GLUCOSAMINE
Glucosamine is found
in human tissue, is a substrate for the pro-duction of articular cartilage, and
serves as a cartilage nutrient. Glucosamine is commercially derived from crabs
and other crustaceans. As a dietary supplement, glucosamine is primarily used
for pain associated with knee osteoarthritis. Sulfate and hydrochloride forms
are available, but recent research has shown the hydrochloride form to be
ineffective.
Endogenous glucosamine
is used for the production of gly-cosaminoglycans and other proteoglycans in
articular cartilage. In osteoarthritis, the rate of production of new cartilage
is exceeded by the rate of degradation of existing cartilage. Supplementation
with glucosamine is thought to increase the supply of the neces-sary
glycosaminoglycan building blocks, leading to better mainte-nance and
strengthening of existing cartilage.
Many clinical trials
have been conducted on the effects of both oral and intra-articular
administration of glucosamine. Early studies reported significant improvements
in overall mobility, range of motion, and strength in patients with
osteoarthritis. More recent studies have reported mixed results, with both
positive and nega-tive outcomes. One of the largest and well-designed clinical
trials, which compared glucosamine, chondroitin sulfate, the combina-tion,
celecoxib, and placebo, found no benefit for glucosamine therapy in mild to
moderate disease. Unfortunately the investiga-tors studied the glucosamine
hydrochloride formulation, which has been shown to be inferior to the sulfate
formulation. The formulation of glucosamine appears to play an important role
with regard to efficacy. More research is needed to better define the specific
patient populations that stand to benefit from glu-cosamine sulfate.
Glucosamine sulfate is
very well tolerated. In clinical trials, mild diarrhea and nausea were
occasionally reported. Cross allergenicity in people with shellfish allergies
is a potential concern; however, this is unlikely if the formulation has been
properly manufactured and purified.
Glucosamine sulfate
may increase the international normalized ratio (INR) in patients taking
warfarin, increasing the risk for bruising and bleeding. The mechanism is not
well understood and may be dose-related as increases in INR have occurred when
the glucosamine dose was increased. Until more is known, the combi-nation
should be avoided or very carefully monitored.
The dosage used most
often in clinical trials is 500 mg three times daily or 1500 mg once daily.
Glucosamine does not have direct analgesic effects, and improvements in
function, if any, may not be observed for 1–2 months.
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