Glucosamine

Glucosamine sulfate

Efficacy

• Indications with possible efficacy:
  Mild to moderate osteoarthritis
• Indications with no proof of efficacy:
  Ankylosing spondylitis
  Bursitis
  Rheumatoid arthritis
  Tendinitis

Security

• Risk of Drug Interactions: Low
• Adverse Effects: Rare

Description

Where it comes from: sea shells or synthetic

Glucosamine is a naturally-occurring molecule found in the human body. It is present in the synovial fluid which is responsible for joint lubrification. In some arthritic diseases, there is a lack of synovial fluid which causes pain, swelling and reduced joint mobility.

Several salts of glucosamine are commercially available, such as sulfate, hydrochloride and others. Since most studies have been performed on glucosamine sulfate, the efficacy of these other salts has not been established.

Oral glucosamine is absorbed at a rate of about 90%.

Direction of use

• Mild to moderate osteoarthritis:
  The efficacy of glucosamine in the treatment of osteoarthritis has been compared to nonsteroidal anti-inflammatory agents (NSAIDs) and evidence suggest that the relief of osteoarthritis symptoms with glucosamine is similar or superior to NSAIDs. NSAIDs are faster acting, but the relief obtained with such agents rapidly disappear as soon as they are stopped.

  Symptoms relief appear within 4 to 6 weeks and its long-term safety and efficacy have not been established.

  Used doses: 500 mg, orally, 3 times a day.

  There is insufficient reliable information to conclude that glucosamine is effective in any other indication.

Precautions

• Side effects
  Glucosamine sulfate is not associated with any severe toxicity. In fact, it is generally very well tolerated and causes very few adverse effects. On occasion, people may suffer from nausea, heartburn, diarrhea or constipation, drowziness, heacache or itching. Glucosamine is associated with a much lower incidence of heartburn than NSAIDs. .
• Contraindications
  Patient suffering from diabetes, high blood pressure or asthma should be cautious. The safety of long term use has not been established. People with allergies to shellfish should use glucosamine with caution
• Interactions
  Glucosamine may enhance the effect of oral anticoagulants, such as Coumadin.
• Pregnancy and lactation
  Since there is no safety data available concerning its use during pregnancy and breast-feeding, pregnant and lactating women should not use glucosamine.

Clinical notes

• Glucosamine is often combined with chondroitin, however it is not known if such a combination is more beneficial than each drug taken alone. A possible synergy between these products remains to be established.

Warning

In 2004, Canada adopted new regulations that control the manufacturing, packaging, labeling and importing of natural health products. The new regulations also include an adverse reaction reporting system. Products that conform to the regulation's criteria are identified with a natural product number (NPN) and can be legally sold in Canada. This number indicates that the product meets specific criteria for safety and purity, not that it is effective for any indication.

Medicinal plant contents vary naturally from plant to plant - just as fruits from the same package may vary in taste and texture. There is no standard to measure the active content of each plant. Thus, efficacy of natural products should be expected to vary from brand to brand as well as from bottle to bottle of the same brand.

For more information about the Natural Health Products Regulations, or to check if a product has been assessed, visit the Health Canada website at www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php.

References

1. Pharmacist's Letter, CE Booklet: Nonherbal Dietary Supplements, Fall 1998
2. Natural Medicines Comprehensive Database, Therapeutic Research Faculty, 2010
3. Lininger S. et Al. The Natural Pharmacy, Prima Health, 1998
4. Passeportsanté.net. Glucosamine. www.passeportsante.net
5. Rotblatt M. et Ziment I. Evidence-Based Herbal Medicine, Hanley & Belfus, 2002
6. Haraoui B. et Ouellet M. La glucosamine dans le traitement de l'arthrose: efficace?, Le Clinicien, February 2003
7. Rinkor LJ. Can Glucosamine be Safely Used in Diabetes Patients? Pharmacist's letter, No. 190906 September 2003
8. Canadian adverse drug reaction newsletter, Vol. 11 No.2, April 2001
9. Kingston Richard L. Glucosamine Therapy: Shellfish Allergy a Problem? APha Drug Info Line, October 2003
10. Natural Therapeutics Pocket Guide, 2000-2001
11. The Review of Natural Products, 6th Edition, 2010
12. Health Canada, Natural Products Database