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• Glucosamine and Chondroitin

Common Names: glucosamine, shark chondroitin
Scientific Names: glucosamine sulfate, glucosamine hydrochloride, chondroitin 4- and 6-sulfate

What are glucosamine and chondroitin?

• Glucosamine is a naturally occurring amino sugar that is produced in humans. It is also found in seashells or could be made in the laboratory. Glucosamine supplements are commonly sold as glucosamine sulfate, glucosamine hydrochloride, or N-acetyl glucosamine.
• Chondroitin is a substance that occurs naturally in the body. It is an important component of the cartilage around joints.

What it is it used for in people with rheumatic conditions?

• Glucosamine and chondroitin are often used alone or together for the management of osteoarthritis (OA).

How is it thought to work?

• Glucosamine is used by the body to make a “cushion” that surrounds the joints. This cushion becomes thinner and stiff in patients with OA.  Glucosamine might help to supply the material needed to rebuild the cushion. There is evidence to suggest that glucosamine may reduce the production of inflammatory mediators that cause joint and cartilage damage.
• Chondroitin is a major building block of the cartilage of the joint and may slow down the breakdown of joint cartilage by stopping certain enzymes from working.

Does it Work? What the Science Says:

Glucosamine sulfate 1500mg per day

• Some studies have shown reduced pain and improved functionality in patients with mild-to-moderate OA, especially knee OA. (2,7-10) However, in the GAIT trial, use of glucosamine hydrochloride and chondroitin, alone or in combination, did not significantly reduce pain in patients with knee OA.
• Limited evidence suggests glucosamine may modestly improve pain compared to placebo (VAS -1 vs 0) and symptoms associated with RA (n=25) after 12 weeks.
• Mixed results for OA
• Weak evidence to suggest benefit in RA
• May try 4-6 weeks for OA of the knee, since generally well tolerated

Glucosamine hydrochloride and N-acetyl glucosamine

• Limited evidence for use in patients with OA or RA, effects of glucosamine sulfate is not expected from these agents
• Limited evidence for benefit

Chondroitin sulfate 200-400mg 2 to 3 times per day

• May provide modest effect in reducing pain and improving joint function in patients with OA, especially the knee, after 8-12 weeks. However, some studies did not show any benefit in OA.
• Mixed results for OA and limited evidence to suggest benefit in RA
• May try 4-6 weeks for OA of the knee, similar to glucosamine

Condrosulf® (³95% highly purified chondroitin 4 and chondroitin 6 sulfate) 800mg once daily

• Recent clinical practice guidelines include a weak recommendation for hand OA based on a single trial of Condrosulf® versus placebo in patients with moderate pain, which demonstrated efficacy (VAS -2 vs. -1.2) without harm.
• In the STOPP trial, Condrosulf® produced significant reduction in pain and slowed joint-space widening compared to placebo in patients with mild-moderate OA.
• Recommended based on a single well conducted study of a specific formulation of chondroitin (only available in Canada via online ordering)
• Good evidence in STOPP trial as well

Combination Products

• It is unclear whether combining glucosamine and chondroitin provides additional benefit compared to the individual components.
• In the MOVES trial, a Spanish prescription product containing glucosamine hydrochloride/chondroitin sulfate 500/400mg three times daily was similar to celecoxib 200 mg daily in reducing pain from knee OA over 6 months.
• However, in another well-conducted trial in patients with knee OA, the placebo group demonstrated more pain reduction (-21 vs -12 on the global pain scale) than glucosamine sulfate/chondroitin sulfate 1500/1200mg once daily for 2 years.
• Combination may not be better than single agent products
• Good evidence in MOVES trial but unknown if dietary supplements available in Canada have similar benefit
• Conflicting evidence exists, potentially due to variation in formulation (hydrochloride vs sulfate salt)

What are possible side effects?

• Glucosamine and chondroitin are generally well tolerated. Side effects associated with glucosamine and chondroitin are generally mild in nature.
  • Glucosamine: nausea, stomach upset, heartburn, diarrhea, constipation. Drowsiness, headache, and skin reactions have also been reported.
  • Chondroitin: stomach upset and nausea, diarrhea, constipation, swelling of eyelid and lower limbs, and hair loss have also been reported.

Interactions

With drugs:

• Both glucosamine and chondroitin can interact with anticoagulant/antiplatelet drugs by increasing risk of bruising and/or bleeding.
  • Common antiplatelet and anticoagulant drugs may include: warfarin (Coumadin), ASA (Aspirin), and clopidogrel (Plavix), ticagrelor (Brilinta), prasugrel (Effient), enoxaparin (Lovenox), dalteparin (Fragmin), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and others.

For complete information about glucosamine or chondroitin, consult your physician and pharmacist.