S-아데노실메티오닌 (SAMe)

간장 보호제 / 영양 보조제

**S-아데노실메티오닌 (SAMe)**은 체내에 자연적으로 존재하는 내인성 분자로, 수의학에서 주로 **간장 보호제**로 널리 사용되는 영양 보조제입니다. 주요 임상 적용 분야: * **간 질환**: 만성 간염, 지방간, 담관간염 및 고양이 세동반질환의 보조 치료제로 사용됩니다. * **독성 관리**: 고갈된 글루타치온을 보충하여 **아세트아미노펜**이나 **자일리톨** 중독과 같은 급성 간독성 물질에 의한 간 손상 치료에 중요한 역할을 합니다. * **기타 용도**: 골관절염, 연령 관련 인지 기능 장애(개 인지 기능 장애 증후군) 및 간독성 잠재력이 있는 약물(예: 페노바르비탈)을 장기 복용하는 환자에게 유익할 수 있습니다. > **임상 팁**: 순수한 SAMe는 반응성이 높고 불안정하기 때문에 상용화된 제품은 안정성을 높이기 위해 다양한 염(예: 토실산염) 형태를 사용합니다. 제품 간 생체 이용률 차이가 크므로 신뢰할 수 있는 수의학 전용 브랜드를 선택하는 것이 강력히 권장됩니다.

작용 기전: SAMe is synthesized from the amino acid methionine and ATP via the enzyme **SAMe synthetase**. In liver compromise, this enzyme's activity is a rate-limiting step, leading to systemic SAMe deficiency. Exogenous SAMe bypasses this block and participates in three major biochemical pathways: * **Transsulfuration** → Generates sulfur-containing compounds → Precursor to **Glutathione (GSH)**. Glutathione is the liver's master antioxidant, essential for ROS scavenging and cellular detoxification. Exogenous SAMe prevents GSH depletion. * **Transmethylation** → Serves as a methyl donor → Essential for phospholipid synthesis (e.g., phosphatidylcholine) → Maintains cell membrane structure, fluidity, and function. * **Aminopropylation** → Donates aminopropyl groups → Source of polyamines → Promotes anti-inflammatory effects, protein/DNA synthesis, and **hepatocyte replication/regeneration**. Additionally, SAMe inhibits hepatocyte apoptosis secondary to alcohol or bile acid accumulation.

동물 종별 용량

Cats

General dosing / Liver support · 18 mg/kg (or based on weight: <5.5 kg: 90 mg; 5.5-11 kg: 180-225 mg) · PO · q24h · Give on an empty stomach, at least one hour before feeding.
Liver Disease (necro-inflammatory/cholestatic, feline hepatic lipidosis) · 20 mg/kg · PO · q24h · Give on an empty stomach; use a proven bioavailable product.
Liver disease, cognitive dysfunction, improve bile flow · 100 mg/cat or 20 mg/kg · PO · q24h · Long-term as needed · Administer on an empty stomach at least 1 hour before food. Tablets should be given whole.

Dogs

General dosing / Liver support · 18 mg/kg (or based on weight: <5.5 kg: 90 mg; 5.5-11 kg: 180-225 mg; 11-16 kg: 225 mg; 16-29.5 kg: 450 mg; 29.5-41 kg: 675 mg; >41 kg: 900 mg) · PO · q24h (may divide q12h if giving >1 tablet) · Give on an empty stomach, at least one hour before feeding.
Liver Disease (necro-inflammatory/cholestatic, vacuolar hepatopathy) · 20 mg/kg · PO · q24h · Give on an empty stomach; use a proven bioavailable product.
Liver disease, cognitive dysfunction, adjunctive therapy · At least 100 mg for every 10 kg or 20 mg/kg · PO · q24h · Long-term as needed · Administer on an empty stomach at least 1 hour before food. Tablets should be given whole.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

No absolute contraindications
Use with caution in pregnant animals (safety not definitively proven)
No absolute contraindications documented
Use with caution during pregnancy (safety not established)

이상반응

Immediate post-dose vomiting
Anorexia
Anxiety
Nausea (reported in humans)
Diarrhea (reported in humans)
Flatulence (reported in humans)
Nausea
Vomiting
Diarrhoea
Paradoxical anxiety
Dry mouth (reported in humans)
Headache (reported in humans)
Sweating (reported in humans)
Dizziness (reported in humans)

약물 상호작용

Tramadol · Theoretical risk of additive serotonergic effects (serotonin syndrome) · major
Meperidine · Theoretical risk of additive serotonergic effects · major
Dextromethorphan · Theoretical risk of additive serotonergic effects
Pentazocine · Theoretical risk of additive serotonergic effects · major
Monoamine oxidase inhibitors (MAOIs) (e.g., selegiline) · Theoretical risk of additive serotonergic effects
Selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine) · Theoretical risk of additive serotonergic effects
Tricyclic antidepressants (TCAs) (e.g., amitriptyline, clomipramine) · Theoretical risk of additive serotonergic effects
Selegiline · Additive serotonergic effects; potential for serotonin syndrome · major
Fluoxetine · Additive serotonergic effects; potential for serotonin syndrome · major
Clomipramine · Additive serotonergic effects; potential for serotonin syndrome · major
Amitriptyline · Additive serotonergic effects; potential for serotonin syndrome · major
Paracetamol · SAMe may increase the clearance of drugs undergoing hepatic glucuronidation · moderate

모니터링

Clinical signs (appetite, activity, attitude)
Liver enzymes (ALT, AST, ALP, GGT)
Bilirubin
Bile acids
Liver biopsies (if indicated)
Hepatic and erythrocyte glutathione levels (Note: may require 1-4 months before changes in lab values are noted)
Liver enzyme panel (ALT, AST, ALP, GGT)
Total bilirubin and bile acids
Clinical signs of cognitive improvement or behavioral changes
Signs of serotonin syndrome (agitation, tremors, hyperthermia) if used concurrently with serotonergic drugs

과용량

SAMe appears to be quite safe. The LD50 in rodents exceeds 4.65 grams/kg. Toxicity studies in dogs and cats at usual prescribed dosages demonstrated no deleterious effects. In the event of a massive overdose, mild gastrointestinal effects (nausea, vomiting, diarrhea) may be observed, but it is highly unlikely to require specific medical treatment beyond supportive care.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.