Recommended Per Kilogram Dosage of S-adenosylmethionine (SAMe) for Pediatric Patients
For pediatric patients, the recommended dosage of S-adenosylmethionine (SAMe) is 15-20 mg/kg/day, with a maximum daily dose of 1.0 g.
Dosing Guidelines
The dosing of SAMe for pediatric patients follows similar principles to other medications used in this population:
- Initial dose: 15-20 mg/kg/day 1
- Maximum daily dose: 1.0 g (1000 mg) 1
- Administration: Can be given as a single daily dose or divided into two doses 1
Administration Considerations
- For better tolerability, SAMe can be administered with food or at bedtime
- Oral administration is the most common route for pediatric patients
- Dosing may need to be adjusted based on clinical response and tolerability
Clinical Applications
SAMe has been studied for several pediatric conditions:
- Functional abdominal pain: Starting dose of 200 mg/day with escalation to a maximum dose of 1400 mg/day over 2 months has shown promise in reducing abdominal pain 2
- Depression: Doses of 200-1600 mg/day have shown efficacy in depression treatment studies, though most studies were conducted in adults 3
Monitoring and Safety Considerations
- Liver function: Monitor liver function tests at baseline and periodically during treatment
- Psychiatric symptoms: Monitor for signs of mania, particularly in patients with bipolar disorder 3
- Tolerability: Watch for common side effects including:
- Gastrointestinal symptoms (nausea, vomiting)
- Headache
- Anxiety or restlessness
Important Caveats
- Limited pediatric-specific data exists for SAMe compared to adult studies
- The pilot study for functional abdominal pain in children 2 used a dose escalation approach starting at 200 mg/day
- SAMe appears to be well-tolerated in the limited pediatric studies available
- Pharmacokinetic studies suggest no significant accumulation of SAMe in plasma on multiple dosing 4
Practical Dosing Approach
For a child weighing 30 kg:
- Initial dose: 15 mg/kg/day = 450 mg/day
- Can be divided into two doses of 225 mg twice daily
- Dose may be adjusted based on clinical response and tolerability
- Maximum dose should not exceed 1 g/day
For optimal clinical effect, the dose may need to be titrated gradually while monitoring for efficacy and side effects.