tested it in steroid users, and large high-quality trials in liver disease are lacking.
What people seek and what studies show
A Cochrane review of 9 trials (434 patients) in alcoholic liver disease found no significant effect on death, transplant or complications. In cholestasis of pregnancy, UDCA eased itching and lowered liver enzymes more than SAMe. In drug-induced liver injury the evidence is of very low certainty. For depression and osteoarthritis results are inconclusive.
Effects
Evidence: Limited human data — some human studies, small or short
Sought effects by goal (as reported)
Possible side effects
Possible does not mean certain: whether they appear depends on dose, duration, individual response and monitoring. Below — what to watch for and how to notice it early.
2 possible side effects
level · how often it is reportedWhat the levels mean
Level: general category from the literature, not your personal risk
How often
- common
- reported often
- possible
- reported in some people
- rare
- reported occasionally
How to lower the risks
For 2 of 2 possible side effects there are specific ways to lower the chance: everyday measures, supplements and options a doctor may consider. No measure removes a risk completely.
Good sleep, fewer stressors, tell someone close to you what to watch for.
How each option helps (2)
- Avoiding alcohol and other liver stressors — Alcohol and other drugs on top of steroids explain much of the link between steroid use and violence.
- Sleep hygiene — Enough sleep lowers irritability and improves impulse control.
Low-level side effects
How each option helps (2)
- Working with a doctor — Assesses persistent vomiting or severe belly pain (possible pancreatitis or gallstones) and adjusts prescribed GLP-1 treatment when nausea persists.
- Pancreatin + dimeticone (Pankreoflat) — May ease heaviness and gas after meals; can cause nausea or diarrhea. Not for pork or cow's milk protein allergy (anaphylaxis reported) or early acute pancreatitis.
Check-ups and blood tests
Which tests and check-ups to do and when. This is a guide — agree the exact schedule with your doctor.
Which doctors can help
Get medical help at once if
- Losing control of anger, thoughts of harming yourself or others — stop and get help today.
In an emergency, call your local emergency number.
For women
Used medically for cholestasis of pregnancy, but its safety in pregnancy has not been established; that decision belongs to the obstetrician.
Myth & fact
“Heptral restores the liver after oral steroids.”
No large, high-quality trial shows clinical benefit in any specific liver disease, and none tested steroid users. Jaundice, itching or dark urine need a doctor and stopping the steroid.
Combinations
No specific combination notes for this substance yet. The stack check still adds up side effects that several substances share.
Sources
Possible side effects by body system, combinations, how to lower the risks and which tests to do — free.
Open the stack check