Glucosamine Sulfate
Focus on Dietart Supplements
With comments by Gail C. Mornhinweg, PhD, ARNP, CS
Glucosamine Sulfate
Scientific Name: 2amino-2deoxyglucose.
Intended Indications: Degenerative joint disease, osteoarthritis.
Mode of Action: Glucosamine is required for the synthesis of glycoproteins. It comprises the body’s ligaments, cartilage, and synovial fluid and stimulates the metabolism of chondrocytes and the regeneration of experimentally induced cartilage damage.1 It is 90% absorbed after oral administration and bioavailability after first pass is 26%. It does not inhibit cyclooxygenases. Glucosamine lacks analgesic activity but does have anti-inflammatory effects.
Safety: No long-term data are available, but it appears safe when used orally in dosages no greater than 1.5 g/d. Safety has not been determined in pregnancy and lactation.
Adverse Reactions: Mild gastrointestinal upset has been reported with short-term use, as well as drowsiness, skin reactions, insomnia, and headache. Adverse reactions were transient and reversible after discontinuation of the product.
Interactions: None known. None are predicted.
Usual Dosage: 500 mg tid. Individuals taking diuretics or weighing over 200 lbs may need a higher dose based on body weight (20 mg/kg).
Research: A 6- to 8-week study of 12 patients on glucosamine and 12 on placebo revealed an 80% reduction in pain in the experimental group.2 Another study reported decreased pain, decreased joint tenderness, and increased active and passive range of motion.3 In a study by Lopez Vas, the ibuprofen group had faster pain relief but the glucosamine group had longer lasting relief.4 Results of studies by Rovati5 and Muller-Fassbender6 were similar: quicker pain relief with ibuprofen, similar response rates (52% with ibuprofen and 48% with glucosamine), but fewer side effects with glucosamine (ibuprofen 35% and glucosamine 6%). da Camara studied the in vitro effects of exogenous glucosamine and found it stimulated the repair and production of articular cartilage proteoglycans.7
The National Institutes of Health is funding a long-term study of glucosamine on osteoarthritis. The placebo-controlled study will examine the effects of glucosamine alone and with chondroitin.
Comments: Approximately 40 million Americans have some degree of osteoarthritis and many suffer varying degrees of joint pain. Millions are relying on over-the-counter, herbal, and supplemental health care products.
Many patients who have been using glucosamine for arthritic pain would not consider stopping its use. Many combine glucosamine and methylsufonylmethane and others add chondroitin to the formula. Chondroitin, a larger molecule, is only 8% absorbed so it probably does not do a lot more than glucosamine alone. Currently, more than 20 different products with various combinations and amounts of glucosamine are available.
Patients also need to be aware that herbs and supplements often take a longer time to reach maximum effect. They may need to take glucosamine for a minimum of four weeks before deciding its efficacy.
However, it is important to note that only one product has been tested. Our role as holistic health care providers is to provide the best information to our patients so they can make informed and knowledgeable decisions.
Dr. Mornhinweg is an Adult Nurse Practitioner at the Choice to Heal Clinic in Floyds Knobs, IN.
References
1. Hagemann RC, ed. The Lawrence Review of Natural Products. St. Louis, MO: Facts & Comparisons; 1996.
2. Pujalte JM, et al. Double-blind clinical evaluation of oral glucosamine sulphate in the basic treatment of osteoarthritis. Curr Med Res Opin 1980;7:110-114.
3. Drovanti A, et al. Therapeutic activity of oral glucosamine sulfate in osteoarthrosis: A placebo-controlled double-blind investigation. Clin Ther 1980;3:260-272.
4. Lopez Vas A. Double-blind clinical evaluation of the relative efficacy of ibuprofen and glucosamine sulphate in the management of osteoarthritis of the knee in out-patients. Curr Med Res Opin 1982;8:145-149.
5. Rovati LC. Clinical research in osteoarthritis: Design and results of short-term and long-term trials with disease modifying drugs. Int J Tissue React 1992;14:243-251.
6. Mueller-Fassbender H, et al. Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis Cartilage 1994;2:61-69.
7. da Camara CC, Dowless GV. Glucosamine sulfate for osteoarthritis. Ann Pharmacother 1998;32:580-87.
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