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glucosamine (Cosamin, Osteo-Bi-Flex)

Uses: - osteoarthritis [7] (also see GAIT study) - often used in combination with chondroitin sulfate - not effective [15,17]* - rheumatoid arthritis [14] - may lower risk for cardiovascular events [18] * on list of medications to avoid [17] Contraindications: 1) shellfish allergy (made from oyster & crab shells) [5] 2) diabetes NOT a contraindication [6] 3) NOT useful for chronic low back pain & degenerative lumbar osteoarthritis [11] 4) NOT useful for hip osteoarthritis alone or in combination with chondroitin [12,16] Dosage: - 1500* mg PO QD to 1 g PO BID * 1500 mg QD for diabetics [6] Pharmacokinetics: - takes 4-8 weeks to relieve pain Adverse effects: 1) hyperglycemia [5]; no increase in HgbA1c [6] 2) hypercholesterolemia [4] 3) hypertension [4] 4) GI upset: nausea, diarrhea, heartburn [14] 5) anorexia 6) insomnia 7) pruritus & pain 8) peripheral edema 9) tachycardia 10) not harmful [12] Drug interactions: - may increase INR in some patients on warfarin [8] - may reduce effectiveness of hypoglycemic agents [14] Laboratory: - glucosamine in serum/plasma - glucosamine/creatinine in urine Mechanism of action: 1) possibly stimulates formation & repair of cartilage 2) may reduce joint pain in osteoarthritis 3) may slow the progression of osteoarthritis [3] a) no benefit of glucosamine or chondroitin for attenuating joint space narrowing [9] b) not much benefit in GAIT trial 4) increases insulin resistance in animal studies [6] 5) may have antiplatelet effects [8]

Interactions

drug interactions

Related

NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT)

Specific

glucosamine-2,6-sulfate glucosamine-2-sulfate (N-sulfoglucosamine, GlcNS) glucosamine-6-phosphate (Robison ester) N-acetylglucosamine (GlcNAc)

General

hexosamine metabolic agent (metabolic modifier)

Properties

Database Correlations

PUBCHEM cid=441477 Kegg map/map00530

References

  1. Prescriber's Letter 6(10):58, Oct, 1999
  2. Prescriber's Letter 8(2):7, Feb, 2001
  3. Journal Watch 21(6):47, 2001 Reginster et al Lancet 357:251, 2001 McAlidon Lancet 357:247, 2001
  4. Prescriber's Letter 8(11):64 2001
  5. Prescriber's Letter 10(5):27 2003
  6. Prescriber's Letter 10(9):49 2003
  7. Prescriber's Letter 13(1): 2006 Detail-Document#: 220102 (subscription needed) http://www.prescribersletter.com
  8. Prescriber's Letter 15(6): 2008 Glucosamine/Chondroitin and Warfarin Interaction Detail-Document#: 240613 (subscription needed) http://www.prescribersletter.com
  9. Sawitzke AD 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 Oct; 58:3183. PMID: 18821708
  10. Prescriber's Letter 15(11): 2008 Detail-Document#: 241111 (subscription needed) http://www.prescribersletter.com
  11. Wilkens P et al Effect of Glucosamine on Pain-Related Disability in Patients With Chronic Low Back Pain and Degenerative Lumbar Osteoarthritis JAMA. 2010;304(1):45-52. PMID: 20606150 http://jama.ama-assn.org/cgi/content/full/304/1/45
  12. Wandel S et al Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis BMJ 2010; 341:c4675 PMID: 20847017 http://www.bmj.com/content/341/bmj.c4675
  13. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  14. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  15. Kwoh CK et al. Effect of oral glucosamine on joint structure in individuals with chronic knee pain: A randomized, placebo-controlled clinical trial. Arthritis Rheumatol 2014 Apr; 66:930 - PMID: 24616448 http://onlinelibrary.wiley.com/doi/10.1002/art.38314/abstract
  16. Fransen M et al. Glucosamine and chondroitin for knee osteoarthritis: A double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens. Ann Rheum Dis 2015 May; 74:851 PMID: 24395557 http://ard.bmj.com/content/74/5/851
  17. Therapeutics Letter #108. Therapeutics Initiative Drugs to Avoid. http://www.ti.ubc.ca/2018/01/04/108-drugs-avoid/
  18. Ma H, Li X, Sun D et al Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank. BMJ 2019;365:l1628 PMID: 31088786 Free Article https://www.bmj.com/content/365/bmj.l1628 - Zheng J, Hukportie DN, Zhang Y et al Association Between Glucosamine Use and the Risk of Incident Heart Failure. The UK Biobank Cohort Study and Mendelian Randomization Analysis. Mayo Clinic Proceedings. 2023. July 7. PMID: 37422736 https://www.mayoclinicproceedings.org/article/S0025-6196(23)00199-4/fulltext

Component-of

calcium carbonate/cholecalferol/chondroitin sulfate/glucosamine capsaicin/chondroitin sulfate/glucosamine/lidocaine chondroitin sulfate/glucosamine chondroitin sulfate/glucosamine/methylsulfonylmethane Flexium glucosamine/methylsulfonylmethane