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

Medically reviewed by Last updated on Nov 1, 2021.

Clinical Overview


Glucosamine is being investigated extensively for its action in osteoarthritis. However, there is a lack of consensus in clinical trials regarding its efficacy.


In clinical studies of arthritis, glucosamine dosage has typically been 1.5 g/day, as a single dose or in divided doses.


Contraindicated in individuals with active bleeding.


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


None well documented.

Adverse Reactions

Glucosamine is generally considered safe. Use caution when administering to individuals with poorly controlled diabetes or liver disease. Use with caution in individuals with allergy to shellfish, or asthma.


Mutagenicity studies are limited and conflicting.


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.1


Chemically, chitin is a biopolymer that is like cellulose but differs in having predominantly unbranched chains of beta (1-4)-2-acetamido-2-deoxy-D-glucose or N-acetyl-D-glucosamine residues. It is thought of as a cellulose derivative in which the C-2 hydroxyl groups of the polymer have been replaced by acetamide moieties.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.2, 3 Glucosamine is isolated from chitin and is chemically stated as 2-amino-2-deoxyglucose.3 It can also be prepared synthetically, and microbial production by bacteria and fungi has been explored.4 Glucosamine sulfate is the preferred form. N-acetyl-D-glucosamine (NAG) is also sold, but it has no advantages over glucosamine. The potential of NAG in a sustained-release or topical formulation hasn't shown any greater benefit either.2, 5, 6

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 post-column derivatization. High performance liquid chromatography7, 8, 9, 10, 11, 12, 13, 14 and capillary electrophoresis methods15, 16, 17 have different advantages and limitations (speed, cost, sensitivity), depending on the application.

Glucosamine is extensively metabolized by the liver after oral administration, with a bioavailability of about 19% in rats.18 Levels of glucosamine in synovial fluid in horses peaked at 1 mcg/mL after nasogastric intubation with 20 mg/kg, while intravenous administration resulted in a peak of 50 mcg/mL.19 In humans, a single oral dose of glucosamine sulfate 500 mg led to peak serum levels of 0.4 mcg/mL, with a half-life of 5 hours,20 while another study found similar levels with a single oral dose of 1.5 g.21 Glucosamine is given as the hydrochloride salt or the sulfate salt; little data support superiority of one over the other.22 Combination of glucosamine with chondroitin sulfate reduced glucosamine peak levels,21 while ingestion with glucose led to a small but clinically insignificant increase in serum glucosamine in humans.23 Glucosamine in urine has also been measured; however, only 1.8% of the dose was found to be excreted by that route.24 The poor bioavailability and peak levels obtained via the oral route have led to research on topical formulations.25, 26

Uses and Pharmacology

Glucosamine is commercially available alone or in combination with chondroitin sulfate (with or without mineral elements). Only studies evaluating the effect of glucosamine alone are discussed in this monograph.


In osteoarthritis, the most common form of arthritis, there is a progressive degeneration of cartilage glycosaminoglycans (GAG). Formation of glucosamine is the rate-limiting step in GAG biosynthesis. It is biochemically formed from the glycolytic intermediate fructose-6-phosphate by way of 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.3, 27, 28, 29

A randomized, double-blind, placebo-controlled trial in 201 patients with mild to moderate knee pain due to osteoarthritis found no evidence of benefit in structure, pain or function after 24 weeks of oral glucosamine supplementation (1,500 mg/day).149 The possibility of a preventative effect of glucosamine 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 in patients receiving either oral glucosamine supplementation or participating in a diet-and-exercise program. When evaluated independently, each intervention reduced incidence of osteoarthritis (odds ratio [OR] 0.6; 95% confidence interval [CI], 0.31 to 1.12 and OR 0.69; 95% CI, 0.39 to 1.21, respectively) but not in participants receiving both interventions (OR 0.97; 95% CI, 0.55 to 1.71).155

Guidelines have been published discussing glucosamine's use in osteoarthritis of the knee and hip. The American College of Rheumatology 2012 guidelines for the management of osteoarthritis of the hand, hip, and knee conditionally recommend that patients with osteoarthritis of the knee or hip should not use glucosamine in the initial management based on significant heterogeneity in effect size found in meta-analyses.145 The American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis of the knee (2010) recommends against the use of glucosamine and/or chondroitin sulfate or hydrochloride for patients with symptomatic osteoarthritis of the knee.146

Cellular studies

In vitro studies of the effects of glucosamine on chondrocytes, the cells responsible for synthesis of cartilage, include inhibition of oxidative damage,30, 31, 32, 33 promotion of the chondrogenic phenotype,34 modulation of proliferation and matrix synthesis,35 inhibition of chondrocyte differentiation,36 inhibition of hyaluronan and sulfated GAG synthesis,37 increased expression of aggrecan and collagen type II genes,38 and inhibition of mitogen-activating protein kinase phosphorylation.39 A proteomic study of chondrocytes treated with glucosamine sulfate found effects on 18 genes involved in a variety of pathways.40 Epigenetic mechanisms were also identified as important in another study.41

Synoviocytes are cells that produce synovial fluid in the joints. Glucosamine has been shown to suppress activation of synovial cells by IL-1beta,42 increase synovial GAG synthesis,43 increase hyaluronic acid production in synovial explants,44 and downregulate matrix metalloproteases and chemokines in synovial fibroblasts.45

Mineralization of mature osteoblasts, the cells that grow bone, was hastened by glucosamine, but it had little effect on early-stage osteoblasts.46 In endothelial cells, glucosamine suppressed cellular activation by both tumor necrosis factor alpha and LL-37.47, 48

A study of explant cultures of bovine tendon, ligament, and joint capsule found that glucosamine stimulated loss of proteoglycan from ligament but not from the other tissues. Large proteoglycan catabolism was also unaffected.49

Animal data

In a papain-injected model of osteoarthritis in mice, glucosamine 100 mg/kg/day in feed counteracted transient damage to the knee joint, which was attributed to an indirect effect via liver and gut cells consistent with cytokine alterations in serum.50 In a collagenase-induced mouse model, glucosamine 20 mg/kg/day inhibited bone resorption in joints via down-regulation of receptor activator of nuclear factor kappa-B ligand.51 In a spontaneous mouse model of osteoarthritis, glucosamine 200 and 400 mg/kg/day subcutaneously improved a variety of osteoarthritis markers, including Osteoarthritis Research Society International (OARSI) histopathology scores.52

Several studies of glucosamine in rats using the anterior cruciate ligament transaction model have been published.53 Enhancement of type II collagen synthesis and inhibition of degradation were found in one study,54 while decreases in p38 and c-Juno aminoterminal kinases with increases in extracellular signal-regulated protein kinase expression in cartilage were noted in a second study.55 Oral dosing of glucosamine in normal rats was shown to increase expression of transforming growth factor (TGF-beta) and connective tissue growth factor mRNA in cartilage.56

In Harley guinea pigs, which spontaneously develop osteoarthritis, oral glucosamine reduced cartilage destruction and down-regulated matrix metalloproteinase-3 in cartilage tissue.57 In rabbits, the effects of anterior cruciate ligament transaction were attenuated by glucosamine.58 In a vitamin A-induced model in rabbits, glucosamine produced osteoarthritis-protective effects on chondrocytes.59 Another rabbit model of atherosclerosis and rheumatoid arthritis found high-dose (500 mg/kg/day) glucosamine effective through a reduction of systemic and tissue inflammation.60

A randomized clinical trial with dogs with osteoarthritis found statistically significant improvements in scores for pain and weight-bearing and osteoarthritis severity.61

Clinical data

An update of an older Cochrane meta-analysis includes high-quality clinical trials. An earlier review found that glucosamine sulfate 1,500 mg/day for 6 weeks resulted in an improvement in function and less pain,62 but the inclusion of newer, higher quality trial data show less consistent and less favorable results.27, 63 For the 20 included studies (N = 2,570), glucosamine 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.27 A limitation of the analysis is the quality of the preparations used in the individual trials. Analysis of the studies using the Rotta brand of glucosamine (as sulfate; available in the United States) provides differing results from the non-Rotta studies. Studies using the Rotta preparation reported glucosamine as more effective in pain reduction compared with placebo. Studies using the non-Rotta preparation showed no statistical difference compared with placebo. Variations in the content of glucosamine compared with label amounts can be up to 100%.27, 63

The findings of 2 large trials were published subsequent to the 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.64, 65 Both trials considered a total daily dosage of glucosamine 1,500 mg for osteoarthritis of the knee. The GUIDE trial favored glucosamine over placebo using the Lequesne Index and WOMAC function index, but results were not significant for the WOMAC pain index. Acetaminophen achieved similar results to glucosamine for the WOMAC indices.64 Overall results of GAIT indicated no differences for glucosamine over placebo using the WOMAC and outcome measures in rheumatology clinical trials (Osteoarthritis Research Society International indices). However, a subgroup analysis, which was not part of the original study design, suggested glucosamine was effective in treating moderate to severe osteoarthritis (n = 354).65

Three studies using radiographic methodology have been conducted regarding the ability of glucosamine to protect cartilage from further loss. After 3 years, no further joint space narrowing was shown in postmenopausal women (319 of a total of 414 participants) taking glucosamine 1,500 mg/day. Total WOMAC indices were also favorable for glucosamine.27, 66, 67, 68

Other studies of glucosamine have been less favorable. A 2011 meta-analysis that included 10 trials with 3,803 osteoarthritis patients did not find clinical improvement in pain scores, with commercially sponsored trials showing larger effects than those conducted independently.69 The analysis has been criticized on methodological grounds.70, 71 A different 2010 meta-analysis with narrower inclusion limits pointed to more important effects with osteoarthritis of the knee after 2 to 3 years of treatment.72 The evaluation of another evidence-based analysis showed inconsistent efficacy.73 A systematic review and meta-analysis that compared relevant clinical outcomes with raw mean differences and 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 scores, WOMAC or Lequesne scores or on delaying progression of joint space narrowing in osteoarthritis of the knee.156 Similarly, in 2017, a systematic review collected trial data from authors willing and/or permitted to release their study data. Of the 21 eligible trials identified through systematic searches, 6 participated and submitted data but 1 of these used green-lipped mussel extract as a comparator so was excluded. In all 5 trials (N=1,625), pain and physical function was measured with WOMAC questionnaire and duration of follow-up ranged from 3 months to 2 years. Pooled patient data revealed no significant main effect for overall or for subgroup analysis of glucosamine compared with placebo for osteoarthritis of the knee; risk of bias and heterogeneity among all trials was low.158 Several other reviews and commentaries have questioned the efficacy of glucosamine in osteoarthritis.74, 75, 76, 77, 78, 79, 80

Not withstanding the growing skepticism, many new trials have been reported in recent years. No effect was found when using glucosamine for osteoarthritis of the jaw,81 and glucosamine was found to be no more effective than placebo in a study of hip osteoarthritis.82 A combination of glucosamine with circuit training and a weight loss program found benefit in osteoarthritis of the knee,83 while another similar trial did not consider the benefits sufficient to justify supplementation.84 Integration of a walking program with glucosamine supplementation yielded improvements over 24 weeks.85 No benefit over placebo was seen in pain, function, or mobility in a knee osteoarthritis study of glucosamine and chondroitin sulfate, with or without exercise.86 Glucosamine was inferior to hydrolyzed collagen for knee osteoarthritis in another study.87 A comparison with ibuprofen found that glucosamine, but not ibuprofen, altered cartilage turnover in osteoarthritis patients undergoing a program of strength training.88 A 2-year study of glucosamine versus celecoxib and placebo found statistically insignificant improvements in pain score for both treatments.89 Another study in which glucosamine and omega-3 fatty acids were combined found a superior effect on pain scores for the combination versus glucosamine alone.90 With osteoarthritis of the spine, no effect on chronic low back pain was seen with glucosamine for 6 months.91, 92, 148 Many other studies have also been published with mixed results.82, 93, 94, 95, 96, 97, 98, 99, 100, 101

A noninferiority, multicenter osteoarthritis intervention trial with symptomatic slow-acting drugs for osteoarthritis (MOVES) compared the combination of chondroitin sulfate (1,200 mg/day) plus glucosamine hydrochloride (1,500 mg/day) with celecoxib (200 mg/day) in adults 40 years and older (mean, 62.7 years) with primary knee osteoarthritis and severe pain. At 6 months, both groups experienced a 79% response rate and no differences in efficacy were seen between groups in stiffness, function score, visual analogue scale, or patients’ and physicians’ global assessment of disease activity. Use of rescue acetaminophen was higher during the 1st month in the chondroitin-glucosamine group but remained low and similar between the groups throughout the rest of the study period. Treatment-emergent adverse effects were also similar between groups.150

Glucosamine was bioavailable via oral administration and detectable at clinically relevant concentrations in serum and synovium of osteoarthritis patients when dosed at 1,500 mg/day for 14 days.102

Other uses

A clinical trial of glucosamine in multiple sclerosis found no benefit.111 Glucosamine was neuroprotective in a rat ischemia/reperfusion model via suppression of inflammation.112 Other anti-inflammatory effects in cells have been linked to inhibition of cyclooxygenase (COX)-2 glycosylation,113 transglutaminase inhibition,114 and cathepsin B inhibition.115 Glucosamine was active in rat models of trauma hemorrhage,116 colitis,117 and osteoporosis.118

Atopic dermatitis

In mouse models of atopic dermatitis119 and proliferative vitreoretinopathy,120, 121 glucosamine showed activity. In a randomized, placebo-controlled, double-blind, parallel clinical trial (n = 33), 8 weeks of combination therapy with glucosamine 25 mg/kg plus low-dose cyclosporine 2 mg/kg significantly improved atopic dermatitis severity scores compared with cyclosporine alone (P < 0.05) in patients 9 to 49 years of age. Clinical improvement was experienced in 93.8% of patients receiving combination therapy compared with 58.8% on cyclosporine monotherapy. Serum levels of chemokine ligand 17 were significantly correlated with clinical efficacy; however, IL-31 was not. Addition of glucosamine to cyclosporine did not result in an increase of adverse events or serum cyclosporine levels.154


An early study found inhibition of Walker 256 cancer cell growth by glucosamine.103 A number of more recent studies have proposed induction of autophagy104, 105 proteasome inhibition,106 mitogen-activating protein kinase inhibition,107 suppression of IL-8 and ICAM-1 expression,108 and inhibition of STAT3 signaling109 as a mechanism of cell growth inhibition in various cancer cell lines. No activity has been reported in animal models or in clinical trials. However, an epidemiological study found a chemopreventative effect for glucosamine in human lung cancer.110

Use of chondroitin or glucosamine was observed to be associated with a decrease in colorectal cancer risk by 27% and 35%, respectively, and a 45% reduced risk in participants who used the combination of both for at least 4 days/week for at least 3 years in the Vitamins and Lifestyle study (VITAL). 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 supplement use, including that of glucosamine and chondroitin. Results from the final sample (N=96,400) aligned with those of the VITAL study revealed that when adjusted for age, any use of glucosamine or chondroitin was associated with a significant reduction (30% and 31%, respectively) in the risk of colorectal cancer. Similarly, combined use of both agents yielded a 32% reduced risk. Benefit held true when stratifying by aspirin use, body mass index, and physical activity, and results were comparable for both colon and rectum cancers. Among participants never screened, the combination of glucosamine plus chondroitin produced a significant 42% reduction in colorectal cancer risk. This latter association 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, so it was not possible to evaluate the impact of glucosamine-only use on the risk of colorectal cancer.157


Glucosamine dosage in clinical studies of arthritis has typically been 1.5 g/day as a single dose or in divided doses of up to 3 times per day.3, 27 Doses of up to 3,200 mg/day have been used in trials, but evidence of improved efficacy at this dosage has not been established.3 Healthy young adults had no adverse reactions from infusions of 9.7 g, while 1 in 5 subjects experienced headache when 30.5 g was infused.3 A systematic study of glucosamine supported safety at doses of up to 2 g/day.122, 123

Pregnancy / Lactation

A study of 54 women who used glucosamine during pregnancy found no increased risk of major malformations and no other adverse fetal effects.124


Agents with antiplatelet properties: Glucosamine may enhance the antiplatelet effect of agents with antiplatelet properties. Monitor therapy.125, 126, 127

Warfarin: Glucosamine may enhance the anticoagulant effect of warfarin. Monitor therapy.128, 129, 130

An increase in the international normalized ratio (INR) may occur in patients taking anticoagulants, such as warfarin, with glucosamine alone or in combination with chondroitin. In case reports,151, 152 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. In one patient, INRs were stabilized at doses of glucosamine 500 mg/chondroitin 400 mg twice daily and did not become supratherapeutic until the dosage was increased.151

In a literature review151 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. Causality assessment was difficult to assess as dosages and quality of report submissions were variable.

It is uncertain if these reports are a result of warfarin with either agent 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.153

Adverse Reactions

The majority of adverse reactions reported have been mild, including itching and gastric discomfort (eg, diarrhea, heartburn, nausea, vomiting). These reactions are similar to those experienced with placebo, but fewer than those reported with nonsteroidal anti-inflammatory drugs.27

Concerns regarding the effect of glucosamine on glucose homeostasis have been based primarily on theoretical considerations, animal studies, and case reports.131, 132, 133, 134, 135, 136 However, specifically designed studies have not shown any detrimental effects associated with usual dosages, and no concerns have been raised regarding adverse reactions in the many randomized clinical trials conducted.3, 27, 137, 138, 139, 140 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.141, 142 Glucosamine should be used with caution in patients with poorly controlled diabetes.137

A link between glucosamine and the development of atherosclerosis is suspected, but there is no supporting clinical evidence. Glucosamine has been found to have a stimulatory effect on the growth rate and toughness of nails. 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.27

Five case reports of acute liver injury associated with glucosamine use have been documented, 2 of these were in elderly patients with chronic hepatitis C.143, 147 A single case of chondritis of the ear improved only partially with cessation of the glucosamine-based supplement.144


Mutagenicity studies have shown variable results. Glucosamine 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.3

Index Terms

  • Glucon
  • Glycomine


1. Budavari S, ed. The Merck Index. 11th ed. NJ: Merck & Co Inc; 1989;4353.
2. Talent JM, Gracy RW. Pilot study of oral polymeric N-acetyl-D-glucosamine as a potential treatment for patients with osteoarthritis. Clin Ther. 1996;18(6):1184-1190.9001835
3. Anderson JW, Nicolosi RJ, Borzelleca JF. Glucosamine effects in humans: a review of effects on glucose metabolism, side effects, safety considerations and efficacy. Food Chem Toxicol. 2005;43(2):187-201.15621331
4. Hsieh JW, Wu HS, Wei YH, Wang SS. Determination and kinetics of producing glucosamine using fungi. Biotechnol Prog. 2007;23(5):1009-1016.17880101
5. Brown MB, Jones SA. Hyaluronic acid: a unique topical vehicle for the localized delivery of drugs to the skin. J Eur Acad Dermatol Venereol. 2005;19(3):308-318.15857456
6. Rubin BR, Talent JM, Kongtawelert P, Pertusi RM, Forman MD, Gracy RW. Oral polymeric N-acetyl-D-glucosamine and osteoarthritis. J Am Osteopath Assoc. 2001;101(6):339-344.11432083
7. César IC, Byrro RM, De Santana E Silva Cardoso FF, et al. Quantitation of glucosamine sulfate in plasma by HPLC-MS/MS after administration of powder for oral solution formulation. Biomed Chromatogr. 2012;26(7):851-856.22031460
8. Hubert C, Houari S, Lecomte F, et al. Development and validation of a sensitive solid phase extraction/hydrophilic interaction liquid chromatography/mass spectrometry method for the accurate determination of glucosamine in dog plasma. J Chromatogr A. 2010;1217(19):3275-3281.20117789
9. Ibrahim A, Jamali F. Improved sensitive high performance liquid chromatography assay for glucosamine in human and rat biological samples with fluorescence detection. J Pharm Pharm Sci. 2010;13(2):128-135.20816000
10. Pashkova E, Pirogov A, Bendryshev A, Ivanaynen E, Shpigun O. Determination of underivatized glucosamine in human plasma by high-performance liquid chromatography with electrochemical detection: application to pharmacokinetic study. J Pharm Biomed Anal. 2009;50(4):671-674.19264438
11. Pastorini E, Rotini R, Guardigli M, et al. Development and validation of a HPLC-ES-MS/MS method for the determination of glucosamine in human synovial fluid. J Pharm Biomed Anal. 2009;50(5):1009-1014.19647388
12. Pastorini E, Vecchiotti S, Colliva C, et al. Identification and quantification of glucosamine in rabbit cartilage and correlation with plasma levels by high performance liquid chromatography-electrospray ionization-tandem mass spectrometry. Anal Chim Acta. 2011;695(1-2):77-83.21601033
13. Shen X, Yang M, Tomellini SA. Liquid chromatographic analysis of glucosamine in commercial dietary supplements using indirect fluorescence detection. J Chromatogr Sci. 2007;45(2):70-75.17425135
14. Wang X, Chen X, Chen L, et al. Optimizing high-performance liquid chromatography method for quantification of glucosamine using 6-aminoquinolyl-N-hydroxysuccinimidyl carbamate derivatization in rat plasma: application to a pharmacokinetic study. Biomed Chromatogr. 2008;22(11):1265-1271.18814196
15. Chaisuwan P, Kongprasertsak T, Sangcakul A, et al. Direct injection of human serum and pharmaceutical formulations for glucosamine determination by CE-C(4)D method. J Chromatogr B Analyt Technol Biomed Life Sci. 2011;879(23):2185-2188.21727040
16. Jác P, Los P, Spácil Z, Pospísilová M, Polásek M. Fast assay of glucosamine in pharmaceuticals and nutraceuticals by capillary zone electrophoresis with contactless conductivity detection. Electrophoresis. 2008;29(17):3511-3518.18803213
17. Volpi N. Capillary electrophoresis determination of glucosamine in nutraceutical formulations after labeling with anthranilic acid and UV detection. J Pharm Biomed Anal. 2009;49(3):868-871.19200685
18. Aghazadeh-Habashi A, Sattari S, Pasutto F, Jamali F. Single dose pharmacokinetics and bioavailability of glucosamine in the rat. J Pharm Pharm Sci. 2002;5(2):181-184.12207871
19. Meulyzer M, Vachon P, Beaudry F, et al. Comparison of pharmacokinetics of glucosamine and synovial fluid levels following administration of glucosamine sulphate or glucosamine hydrochloride. Osteoarthritis Cartilage. 2008;16(9):973-979.18295513
20. Zhu Y, Zou J, Xiao D, et al. Bioequivalence of two formulations of glucosamine sulfate 500-mg capsules in healthy male Chinese volunteers: an open-label, randomized-sequence, single-dose, fasting, two-way crossover study. Clin Ther. 2009;31(7):1551-1558.19695404
21. Jackson CG, Plaas AH, Sandy JD, et al. The human pharmacokinetics of oral ingestion of glucosamine and chondroitin sulfate taken separately or in combination. Osteoarthritis Cartilage. 2010;18(3):297-302.19912983
22. Aghazadeh-Habashi A, Jamali F. The glucosamine controversy; a pharmacokinetic issue. J Pharm Pharm Sci. 2011;14(2):264-273.21733414
23. Biggee BA, Blinn CM, Nuite M, McAlindon TE, Silbert JE. Changes in serum levels of glucosamine and sulphate after ingestion of glucosamine sulphate with and without simultaneous ingestion of glucose. Ann Rheum Dis. 2007;66(10):1403-1404.17881667
24. Guan Y, Tian Y, Li Y, et al. Application of a liquid chromatographic/tandem mass spectrometric method to a kinetic study of derivative glucosamine in healthy human urine. J Pharm Biomed Anal. 2011;55(1):181-186.21310576
25. Han IH, Choi SU, Nam DY, et al. Identification and assessment of permeability enhancing vehicles for transdermal delivery of glucosamine hydrochloride. Arch Pharm Res. 2010;33(2):293-299.20195831
26. Tekko IA, Bonner MC, Williams AC. An optimized reverse-phase high performance liquid chromatographic method for evaluating percutaneous absorption of glucosamine hydrochloride. J Pharm Biomed Anal. 2006;41(2):385-392.16426790
27. Towheed TE, Maxwell L, Anastassiades TP, et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev. 2005;(2):CD002946.15846645
28. Simanek V, Kren V, Ulrichova J, Gallo J. The efficacy of glucosamine and chondroitin sulfate in the treatment of osteoarthritis: are these saccharides drugs or nutraceuticals? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2005;149(1):51-56.16170388
29. Herrero-Beaumont G, Rovati LC. Use of crystalline glucosamine sulfate in osteoarthritis. Fut Rheumatol. 2006;1(4):397-414.
30. Mendis E, Kim MM, Rajapakse N, Kim SK. Sulfated glucosamine inhibits oxidation of biomolecules in cells via a mechanism involving intracellular free radical scavenging. Eur J Pharmacol. 2008;579(1-3):74-85.18036590
31. Qu CJ, Pöytäkangas T, Jauhiainen M, Auriola S, Lammi MJ. Glucosamine sulphate does not increase extracellular matrix production at low oxygen tension. Cell Tissue Res. 2009;337(1):103-111.19440735
32. Tiku ML, Narla H, Jain M, Yalamanchili P. Glucosamine prevents in vitro collagen degradation in chondrocytes by inhibiting advanced lipoxidation reactions and protein oxidation. Arthritis Res Ther. 2007;9(4):R76.17686167
33. Valvason C, Musacchio E, Pozzuoli A, Ramonda R, Aldegheri R, Punzi L. Influence of glucosamine sulphate on oxidative stress in human osteoarthritic chondrocytes: effects on HO-1, p22(Phox) and iNOS expression. Rheumatology. 2008;47(1):31-35.18077487
34. Derfoul A, Miyoshi AD, Freeman DE, Tuan RS. Glucosamine promotes chondrogenic phenotype in both chondrocytes and mesenchymal stem cells and inhibits MMP-13 expression and matrix degradation. Osteoarthritis Cartilage. 2007;15(6):646-655.17337215
35. Varghese S, Theprungsirikul P, Sahani S, Hwang N, Yarema KJ, Elisseeff JH. Glucosamine modulates chondrocyte proliferation, matrix synthesis, and gene expression. Osteoarthritis Cartilage. 2007;15(1):59-68.16849037
36. Nakatani S, Mano H, Im R, Shimizu J, Wada M. Glucosamine regulates differentiation of a chondrogenic cell line, ATDC5. Biol Pharm Bull. 2007;30(3):433-438.17329833
37. Shikhman AR, Brinson DC, Valbracht J, Lotz MK. Differential metabolic effects of glucosamine and N-acetylglucosamine in human articular chondrocytes. Osteoarthritis Cartilage. 2009;17(8):1022-1028.19332174
38. Toegel S, Wu SQ, Piana C, et al. Comparison between chondroprotective effects of glucosamine, curcumin, and diacerein in IL-1beta-stimulated C-28/I2 chondrocytes. Osteoarthritis Cartilage. 2008;16(10):1205-1212.18321735
39. d'Abusco AS, Calamia V, Cicione C, Grigolo B, Politi L, Scandurra R. Glucosamine affects intracellular signalling through inhibition of mitogen-activated protein kinase phosphorylation in human chondrocytes. Arthritis Res Ther. 2007;9(5):R104.17925024
40. Calamia V, Ruiz-Romero C, Rocha B, et al. Pharmacoproteomic study of the effects of chondroitin and glucosamine sulfate on human articular chondrocytes. Arthritis Res Ther. 2010;12(4):R138.20626852
41. Imagawa K, de Andrés MC, Hashimoto K, et al. The epigenetic effect of glucosamine and a nuclear factor-kappa B (NF-kB) inhibitor on primary human chondrocytes--implications for osteoarthritis. Biochem Biophys Res Commun. 2011;405(3):362-367.21219853
42. Hua J, Sakamoto K, Kikukawa T, Abe C, Kurosawa H, Nagaoka I. Evaluation of the suppressive actions of glucosamine on the interleukin-1beta-mediated activation of synoviocytes. Inflamm Res. 2007;56(10):432-438.18026701
43. Igarashi M, Kaga I, Takamori Y, Sakamoto K, Miyazawa K, Nagaoka I. Effects of glucosamine derivatives and uronic acids on the production of glycosaminoglycans by human synovial cells and chondrocytes. Int J Mol Med. 2011;27(6):821-827.21455564
44. Uitterlinden EJ, Koevoet JL, Verkoelen CF, et al. Glucosamine increases hyaluronic acid production in human osteoarthritic synovium explants. BMC Musculoskelet Disord. 2008;9:120.18786270
45. Lu HT, Liang YC, Sheu MT, et al. Disease-modifying effects of glucosamine HCl involving regulation of metalloproteinases and chemokines activated by interleukin-1beta in human primary synovial fibroblasts. J Cell Biochem. 2008;104(1):38-50.18080321
46. Igarashi M, Sakamoto K, Nagaoka I. Effect of glucosamine, a therapeutic agent for osteoarthritis, on osteoblastic cell differentiation. Int J Mol Med. 2011;28(3):373-379.21537831
47. Ju Y, Hua J, Sakamoto K, Ogawa H, Nagaoka I. Glucosamine, a naturally occurring amino monosaccharide modulates LL-37-induced endothelial cell activation. Int J Mol Med. 2008;22(5):657-662.18949387
48. Ju Y, Hua J, Sakamoto K, Ogawa H, Nagaoka I. Modulation of TNF-alpha-induced endothelial cell activation by glucosamine, a naturally occurring amino monosaccharide. Int J Mol Med. 2008;22(6):809-815.19020780
49. Ilic MZ, Martinac B, Samiric T, Handley CJ. Effects of glucosamine on proteoglycan loss by tendon, ligament and joint capsule explant cultures. Osteoarthritis Cartilage. 2008;16(12):1501-1508.18554935
50. Panicker S, Borgia J, Fhied C, Mikecz K, Oegema TR. Oral glucosamine modulates the response of the liver and lymphocytes of the mesenteric lymph nodes in a papain-induced model of joint damage and repair. Osteoarthritis Cartilage. 2009;17(8):1014-1021.19364543
51. Ivanovska N, Dimitrova P. Bone resorption and remodeling in murine collagenase-induced osteoarthritis after administration of glucosamine. Arthritis Res Ther. 2011;13(2):R44.21410959
52. Chiusaroli R, Piepoli T, Zanelli T, et al. Experimental pharmacology of glucosamine sulfate. Int J Rheumatol. 2011;2011.2200722710.1155/2011/939265
53. Silva FS Jr, Yoshinari NH, Castro RR, et al. Combined glucosamine and chondroitin sulfate provides functional and structural benefit in the anterior cruciate ligament transection model. Clin Rheumatol. 2009;28(2):109-117.18791656
54. Naito K, Watari T, Furuhata A, et al. Evaluation of the effect of glucosamine on an experimental rat osteoarthritis model. Life Sci. 2010;86(13-14):538-543.20188111
55. Wen ZH, Tang CC, Chang YC, et al. Glucosamine sulfate reduces experimental osteoarthritis and nociception in rats: association with changes of mitogen-activated protein kinase in chondrocytes. Osteoarthritis Cartilage. 2010;18(9):1192-1202.20510383
56. Ali AA, Lewis SM, Badgley HL, Allaben WT, Leakey JE. Oral glucosamine increases expression of transforming growth factor beta1 (TGFbeta1) and connective tissue growth factor (CTGF) mRNA in rat cartilage and kidney: implications for human efficacy and toxicity. Arch Biochem Biophys. 2011;510(1):11-18.21466783
57. Taniguchi S, Ryu J, Seki M, Sumino T, Tokuhashi Y, Esumi M. Long-term oral administration of glucosamine or chondroitin sulfate reduces destruction of cartilage and up-regulation of MMP-3 mRNA in a model of spontaneous osteoarthritis in Hartley guinea pigs. J Orthop Res. 2012;30(5):673-678.22058013
58. Wang SX, Laverty S, Dumitriu M, Plaas A, Gynpas MD. The effects of glucosamine hydrochloride on subchondral bone changes in an animal model of osteoarthritis. Arthritis Rheum. 2007;56(5):1537-1548.17469133
59. Scotto dA, et al. Effects of intra-articular administration of glucosamine and a peptidyl-glucosamine derivative in a rabbit model of experimental osteoarthritis: a pilot study. Rheumatol Int. 2008;28:437.
60. Largo R, Martinez-Calatrava MJ, Sánchez-Pernaute O, et al. Effect of a high dose of glucosamine on systemic and tissue inflammation in an experimental model of atherosclerosis aggravated by chronic arthritis. Am J Physiol Heart Circ Physiol. 2009;297(1):H268-H276.19411287
61. McCarthy G, O-Donovan J, Jones B, McAllister H, Seed M, Mooney C. Randomised double-blind, positive-controlled trial to assess the efficacy of glucosamine/chondroitin sulfate for the treatment of dogs with osteoarthritis. Vet J. 2007;174(1):54-61.16647870
62. Towheed TE, Anastassiades TP, Shea B, Houpt J, Welch V, Hochberg MC. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev. 2001;(1):CD002946.11279782
63. Gatti JC. Glucosamine treatment for osteoarthritis. Am Fam Physician. 2006;73(7):1189-1191.16623204
64. Herrero-Beaumont G, Ivorra JA, Del Carmen Trabado M, et al. Glucosamine sulfate in the treatment of knee osteoarthritis symptoms. Arthritis Rheum. 2007;56(2):555-567.17265490
65. Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006;354(8):795-808.16495392
66. Bruyere O, Pavelka K, Rovati LC, et al. Glucosamine sulfate reduces osteoarthritis progression in postmenopausal women with knee osteoarthritis: evidence from two 3-year studies. Menopause. 2004;11(2):138-143.15021442
67. Reginster JY, Bruyere O, Fraikin G, Henrotin Y. Current concepts in the therapeutic management of osteoarthritis with glucosamine. Bull Hosp Jt Dis. 2005;63(1-2):31-36.
68. Fox BA, Schmitz ED, Wallace R. FPIN's clinical inquiries. Glucosamine and chondroitin for osteoarthritis. Am Fam Physician. 2006;73(7):1245-1246.16623213
69. Wandel S, Jüni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ. 2010;341:c4675.20847017
70. Markenson JA. ACP Journal Club. Review: glucosamine and chondroitin, alone or in combination, do not clinically improve knee or hip pain in osteoarthritis. Ann Intern Med. 2011;154(6):JC3-JC4.21403067
71. Bruyére O. Large review finds no clinically important effect of glucosamine or chondroitin on pain in people with osteoarthritis of the knee or hip but results are questionable and likely due to heterogeneity. Evid Based Med. 2011;16(2):52-53.21224279
72. Lee YH, Woo JH, Choi SJ, Ji JD, Song GG,. Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis. Rheumatol Int. 2010;30(3):357-363.19544061
73. Vangsness CT Jr, Spiker W, Erickson J. A review of evidence-based medicine for glucosamine and chondroitin sulfate use in knee osteoarthritis. Arthroscopy. 2009;25(1):86-94.19111223
74. Block JA, Oegema TR, Sandy JD, Plaas A. The effects of oral glucosamine on joint health: is a change in research approach needed? Osteoarthritis Cartilage. 2010;18(1):5-11.19733270
75. Muniyappa R. Glucosamine and osteoarthritis: time to quit? Diabetes Metab Res Rev. 2011;27(3):233-234.21370382
76. Reginster JY, Bruyere O, Neuprez A. Current role of glucosamine in the treatment of osteoarthritis. Rheumatology (Oxford). 2007;46(5):731-735.
77. Reginster JY. The efficacy of glucosamine sulfate in osteoarthritis: financial and nonfinancial conflict of interest. Arthritis Rheum. 2007;56(7):2105-2110.17599727
78. Silbert JE. Dietary glucosamine under question. Glycobiology 2009;19(6):564-567.19254962
79. Vlad SC, LaValley MP, McAlindon TE, Felson DT. Glucosamine for pain in osteoarthritis: why do trial results differ? Arthritis Rheum. 2007;56(7):2267-2277.17599746
80. Wigley R. The glucosamine debate: is it better than placebo? Inflammopharmacology. 2009;17(3):191-192.19526312
81. Cahlin BJ, Dahlström L. No effect of glucosamine sulfate on osteoarthritis in the temporomandibular joints--a randomized, controlled, short-term study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(6):760-766.22001199
82. Rozendaal RM, Uitterlinden EJ, van Osch GJ, et al. Effect of glucosamine sulphate on joint space narrowing, pain and function in patients with hip osteoarthritis; subgroup analyses of a randomized controlled trial. Osteoarthritis Cartilage. 2009;17(4):427-432.18848470
83. Magrans-Courtney T, Wilborn C, Rasmussen C, et al. Effects of diet type and supplementation of glucosamine, chondroitin, and MSM on body composition, functional status, and markers of health in women with knee osteoarthritis initiating a resistance-based exercise and weight loss program. J Int Soc Sports Nutr. 2011;8(1):8.21689421
84. Petersen SG, Beyer N, Hansen M, et al. Nonsteroidal anti-inflammatory drug or glucosamine reduced pain and improved muscle strength with resistance training in a randomized controlled trial of knee osteoarthritis patients. Arch Phys Med Rehabil. 2011;92(8):1185-1193.21807137
85. Ng NT, Heesch KC, Brown WJ. Efficacy of a progressive walking program and glucosamine sulphate supplementation on osteoarthritic symptoms of the hip and knee: a feasibility trial. Arthritis Res Ther. 2010;12(1):R25.20152042
86. Messier SP, Mihalko S, Loeser RF, et al. Glucosamine/chondroitin combined with exercise for the treatment of knee osteoarthritis: a preliminary study. Osteoarthritis Cartilage. 2007;15(11):1256-1266.17561418
87. Trč T, Bohmová. Efficacy and tolerance of enzymatic hydrolysed collagen (EHC) vs. glucosamine sulphate (GS) in the treatment of knee osteoarthritis (KOA). Int Orthop. 2011;35(3):341-348.20401752
88. Petersen SG, Saxne T, Heinegard D, et al. Glucosamine but not ibuprofen alters cartilage turnover in osteoarthritis patients in response to physical training. Osteoarthritis Cartilage. 2010;18(1):34-40.19679221
89. Sawitzke AD, Shi H, Finco MF, et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT. Ann Rheum Dis. 2010;69(8):1459-1464.20525840
90. Gruenwald J, Petzold E, Busch R, Petzold HP, Graubaum HJ. Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis. Adv Ther. 2009;26(9):858-871.19756416
91. Wilkens P, Scheel IB, Grundnes O, Hellum C, Storheim K. Effect of glucosamine on pain-related disability in patients with chronic low back pain and degenerative lumbar osteoarthritis: a randomized controlled trial. JAMA. 2010;304(1):45-52.20606148
92. Runhaar J, van der Wouden JC. Effect of oral glucosamine on pain-related disability in patients with chronic low back pain. JAMA. 2010;304(15):1673.20959576
93. Bruyere O, Pavelka K, Rovati LC, et al. Total joint replacement after glucosamine sulphate treatment in knee osteoarthritis: results of a mean 8-year observation of patients from two previous 3-year, randomised, placebo-controlled trials. Osteoarthritis Cartilage. 2008;16(2):254-260.17681803
94. Delialioglu OM, Daglar B, Bayrakci K, Ceyhan E, Gunel U. Does the combination of chondroitin sulfate and glucosamine delay the cartilage destruction in ochronopathy? Knee Surg Sports Traumatol Arthrosc. 2009;17(10):1270-1271.19756514
95. Herrero-Beaumont G, Rovati LC, Casteñeda S, Alvarez-Soria MA, Largo R. The reverse glucosamine sulfate pathway: application in knee osteoarthritis. Expert Opin Pharmacother. 2007;8(2):215-225.17257091
96. Martí-Bonmatí L, Sanz-Requena R, Rodrigo JL, Alberich-Bayarri A, Carot JM. Glucosamine sulfate effect on the degenerated patellar cartilage: preliminary findings by pharmacokinetic magnetic resonance modeling. Eur Radiol. 2009;19(6):1512-1518.19214525
97. Mehta K, Gala J, Bhasale S, et al. Comparison of glucosamine sulfate and a polyherbal supplement for the relief of osteoarthritis of the knee: a randomized controlled trial [ISRCTN25438351]. BMC Complement Altern Med. 2007;7:34.17974032
98. Nakamura H, Masuko K, Yudoh K, Kato T, Kamada T, Kawahara T. Effects of glucosamine administration on patients with rheumatoid arthritis. Rheumatol Int. 2007;27(3):213-218.16953394
99. Sawitzke AD, Shi H, Rinco MF, et al. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial. Arthritis Rheum. 2008;58(10):3183-3191.18821708
100. Yoshimura M, Sakamoto K, Tsuruta A, et al. Evaluation of the effect of glucosamine administration on biomarkers for cartilage and bone metabolism in soccer players. Int J Mol Med. 2009;24(4):487-494.19724889
101. Zhang YX, Dong W, Liu H, Cicuttini F, de Courten M, Yang JB. Effects of chondroitin sulfate and glucosamine in adult patients with Kaschin-Beck disease. Clin Rheumatol. 2010;29(4):357-362.20108108
102. Persiani S, Rotini R, Trisolino G, et al. Synovial and plasma glucosamine concentrations in osteoarthritic patients following oral crystalline glucosamine sulphate at therapeutic dose. Osteoarthritis Cartilage. 2007;15(7):764-772.17353133
103. Bekesi J, Winzler RJ. Inhibitory effects of D-glucosamine on the growth of Walker 256 carcinosarcoma and on protein, RNA, and DNA synthesis. Cancer Res. 1970;30(12):2905-2912.5494575
104. Hwang MS, Baek WK. Glucosamine induces autophagic cell death through the stimulation of ER stress in human glioma cancer cells. Biochem Biophys Res Commun. 2010;399(1):111-116.20643103
105. Shintani T, Yamazaki F, Katoh T, et al. Glucosamine induces autophagy via an mTOR-independent pathway. Biochem Biophys Res Commun. 2010;391(4):1775-1779.20045674
106. Liu BQ, Meng X, Li C, et al. Glucosamine induces cell death via proteasome inhibition in human ALVA41 prostate cancer cell. Exp Mol Med. 2011;43(9):487-493.21697645
107. Tsai CY, Lee TS, Kou YR, Wu YL. Glucosamine inhibits IL-1beta-mediated IL-8 production in prostate cancer cells by MAPK attenuation. J Cell Biochem. 2009;108(2):489-498.19626664
108. Yomogida S, Hua J, Sakamoto K, Nagaoka I. Glucosamine suppresses interleukin-8 production and ICAM-1 expression by TNF-alpha-stimulated human colonic epithelial HT-29 cells. Int J Mol Med. 2008;22(2):205-211.18636175
109. Chesnokov V, Sun C, Itakura K. Glucosamine suppresses proliferation of human prostate carcinoma DU145 cells through inhibition of STAT3 signaling. Cancer Cell Int. 2009;9:25.19744341
110. Brasky TM, Lampe JW, Slatore CG, White E. Use of glucosamine and chondroitin and lung cancer risk in the VITamins And Lifestyle (VITAL) cohort. Cancer Causes Control. 2011;22(9):1333-1342.21706174
111. Shaygannejad V, Janghorbani M, Savoj MR, Ashtari F. Effects of adjunct glucosamine sulfate on relapsing-remitting multiple sclerosis progression: preliminary findings of a randomized, placebo-controlled trial. Neurol Res. 2010;32(9):981-985.20223094
112. Hwang SY, Shin JH, Hwang JS, et al. Glucosamine exerts a neuroprotective effect via suppression of inflammation in rat brain ischemia/reperfusion injury. Glia. 2010;58(15):1881-1892.20737476
113. Jang BC, Sung SH, Park JG, et al. Glucosamine hydrochloride specifically inhibits COX-2 by preventing COX-2 N-glycosylation and by increasing COX-2 protein turnover in a proteasome-dependent manner. J Biol Chem. 2007;282(38):27622-27632.17635918
114. Jeong KC, Ahn KO, Lee BI, Lee CH, Kim SY. The mechanism of transglutaminase 2 inhibition with glucosamine: implications of a possible anti-inflammatory effect through transglutaminase inhibition. J Cancer Res Clin Oncol. 2010;136(1):143-150.19655169
115. Kim DE, Kim JY, Schellingerhout D, et al. Molecular imaging of cathepsin B proteolytic enzyme activity reflects the inflammatory component of atherosclerotic pathology and can quantitatively demonstrate the antiatherosclerotic therapeutic effects of atorvastatin and glucosamine. Mol Imaging. 2009;8(5):291-301.19796606
116. Zou L, Yang S, Champattanachai V, et al. Glucosamine improves cardiac function following trauma-hemorrhage by increased protein O-GlcNAcylation and attenuation of NF-(kappa)B signaling. Am J Physiol Heart Circ Physiol. 2009;296(2):H515-H523.19098112
117. Yomogida S, Kojima Y, Tsutsumi-Ishii Y, et al. Glucosamine, a naturally occurring amino monosaccharide, suppresses dextran sulfate sodium-induced colitis in rats. Int J Mol Med. 2008;22(3):317-323.17952322
118. Maganhin CC, Correa O, Regina Ct G, Simões R, Baracat EC, Soares-Jr JM. Effects of glucosamine on the tibial epiphyseal disk of ovariectomized rats: morphologic and morphometric analysis. Clinics (Sao Paulo). 2007;62(5):607-612.
119. Kim CH, ChPark CD, Lee AY. Glucosamine improved atopic dermatitis-like skin lesions in NC/Nga mice by inhibition of Th2 cell development. Scand J Immunol. 2011;73(6):536-545.21284687
120. Liang CM, Tai MC, Chang YH, et al. Glucosamine inhibits epidermal growth factor-induced proliferation and cell-cycle progression in retinal pigment epithelial cells. Mol Vis. 2010;16:2559-2571.21151603
121. Liang CM, Tai MC, Chang YH, et al. Glucosamine inhibits epithelial-to-mesenchymal transition and migration of retinal pigment epithelium cells in culture and morphologic changes in a mouse model of proliferative vitreoretinopathy. Acta Ophthalmol. 2011;89(6):e505-e514.21457483
122. Borzelleca JF. Risk associated with glucosamine and chondroitin sulfate treatment. Regul Toxicol Pharmacol. 2007;49(1):75-76.17703859
123. Hathcock JN, Shao A. Risk assessment for glucosamine and chondroitin sulfate. Regul Toxicol Pharmacol. 2007;47(1):78-83.1694821
124. Sivojelezova A, Koren G, Einarson A. Glucosamine use in pregnancy: an evaluation of pregnancy outcome. J Womens Health (Larchmt ). 2007;16(3):345-348.17439379
125. Lu-Suguro JF, Hua J, Sakamoto K, Nagaoka I. Inhibitory action of glucosamine on platelet activation in guinea pigs. Inflamm Res. 2005;54(12):493-499.16389570
126. Hua J, Suguro S, Iwabuchi K, et al. Glucosamine, a naturally occurring amino monosaccharide, suppresses the ADP-mediated platelet activation in humans. Inflamm Res. 2004;53(12):680-688.15654516
127. Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006;354(8):795-808.16495392
128. Rozenfeld V, Crain JL, Callahan AK. Possible augmentation of warfarin effect by glucosamine-chondroitin. Am J Health Syst Pharm. 2004;61(3):306-307.14986566
129. Weimann G, Lubenow N, Selleng K, et al. Glucosamine sulfate does not crossreact with the antibodies of patients with heparin-induced thrombocytopenia. Eur J Haematol. 2001;66(3):195-199.11350488
130. Wilde MI, Markham A. Danaparoid. A review of its pharmacology and clinical use in the management of heparin-induced thrombocytopenia. Drugs. 1997;54(6):903-924.9421696
131. Baron AD, Zhu JS, Zhu JH, Weldon H, Maianu L, Garvey WT. Glucosamine induces insulin resistance in vivo by affecting GLUT 4 translocation in skeletal muscle. Implications for glucose toxicity. J Clin Invest. 1995;96(6):2792-2801.8675649
132. Virkamaki A, Yki-Jarvinen H. Allosteric regulation of glycogen synthase and hexokinase by glucosamine-6-phosphate during glucosamine-induced insulin resistance in skeletal muscle and heart. Diabetes. 1999;48(5):1101-1107.10331416
133. Patti ME, Virkamaki A, Landaker EJ, Kahn CR, Yki-Jarvinen H. Activation of the hexosamine pathway by glucosamine in vivo induces insulin resistance of early postreceptor insulin signaling events in skeletal muscle. Diabetes. 1999;48(8):1562-1571.10426374
134. Miles PD, Higo K, Romeo, OM, Lee MK, Rafaat K, Olefsky JM. Troglitazone prevents hyperglycemia-induced by not glucosamine-induced insulin resistance. Diabetes. 1998;47(3):395-400.9519745
135. Monauni T, Zenti MG, Cretti A, et al. Effects of glucosamine infusion on insulin secretion and insulin action in humans. Diabetes. 2000;49(6):926-935.10866044
136. Mooradian AD, Haas MJ, Wong NC. The effect of select nutrients on serum high-density lipoprotein cholesterol and apolipoprotein A-I levels. Endocr Rev. 2006;27(1):2-16.16243964
137. Marshall PD, Poddar S, Tweed EM, Brandes L. Clinical injuries: do glucosamine and chondroitin worsen blood sugar control in diabetes? J Fam Pract. 2006;55(12):1091-1093.17137550
138. Tannis AJ, Barban J, Conquer JA. Effect of glucosamine supplementation on fasting and non-fasting plasma glucose and serum insulin concentrations in healthy individuals. Osteoarthritis Cartilage. 2004;12(6):506-511.15135147
139. Muniyappa R, Karne RJ, Hall G, et al. Oral glucosamine for 6 weeks at standard doses does not cause or worsen insulin resistance or endothelial dysfunction in lean or obese subjects. Diabetes. 2006;55(11):3142-3150.17065354
140. Albert SG, Oiknine RF, Parseghian S. The effect of glucosamine on Serum HDL cholesterol and apolipoprotein AI levels in people with diabetes. Diabetes Care. 2007;30(11):2800-2803.17682119
141. Dostrovsky NR, Towheed TE, Hudson RW, Anastassiades TP. The effect of glucosamine on glucose metabolism in humans: A systematic review of the literature. Osteoarthritis Cartilage. 2011;19(4):375-380.21251987
142. Simon RR, Marks V, Leeds AR, Anderson JW. A comprehensive review of oral glucosamine use and effects on glucose metabolism in normal and diabetic individuals. Diabetes Metab Res Rev. 2011;27(1):14-27.21218504
143. Smith A, Dillon J. Acute liver injury associated with the use of herbal preparations containing glucosamine: three case studies. BMJ Case Rep. 2009;2009.21887162
144. Furer V, Wieczorek RL, Pillinger MH. Bilateral pinna chondritis preceded by glucosamine chondroitin supplement initiation. Scand J Rheumatol. 2011;40(3):241-243.21077795
145. Hochberg MC, Altman RD, April KT, et al; American College of Rheumatology. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64(4):465-474.22563589
146. Richmond J, Hunter D, Irrgang J, et al; American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. J Bone Joint Surg Am. 2010;92(4):990-993.20360527
147. Cerda C, Bruguera M, Parés A. Hepatotoxicity associated with glucosamine and chondroitin sulfate in patients with chronic liver disease. World J Gastroenterol. 2013;19(32):5381-5384.23983444
148. Cawston H, Davie A, Paget MA, Skljarevski V, Happich M. Efficacy of duloxetine versus alternative oral therapies: an indirect comparison of randomised clinical trials in chronic low back pain. Eur Spine J. 2013;22(9):1996-2009.23686477
149. Kwoh CK, Roemer FW, Hannon MJ, et al. Effect of oral glucosamine on joint structure in individuals with chronic knee pain-a randomized, placeo-controlled clinical trial. Arthritis Rheumatol. 2014;66(4):930-939.24616448
150. Hochberg MC, Martel-Pelletier J, Monfort J, et al; on behalf of the MOVES Investigation Group. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicenter, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis. 2015;pii:annrheumdis-2014-206792.25589511
151. Knudsen JF, Sokol GH. Potential glucosamine-warfarin interaction resulting in increased international normalized ratio: case report and review of the literature and MedWatch database. Pharmacotherapy. 2008;28(4):540-548.
152. Rozenfeld V, Crain JL, Callahan AK. Possible augmentation of warfarin effect by glucosamine-chondroitin. Am J Health Syst Pharm. 2004;61(3):306-307.
153. Scott GN. Interaction of warfarin with glucosamine--chondroitin. Am J Health Syst Pharm. 2004;61(11):1186.
154. Jin SY, Lim WS, Sung NH, Cheong KA, Lee AY. Combination of glucosamine and low-dose cyclosporine for atopic dermatitis treatment: a randomized, placebo-controlled, double-blind, parallel clinical trial. Dermatol Ther. 2015;28(1):44-51.25113885
155. Runhaar J, van Middelkoop M, Reijman M, et al. Prevention of knee osteoarthritis in overweight females: the first preventive randomized controlled trial in osteoarthritis. Am J Med. 2015;128(8):888-895.25818496
156. Kongtharvonskul J, Anothaisintawee T, McEvoy M, Attia J, Woratanarat P, Thakkinstian A. Efficacy and safety of glucosamine, diacerein, and NSAIDs in osteoarthritis knee: a systematic review and network meta-analysis. Eur J Med Res. 2015;20:24.25889669
157. Kantor ED, Zhang X, Wu K, et al. Use of glucosamine and chondroitin supplements in relation to risk of colorectal cancer: results from the Nurses’ Health Study and Health Professionals follow-up study. Int J Cancer. 2016;139:1949-1957.27357024
158. Runhaar J, Rozendaal RM, van Middelkoop M, et al. Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trial bank. Ann Rheum Dis. 2017;76(11):1862-1869.28754801


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