Glucosamine

Common Name(s): 2-amino-2-deoxyglucose, Chitosamine, Glucosamine, Glucosamine hydrochloride, Glucosamine sulfate

Medically reviewed by Drugs.com. Last updated on Nov 21, 2022.

Clinical Overview

Use

Glucosamine sulfate and glucosamine hydrochloride have been extensively evaluated in multiple large comparative trials for effects in osteoarthritis, with mixed findings regarding efficacy. Associated guidelines do not recommend the routine use of glucosamine for osteoarthritis. Other potential uses for glucosamine salts include atopic dermatitis, cancer, and osteoporosis.

Dosing

In clinical studies of osteoarthritis, the typical glucosamine dosage (for both sulfate and hydrochloride salt forms) has been 1.5 g/day as a single dose or in divided doses of up to 3 times per day (treatment duration of up to 3 years).

Contraindications

Caution should be used in patients with a shellfish allergy, as glucosamine is derived from the exoskeletons of shellfish.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

Agents with antiplatelet properties: Glucosamine may enhance the antiplatelet effect of agents with antiplatelet properties. Monitor therapy.

Warfarin: Glucosamine may enhance the anticoagulant effect of warfarin. Monitor therapy.

Adverse Reactions

Glucosamine is generally considered safe. The majority of reported adverse reactions have been mild, including itching and gastric discomfort (eg, diarrhea, heartburn, nausea, vomiting), which may be alleviated by taking with food. Use caution when administering to individuals with poorly controlled diabetes or liver disease. Use with caution in individuals with allergy to shellfish or with asthma.

Toxicology

No data.

Biology

Glucosamine is a component of mucopolysaccharides, mucoproteins, and chitin. Chitin is found in yeasts, fungi, arthropods, and various marine invertebrates as a major structural component of the exoskeleton. It also occurs in other animals and members of the plant kingdom.Budavari 1989

Chemistry

Chemically, chitin is a biopolymer similar to cellulose but with predominantly unbranched chains of beta (1-4)-2-acetamido-2-deoxy-D-glucose or N-acetyl-D-glucosamine residues. Chitin is thought of as a cellulose derivative in which the C-2 hydroxyl groups of the polymer have been replaced by acetamide moieties. Chitin is an important structural component of shellfish, such as crab, shrimp, and lobster.Anderson 2005, Talent 1996 Glucosamine is isolated from chitin and is chemically stated as 2-amino-2-deoxyglucose.Anderson 2005 It can also be prepared synthetically, and microbial production by bacteria and fungi has been explored.Hsieh 2007 Glucosamine sulfate and glucosamine hydrochloride are typically the forms used for treatment of osteoarthritis. N-acetyl-D-glucosamine is also available commercially but has no advantages over glucosamine. N-acetyl-D-glucosamine as an oral sustained-release formulation or as a topical formulation has not shown any greater benefit.Brown 2005, Rubin 2001, Talent 1996

Considerable effort has been applied to the design of analytical methods for quantitation of glucosamine in dietary supplements and in body fluids. Because glucosamine does not possess a chromophore, many methods require pre- or postcolumn derivatization. High-performance liquid chromatographyCésar 2012, Hubert 2010, Ibrahim 2010, Pashkova 2009, Pastorini 2009, Pastorini 2011, Shen 2007, Wang 2008 and capillary electrophoresis methodsChaisuwan 2011, Jác 2008, Volpi 2009 have different advantages and limitations (speed, cost, sensitivity), depending on the application.

Uses and Pharmacology

Glucosamine is commercially available alone or in combination with chondroitin sulfate (with or without mineral elements). While some studies discussed in this monograph include data regarding the efficacy of glucosamine/chondroitin sulfate combination products, only those also providing data regarding glucosamine use alone are summarized.

Atopic dermatitis

Animal and in vitro data

Glucosamine (salt form not specified) demonstrated activity in murine models of atopic dermatitis(Kim 2011) and proliferative vitreoretinopathy.(Liang 2010, Liang 2011)

Clinical data

In a randomized, placebo-controlled, double-blind, parallel clinical trial of patients 9 to 49 years of age with moderate to severe atopic dermatitis (N=33), 8 weeks of adjunctive therapy with glucosamine sulfate 25 mg/kg/day plus low-dose cyclosporine 2 mg/kg/day significantly improved atopic dermatitis severity scores compared with cyclosporine treatment alone (P<0.05). Clinical improvement occurred in 93.8% of patients receiving glucosamine sulfate plus cyclosporine compared with 58.8% receiving cyclosporine monotherapy. Serum levels of chemokine ligand 17 were significantly correlated with clinical efficacy; however, interleukin 31 (IL-31) was not. Addition of glucosamine to cyclosporine did not result in an increase in adverse events or serum cyclosporine levels.(Jin 2015)

Cancer

Several mechanisms regarding anticancer activity of glucosamine have been evaluated and include alteration of uracil and adenine nucleotide contents; damage to cell membrane structure and function; induction of autophagy; inhibition of ubiquitin proteasome pathway; inhibition of signal transducer and activator of transcription 3 (STAT3) signaling pathway; inhibition of p70S6K; suppression of the phosphorylation of forkhead transcription factors of the O class (FOXOs); suppression of matrix metalloproteinase (MMP) levels; induction of cell cycle arrest at G0/G1 phase; and inhibition of hypoxia-inducible factor 1 transcription factor. Functional groups including hydroxyl, amide, and acetylamine from glucosamine, D-glucosamine, and N-acetyl glucosamine are believed to be linked to properties against cancer. These effects have been evaluated in a variety of cancer cell lines including breast, lung, oral, renal, and prostate cancers; osteosarcoma; and glioma.(Pohlig 2016, Wang 2017, Yu 2017, Zahedipour 2017)

Clinical data

In an epidemiological study of members of the Vitamins and Lifestyle (VITAL) cohort that evaluated previous findings of an inverse relationship between glucosamine and chondroitin use and the risk of lung cancer, a chemopreventive effect against human lung cancer was noted for glucosamine; salt form and dosing information were not ascertained.(Brasky 2011) Use of chondroitin or glucosamine in the VITAL cohort was associated with decreased colorectal cancer risk (by 35% and 27%, respectively); in participants who used the combination at least 4 days per week for at least 3 years, a 45% reduced risk was observed. Based on this early but limited evidence, participants in the Nurses' Health Study (NHS) and the Health Professionals Follow-up Study (HPFS) were queried over an 8-year period about patient supplement use, including with glucosamine and chondroitin. Results from the final sample (N=96,400) aligned with those of the VITAL cohort study and revealed that when adjusted for age, any use of glucosamine or chondroitin was associated with a reduction (30% and 31%, respectively) in the risk of colorectal cancer. Similarly, combined use of both agents yielded a 32% reduced risk. Benefit was maintained when stratifying by aspirin use, body mass index, and physical activity, and results were comparable for cancers of the colon and rectum. Among participants never screened, the combination of glucosamine and chondroitin produced a 42% reduction in colorectal cancer risk, an association that did not change when adjusted for nonsteroidal anti-inflammatory drug use, duration of aspirin or non-aspirin use, fiber intake, or vitamin E use. No reduced risk was found with use of glucosamine only; however, it was noted that a relatively small number of participants reported using glucosamine alone. Chondroitin was used in the presence of glucosamine 97% to 98% of the time; therefore, it was not possible to evaluate the impact of glucosamine-only use on the risk of colorectal cancer.(Kantor 2016)

Colitis

Animal data

In a murine model of experimental colitis, glucosamine supplementation at a concentration of 0.1% (w/w) of the diet decreased the disease activity index of colitis symptoms; tumor necrosis factor alpha, IL-beta, and nuclear factor-kappa B mRNA expression in the colonic mucosa were lower in animals receiving 0.1% (w/w) glucosamine compared to control.(Bak 2014)

Dental pain

Animal data

In a murine model of dental pain (ie, pulpalgia), D-glucosamine hydrochloride suppressed nociceptive responses caused by 5-hydroxytriptamine and bradykinin.(Kaida 2014)

Magnetic resonance imaging

Animal and in vitro data

Glucosamine (sulfate and hydrochloride) and N-acetyl glucosamine were effective at detecting tumors when used as contrast agents for chemical exchange saturation transfer (CEST) magnetic resonance molecular imaging (MRI).(Rivlin 2016)

Multiple sclerosis

Clinical data

A clinical trial evaluating the effects of addition of glucosamine sulfate to disease-modifying therapy on relapsing-remitting multiple sclerosis progression showed no benefit.(Shaygannejad 2010)

Obesity

Animal data

In a rat model of obesity, glucosamine hydrochloride decreased weight and body fat while minimally impacting appetite.(Huang 2015)

Osteoarthritis

In osteoarthritis, a progressive degeneration of cartilage glycosaminoglycans (GAG) occurs. The rate-limiting step in GAG biosynthesis is biochemical formation of glucosamine from the glycolytic intermediate fructose-6-phosphate by amination of glutamine as the donor, ultimately yielding glucosamine-6-phosphate. This is subsequently acetylated to galactosamine before being incorporated into growing GAG. Thus, glucosamine taken orally may provide an essential building block for cartilage regeneration; however, this may be an oversimplification.(Anderson 2005, Herrero-Beaumont 2006, Simanek 2005, Towheed 2005)

Glucosamine is often referred to as a slow-acting drug for osteoarthritis. Guidelines have been published discussing glucosamine's use in osteoarthritis of the knee and hip. The American College of Rheumatology/Arthritis Foundation (ACR/AF) guideline for the management of osteoarthritis of the hand, hip, and knee (2019) strongly recommends against the use of glucosamine in patients with knee, hip and/or hand osteoarthritis (strong).(Kolansinski 2020) However, the updated American Academy of Orthopedic Surgeons clinical practice guideline on the treatment of osteoarthritis of the knee (2021) revised their recommendation against its use and now states that glucosamine may be helpful in reducing pain and improving function for patients with mild to moderate osteoarthritis of the knee (limited).(Brophy 2022) The European League Against Rheumatism updated recommendations for the management of hand osteoarthritis (2018) indicated that no placebo-controlled trials of glucosamine have been conducted in patients with hand osteoarthritis. Additionally, they note that less convincing data for use in knee and hip osteoarthritis led to the National Institute for Health and Care Excellence in England to recommend against the use of chondroitin sulfate and glucosamine.(Kloppenburg 2018)

Clinical data

An early Cochrane review found that glucosamine sulfate 1,500 mg/day for 6 weeks improved function and pain in patients with osteoarthritis,(Towheed 2001) but newer, higher-quality trial data included in an updated Cochrane meta-analysis show less consistent and less favorable results.(Gatti 2006, Towheed 2005) For the 20 included studies (N=2,570), glucosamine sulfate demonstrated a 28% improvement in pain outcome and a 21% improvement in function using the Lequesne Index. Outcomes using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in pain, stiffness, and function indices did not reach statistical significance compared with placebo.(Towheed 2005) While the meta-analysis only included studies using glucosamine-only preparations, a limitation of the analysis was the quality of the preparations used in the individual trials. Analysis of studies using Rotta pharmaceutical company (Rotta Pharmaceuticals [United States] and Rottapharm/Meda [Europe]) brands of glucosamine (as sulfate) shows differing results from studies using non-Rotta products. Studies using the Rotta preparation reported glucosamine was more effective in reducing pain compared with placebo. Studies using the non-Rotta preparation showed no statistical difference compared with placebo. It should be noted that investigation of non-Rotta glucosamine preparations revealed that variations in actual glucosamine content compared with label amounts can be greater than 100%.(Gatti 2006, Kucharz 2016, Towheed 2005) Another meta-analysis that investigated potential factors leading to discrepancies in results among osteoarthritis trials of glucosamine (25 trials; N=3,465) also identified the Rottapharm/Madaus brand of glucosamine sulfate as an important factor. While trials using the Rotta product resulted in significant pain reduction, trials using other brands (of glucosamine sulfate or glucosamine hydrochloride) consistently failed to show a reduction in pain.(Eriksen 2014)

Findings of 2 large trials in patients with osteoarthritis of the knee were published subsequent to the 2005 Cochrane meta-analysis. The Glucosamine Unum In Die Efficacy (GUIDE) trial (N=318) was conducted in a European population, while the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) (N=1,583) was sponsored by the National Institutes of Health and conducted in the United States.(Clegg 2006, Herrero-Beaumont 2007) GUIDE trial results favored glucosamine sulfate 1,500 mg/day over placebo, based on Lequesne Index and WOMAC function index scores, but results were not significant for the WOMAC pain index. Acetaminophen achieved similar results to glucosamine for the WOMAC indices.(Herrero-Beaumont 2007) In the GAIT trial, patients were randomized to 1 of 5 treatment groups: glucosamine hydrochloride (500 mg 3 times daily), chondroitin sulfate, glucosamine hydrochloride plus chondroitin sulfate, celecoxib, or placebo. Overall results of GAIT indicated glucosamine and chondroitin sulfate alone or in combination did not show differences from placebo for primary (WOMAC pain scores) or secondary (Osteoarthritis Research Society International indices) outcome measures. However, a subgroup analysis, which was not part of the original study design, suggested glucosamine in combination with chondroitin sulfate may be effective in treating moderate to severe osteoarthritis (n=354).(Clegg 2006)

In a 2018 systematic review and meta-analysis, glucosamine sulfate decreased pain associated with knee osteoarthritis (standardized mean difference [SMD], –0.29; 95% credibility interval [CrI], –0.49 to –0.09). An improvement in pain was maintained when data were analyzed as a mean difference on a normalized scale from 0 to 100, as well as when studies with a high risk of bias were excluded. Joint space narrowing was also reduced with glucosamine sulfate compared with placebo (SMD, –0.42; 95% CrI, –0.65 to –0.19).(Gregori 2018) Similarly, a systematic review and meta-analysis of 18 studies evaluated the effects of glucosamine in patients with knee osteoarthritis. Nine studies used glucosamine alone and 9 used commercial supplements containing glucosamine and other supplements such as chondroitin; 5 studies used glucosamine sulfate and 6 used glucosamine hydrochloride. Glucosamine marginally improved visual analog scale pain scores, did not improve knee function as measured by the WOMAC, and was superior to placebo in alleviating symptoms as measured by the Japanese Knee Osteoarthritis Measure (JKOM).(Ogata 2018)

Studies using radiographic methodology to evaluate the ability of glucosamine sulfate to protect cartilage from further loss have been conducted. Evidence from two 3-year studies (N=319) showed that after 3 years there was no further joint space narrowing in postmenopausal women taking glucosamine sulfate 1,500 mg/day, while those receiving placebo did show narrowing. Total WOMAC indices were also statistically significant in favor of glucosamine.(Bruyere 2004, Fox 2006, Reginster 2005)

Other studies of glucosamine have shown less favorable results. A 2011 meta-analysis that included 10 trials of 3,803 osteoarthritis patients receiving glucosamine (sulfate or hydrochloride), chondroitin, or a combination of the 2 did not show clinical improvement in joint pain or joint space narrowing for any group compared to placebo, with commercially sponsored trials showing larger effects than those conducted independently.(Wandel 2010) The analysis has been criticized on methodological grounds.(Bruyére 2011, Markenson 2011) A 2010 meta-analysis with narrower inclusion limits suggested small to moderate protective effects on joint space narrowing in osteoarthritis of the knee after 2 to 3 years of glucosamine sulfate treatment.(Lee 2010) According to another evidence-based analysis, glucosamine sulfate, glucosamine hydrochloride, and chondroitin sulfate individually showed inconsistent efficacy in decreasing osteoarthritis pain and improving joint function, while studies evaluating glucosamine and chondroitin sulfate combination therapy showed pain relief.(Vangsness 2009) A systematic review and meta-analysis comparing relevant clinical outcomes with raw mean differences and a network meta-analysis of 31 randomized clinical trials and quasi-experimental designs found no statistically or clinically relevant differences among glucosamine, diacerein, and placebo in pain visual analog, WOMAC, or Lequesne scores, or regarding delayed progression of joint space narrowing in osteoarthritis of the knee.(Kongtharvonskul 2015) For a 2017 systematic review, trial data evaluating oral glucosamine (sulfate or hydrochloride) in patients with hip or knee osteoarthritis were collected from authors willing and/or permitted to release their study data. Of the 21 eligible trials identified through systematic searches, data were submitted for 6, but 1 study used green-lipped mussel extract as a comparator and was excluded. In all 5 trials (N=1,625), pain and physical function were measured via WOMAC questionnaire; follow-up duration ranged from 3 months to 2 years. Pooled patient data revealed no effect for overall or subgroup analysis of glucosamine compared with placebo for osteoarthritis of the knee; risk of bias and heterogeneity among all trials were low.(Runhaar 2017) Several other reviews and commentaries have questioned the efficacy of glucosamine in osteoarthritis.(Block 2010, Muniyappa 2011, Reginster 2007, Reginster 2007, Silbert 2009, Vlad 2007, Wigley 2009)

In a randomized, double-blind, placebo-controlled trial of 201 patients with mild to moderate chronic knee pain due to osteoarthritis, oral glucosamine hydrochloride supplementation (1,500 mg/day) for 24 weeks produced no evidence of benefit in structure, pain, or function.(Kwoh 2014) The possibility of a preventative effect of glucosamine sulfate on osteoarthritis of the knee was assessed in a randomized, placebo-controlled trial in high-risk middle-aged women (N=407). After 2.5 years, 17% of all knees showed evidence of osteoarthritis, with no significant effect noted for either oral glucosamine sulfate supplementation or a diet and exercise program. When evaluated independently, each intervention reduced incidence of osteoarthritis (odds ratio [OR], 0.6; 95% CI, 0.31 to 1.12 and OR, 0.69; 95% CI, 0.39 to 1.21, respectively) but incidence was not reduced in participants receiving both interventions (OR, 0.97; 95% CI, 0.55 to 1.71).(Runhaar 2015)

Notwithstanding conflicting data regarding glucosamine use in osteoarthritis, many new trials have been conducted. No effect was found in a study evaluating glucosamine sulfate for osteoarthritis of the jaw,(Cahlin 2011) and glucosamine sulfate was no more effective than placebo in a study of hip osteoarthritis.(Rozendaal 2009) In one trial, glucosamine sulfate added to a strength training program did not improve muscle mass gain but improved maximal muscle strength gain compared to placebo; however, the authors determined the benefit was not sufficient to justify or recommend supplementation with glucosamine.(Petersen 2011) In a 24-week study, integration of a walking program with glucosamine sulfate supplementation in patients with hip or knee osteoarthritis yielded improvements in physical activity levels, physical function, and total WOMAC scores.(Ng 2010) Glucosamine sulfate was inferior to hydrolyzed collagen in a study of patients with knee osteoarthritis.(Trč 2011) A comparison with ibuprofen showed that glucosamine (salt form not specified), but not ibuprofen, altered cartilage turnover in osteoarthritis patients undergoing a strength training program.(Petersen 2010) In a 2-year study, patients who had been randomized to 1 of the 5 groups in the GAIT study (glucosamine hydrochloride, chondroitin sulfate, glucosamine hydrochloride plus chondroitin sulfate, celecoxib, or placebo) continued to receive their originally assigned treatment in order to evaluate the long-term efficacy and safety of treatment on painful knee osteoarthritis. No statistically significant improvements in WOMAC pain or function scores were observed with any treatment versus placebo; however, glucosamine and celecoxib showed beneficial trends.(Sawitzke 2010) Another study in osteoarthritis patients receiving glucosamine sulfate with or without omega-3 fatty acids showed a superior effect on pain scores for the combination versus glucosamine alone.(Gruenwald 2009) In studies of osteoarthritis of the spine, treatment with glucosamine (salt form not specified) for up to 6 months produced no effects on chronic low back pain.(Cawston 2013, Runhaar 2010, Wilkens 2010) Many other studies have been published with mixed results.(Bruyere 2008, Delialioglu 2009, Herrero-Beaumont 2007, Martí-Bonmatí 2009, Mehta 2007, Nakamura 2007, Rozendaal 2009, Sawitzke 2008, Yoshimura 2009, Zhang 2010)

Osteoporosis

Animal and in vitro data

In an ovariectomized rat model of postmenopausal osteoporosis, N-acetyl-D-glucosamine derived from liquefied chitin increased trabecular bone volume and trabecular numbers; increased femur and tibia calcium content; improved biomechanical properties; increased calcium serum content; and reduced alkaline phosphatase serum levels. Additionally, osteoblastic differentiation was stimulated in vitro.(Jiang 2018) Proliferation of human osteoblastic cells was promoted with low concentrations of glucosamine. Of note, high concentrations of glucosamine were associated with apoptosis.(Lv 2018)

Retinal injury

In vitro data

Glucosamine (salt form not specified) provided retinal protection in an in vitro model of retinal ganglion cells, including antiapoptotic, anti-inflammatory, and antioxidant effects.(Chen 2015)

Rheumatoid arthritis

Animal data

Glucosamine (salt form not specified) given with vitamin E in neonatal rats with rheumatoid arthritis exerted a synergistic effect, including decreased plasma malondialdehyde levels and increased superoxide dismutase, catalase, reduced glutathione, glutathione peroxidase, and zinc levels.(Dai 2018)

Dosing

In clinical studies of osteoarthritis, the typical glucosamine dosage (for both sulfate and hydrochloride salt forms) has been 1.5 g/day as a single dose or in divided doses of up to 3 times per day (treatment duration of up to 3 years).Anderson 2005, Bruyere 2004, Clegg 2006, Gregori 2018, Herrero-Baumont 2007, Kongtharvonskul 2015, Kwoh 2014, Magrans-Courtney 2011, McCarty 2019, Messier 2007, Ng 2010, Ogata 2018, Petersen 2010, Petersen 2011, Reginster 2005, Rozendaal 2009, Runhaar 2015, Sawitzke 2010, Trč 2011, Vangsness 2009, Wilkens 2010 Doses of up to 3,200 mg/day have been used in clinical trials and were well tolerated, but evidence of improved efficacy at this dosage has not been established.Anderson 2005 A systematic study of glucosamine supported safety at doses of up to 2 g/day.Borzelleca 2007, Hathcock 2007 A recent opinion paper suggested that higher doses of glucosamine should be evaluated in clinical studies, given the beneficial effects noted with higher doses in animal studies.McCarty 2019

Pregnancy / Lactation

A study of 54 women who used glucosamine during pregnancy showed no increased risk of major malformations and no other adverse fetal effects.Sivojelezova 2007 However, an animal study revealed that glucosamine reduced litter size when given to 8-week-old mice around the time of conception and reduced fetal size when given to 16-week-old mice.Schelbach 2013 Due to a lack of clinical information in pregnant women, it is generally recommended that supplementation with glucosamine be avoided in pregnancy.

N-acetyl glucosamine is a derivative of glucosamine found naturally in breast milk. Although clinical studies in lactating women using glucosamine are lacking, adverse effects in breastfeeding infants are not expected.NLM 2018

Interactions

Agents with antiplatelet properties: Glucosamine may enhance the antiplatelet effect of agents with antiplatelet properties. Monitor therapy.Clegg 2006, Hua 2004, Lu-Suguro 2005

Warfarin: Glucosamine may enhance the anticoagulant effect of warfarin. Monitor therapy.Rozenfeld 2004, Weimann 2001, Wilde 1997

An increase in international normalized ratio (INR) may occur in patients taking anticoagulants, such as warfarin, with glucosamine alone or with the combination of glucosamine and chondroitin. In 2 case reports, 2 patients previously stabilized on warfarin therapy with INRs in therapeutic ranges developed elevated INRs after an increase in dosage or initiation of a total daily dosage of glucosamine 3,000 mg/chondroitin 2,400 mg.Knudsen 2008, Rozenfeld 2004 In one of those patients, INRs had previously been stabilized with glucosamine 500 mg/chondroitin 400 mg twice daily and did not become supratherapeutic until the dosage was increased.Knudsen 2008

In a literature review of 20 cases of potential interactions with warfarin reported to the United States Food and Drug Administration MedWatch database, the majority of cases (n=15) involved the combination of glucosamine and chondroitin. Only one case involved chondroitin alone, and the remaining 4 reported using glucosamine alone. Causality assessment was difficult to assess, as dosages and quality of report submissions were variable.Knudsen 2008

It is uncertain if these reports are a result of warfarin with either agent (glucosamine and chondroitin) alone or the combination of the 2 in higher than usual dosages. It has been suggested that a pharmacokinetic interaction is unlikely; the mechanism of action may be related to an additive pharmacodynamic effect on coagulation.Scott 2004

Adverse Reactions

The majority of adverse reactions reported have been mild, including itching and gastric discomfort (eg, diarrhea, heartburn, nausea, vomiting). GI distress may be ameliorated by taking with food. Reported reactions are similar to those experienced with placebo, but at a lower incidence than with nonsteroidal anti-inflammatory drugs.Kongtharvonskul 2015, NLM 2018

Concerns regarding effects of glucosamine on glucose homeostasis have been based primarily on theoretical considerations, animal studies, and case reports.Baron 1995, Miles 1998, Monauni 2000, Mooradian 2006, Patti 1999, Virkamaki 1999 However, specifically designed studies have not shown detrimental effects associated with usual dosages, and no concerns have been raised regarding adverse reactions in the many randomized clinical trials conducted.Albert 2007, Anderson 2005, Marshall 2006, Muniyappa 2006, Tannis 2004 Long-term effects of glucosamine on insulin secretion and insulin resistance have not been established, and 2 systematic literature reviews concluded that oral glucosamine supplementation does not pose a risk to diabetic patients.Dostrovsky 2011, Simon 2011 Glucosamine should be used with caution in patients with poorly controlled diabetes.Marshall 2006

In two clinical studies, glucosamine sulfate was associated with a statistically significant increase in intraocular pressure. One of these studies noted a greater risk in older patients.Esfandiari 2017, Murphy 2013

Five case reports of acute liver injury associated with glucosamine sulfate use have been documented, 2 of which were in elderly patients with chronic hepatitis C.Cerda 2013, Smith 2009 A single case of chondritis of the ear improved only partially with cessation of the glucosamine-based supplement.Furer 2011

A case of possible exacerbation of asthma with the use of a glucosamine/chondroitin preparation has been reported, as well as an immediate hypersensitivity reaction to glucosamine.Tallia 2002 Another case report describes renal toxicity resulting from glucosamine (salt form not specified), with improvements noted upon discontinuation and deterioration occurring upon re-challenge.Gueye 2016

Toxicology

Mutagenicity studies have shown variable results. Glucosamine hydrochloride failed to show mutagenicity in Escherichia coli reverse mutation and Salmonella typhimurium studies, but it induced breaks in bacteriophage DNA. Glucosamine produced an increase in chromosome aberration frequency in mice bone marrow cells versus control, whereas no increases in micronucleated polychromatic erythrocyte and bone marrow cells were demonstrated in another experiment.Anderson 2005

Healthy young adults did not experience adverse reactions following infusions of 9.7 g, while 1 in 5 subjects experienced headache when subsequently administered an intravenous infusion of 30.5 g (which led to plasma levels greater than 20-fold higher than would be expected with usual doses of oral glucosamine).Anderson 2005

Index Terms

• Glucon
• Glycomine

References

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