Drug Topics - December 10, 2007 - (Page 37)

37 fect INR values and interact with warfarin administration. The interaction was seen in patients taking the combination of high-dose glucosamine and chondroitin daily. The INR value was seen to increase, placing patients at an increased risk of bleeding. SAMe: S-adenosylmethionine, or SAMe, is a naturally pro- duced endogenous substance found in almost all tissues and fluids. It plays an important role in biochemical reactions that involve enzymatic transmethylation. Therefore, it leads to the synthesis, activation, and metabolism of a variety of substances within the body, including hormones, neurotransmitters, proteins, lipids, nucleic acids, and some drugs. SAMe is believed to be beneficial for patients diagnosed with osteoarthritis due to analgesia and anti-inflammatory effects. It has also been hypothesized that it may stimulate articular cartilage growth and repair. SAMe is believed to focus primarily on chondrocyte and proteoglycan synthesis as well as proliferation rates. It may also protect against cell damage by antagonizing cytokine activity as seen with tumor necrosis factor-alpha (TNF-alpha) and fibronectin expression. A normal therapeutic dose of SAMe for osteoarthritis is 200 mg taken orally three times daily. SAMe has been relatively safe and well tolerated when used appropriately. One meta-analysis study of randomized control trials focused on the efficacy of SAMe compared with NSAIDs or placebo. Pain, functional limitations, and adverse effects were the outcomes considered. The results showed patients taking SAMe were found to have fewer adverse effects when compared with placebo. SAMe was also found to produce a greater effect at decreasing functional limitations when compared with placebo. This study concluded that SAMe was as effective as NSAIDs in reducing osteoarthritis pain as well as more beneficial than NSAIDs due to its decreased side-effect profile. In addition to these findings, a double-blind crossover study fo- cused on the efficacy of SAMe compared with COX-2 inhibitors when used in patients with osteoarthritis of the knee. Pain control, adverse effects, and functional limitations were once again measured against these medications. A dose of 1,200 mg of SAMe and 200 mg of celecoxib was given to patients for 16 weeks. The results found SAMe to have a slower onset of action when compared with celecoxib; however, both agents were equally effective for the treatment of osteoarthritis of the knee. SAMe is considered to be well tolerated by patients. Adverse effects such as nausea, vomiting, diarrhea, flatulence, constipation, dry mouth, dizziness, sweating, headache, mild insomnia, and nervousness were found to occur with high doses. It has also been reported that SAMe may be effective for the treatment of depression by increasing serotonin turnover as well as elevating norepinephrine and dopamine levels. Because of its serotonergic effect, SAMe is believed to interact with a variety of antidepressant medications, levodopa, monoamine oxidase inhibitors, tramadol, pentazocine, and St. John’s wort. Caution should be taken with the combination of these products. Selected USP-certified products for osteoporosis and osteoarthritis are listed on Table 2. CONCLUSION It is imperative that pharmacists have knowledge of natural supplements to help patients make the most educated choices based on efficacy, safety, and adverse effects when purchasing drug products. Increased media attention to osteoporosis along with increased concerns over the use of nonsteroidal medications in the treatment of osteoarthritis have prompted patients to turn more attention to OTC and natural products for relief. Therefore, pharmacists should expand their knowledge beyond prescription medications to supplements found on community pharmacy shelves. References are available upon request. TEST QUESTIONS Write your answers on the answer form appearing on page 39 (photocopies of the answer form are acceptable) or on a separate sheet of paper. Mark the most appropriate answer. 1. How many women in the United States have osteo2. What is the recommended dose of calcium for a 55- porosis or low bone mass? a. 10 million b. 20 million c. 30 million d. 40 million year-old female patient? a. 600 mg b. 800 mg c. 1,000 mg d. 1,200 mg to 1,500 mg

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Drug Topics - December 10, 2007 Latebreakers Latebreakers in Depth Letters Health-System Edition - Cover Story Clinical Practice Professional Practice Special Report Technology Community Practice Unraveling Medicare 150 Years of American Pharmacy Rx Care In the Pipeline Cover Story: Fair or foul? Self-Care Chains and Business Government and Law Continuing Education: Natural Medicines for Bone Health New Products Advertisers Index Classified Viewpoint

Drug Topics - December 10, 2007

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