Scientific Name: Glucosamine
Other Names: 2-Amino-2-Deoxyglucose, Chitosamine, Glucosamine Hydrochloride, Glucosamine Sulfate, N-acetyl Glucosamine

Who is this for?

Uses

Glucosamine is available in several different forms that are usually called "salts". In chemistry, salts are neutral combinations of an acidic substance with a basic substance. Salt forms of some substances may be easier than the uncombined form for the body to use. Most of the clinical studies investigating glucosamine's medical effects have used a salt known as glucosamine sulfate, but other salts such as glucosamine hydrochloride and n-acetyl glucosamine are also sold widely. While all the salts of glucosamine contain the same general components, they may not all produce the same effects in the body. Generally, researchers have reported more effectiveness for glucosamine sulfate than glucosamine hydrochloride. No studies have compared them, though, so not enough information is available about potential differences in their activity to know whether glucosamine salts are interchangeable.

Alone or combined with another dietary supplement called chondroitin, glucosamine has been studied extensively for treating osteoarthritis (OA), a condition that generally results from wear-and-tear on joints. In OA, deterioration of the cartilage, which cushions the joints, leads to pain, swelling, and loss of movement. Since glucosamine provides a major component of cartilage, it is believed that supplemental glucosamine may delay further degeneration. Glucosamine may also actually help to repair deteriorating cartilage and it may promote the manufacture of synovial fluid--the jelly-like substance that cushions and lubricates the joints. In general, glucosamine has shown moderate ability to relieve the pain of OA, as well as to restore partial movement to affected joints. Chondroitin is believed to provide a different chemical that is also important in the formation of cartilage, but its effects are not as well defined as glucosamine's. Although glucosamine has been studied most for treating OA of large joints such as knees and hips, it has showed some possible effectiveness for relieving arthritis in other joints such as the lower back and the jaw, which is also known as the temporomandibular joint (TMJ).

Glucosamine is important for healthy skin. Adequate amounts of it in the blood are necessary for the production of hyaluronic acid, one of the substances essential to heal skin injuries. Therefore, glucosamine plays a major role in the healing of surgical incisions and skin wounds. In a few studies, participants who began taking supplemental glucosamine before surgery and continued taking it until their incisions were completely healed showed generally faster healing with less scarring than other participants who did not take glucosamine. Wound dressings that contain a modified type of glucosamine known as poly-N-acetyl glucosamine are being studied to stop major bleeding. In other research, a few studies evaluating whether supplemental glucosamine helps to prevent or reverse wrinkling have had mixed results. Because natural production of hyaluronic acid decreases as individuals age, decreases in it may contribute to wrinkling of the skin. Increasing glucosamine may help the skin stay more flexible, but much more study is needed to prove or disprove this theory.

In a few small studies, n-acetyl glucosamine has shown promise for treating inflammatory bowel diseases such as Crohn's disease and ulcerative colitis. N-acetyl glucosamine forms part of an enzyme needed to produce mucus. Therefore, it is believed to increase the production of the mucus that lines the lower gastrointestinal (GI) tract, providing a protective effect. More research for this possible use is needed.

Precautions

Very little information is available on how glucosamine might affect a developing fetus, an infant, or a small child. Therefore, its use is not recommended during pregnancy, while breastfeeding, or during early childhood.

The source of glucosamine is not required to be stated on the label. Since it may be made from crabs, lobsters, shrimp, or other shellfish; individuals who are allergic to these foods may also be allergic to glucosamine. Individuals with allergies to shellfish should not use glucosamine unless it can be verified to come from a synthetic source.

Results from a few small studies suggest that injected glucosamine supplementation may raise blood sugar for some individuals whether or not they have diabetes. While insulin levels did not always change, blood sugar amounts went up for some individuals, including some who previously had not been diagnosed with diabetes or glucose intolerance (blood sugar levels that consistently are higher than normal, but not high enough to indicate diabetes). Therefore, it is possible that injected glucosamine--particularly in doses higher than recommended amounts--may interfere with the use of insulin by muscle cells. In individuals with diabetes, blood sugar levels may become too high and diabetes may not be well controlled. Study participants using oral glucosamine did not experience changes in blood sugar.

What side effects should I watch for?

The main side effects reported during clinical trials with all salts of glucosamine were mild and temporary. Gastrointestinal (GI) complaints such as constipation or diarrhea, cramping, gas, heartburn, and nausea; were most common. Drowsiness and headache have also been associated with taking glucosamine sulfate.

What interactions should I watch for?

Recently, one case was reported of a tendency toward excessive bleeding in an individual taking both warfarin and a glucosamine/chondroitin supplement. Warfarin is an anticoagulant drug taken to prevent blood clots by "thinning the blood". Although this possible interaction has not been confirmed, individuals who take anticoagulants or a related group of drugs known as antiplatelet agents should not take glucosamine.

• Anticoagulants include heparin and warfarin
• Antiplatelets include clopidogrel and Ticlid

Oral glucosamine is not believed to affect blood sugar. However, injected glucosamine may interfere with insulin and oral drugs for diabetes, such as:

• acarbose
• Avandia
• glimepiride
• glipizide
• glyburide
• Glyset
• metformin
• Prandin

Because injected glucosamine may increase blood sugar levels, using it with herbal products that lower blood sugar may have a very slight risk of resulting in blood sugar that is too high or too low. Herbals that may reduce blood sugar include:

• Eleuthero
• Fenugreek
• Ginger (in high amounts)
• Kudzu
• Panax Ginseng

Although no cases of interactions with other herbal anticoagulants have been reported with glucosamine, it is possible that the risk of excessive or uncontrolled bleeding may be slightly higher if glucosamine is used with other herbs that may decrease blood clotting. Some of the most common herbal products that might inhibit blood clotting are:

• Danshen
• Devil's Claw
• Eleuthero
• Garlic
• Ginger (in high amounts)
• Ginkgo
• Horse Chestnut
• Panax Ginseng
• Papain
• Red Clover
• Saw Palmetto

Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how glucosamine interacts with drugs, other herbals, and foods and the severity of those interactions, please use our Drug Interactions Checker to check for possible interactions.

Should I take it?

Glucosamine is a molecule that contains both sugar and protein. It is one of the essential components that the body uses in building and repairing tissues such as cartilage, heart valves, mucous membranes, and synovial fluid--the jelly-like substance that fills the joints. Although glucosamine is produced in the body, its natural production slows down as individuals get older. For supplemental use, glucosamine may be made in a laboratory. More often, however, it is obtained from natural sources such as the shells (also called exoskeletons) of crabs, lobsters, and other sea creatures. In addition to its use as a dietary supplement for arthritis, glucosamine is added to sports drinks for athletes and to cosmetics and shampoos.

Dosage and Administration

In the United States, glucosamine is most often taken orally--typically as capsules and usually combined with chondroitin, manganese, vitamin C, or other dietary supplements. Occasionally, different salts of glucosamine may be combined into one product. Although study evidence does not prove that taking glucosamine and chondroitin together is more effective than glucosamine alone, the two products frequently are sold in combination. Less frequently, glucosamine is applied topically--again often in combination with chondroitin. In other countries, glucosamine is available in forms that may be injected into muscles or directly into joints. While injectable glucosamine is not sold in the United States, a similar product--injectable hyaluronic acid--is available by prescription.

By mouth, a typical daily dose of glucosamine ranges from 500 mg to 3,000 mg (one-half gram to 3 grams) per day. Many studies used glucosamine sulfate 500 mg three times a day to treat either OA or TMJ pain. Some studies found that doses higher than 1,500 mg (1.5 grams) per day did not provide additional benefit. Full effectiveness in controlling arthritis pain may take up to 4 weeks to develop after glucosamine has been started.

Note: Glucosamine and chondroitin are frequently sold in combination with the trace element manganese, because manganese is thought to be involved in cartilage production. A trace element is a substance that is required by the body in very small amounts for proper growth and functioning. However, care should be taken to limit manganese intake. The upper tolerable limit, which is the maximum amount that probably will not cause any side effects for most individuals taking manganese, has been set by the U.S. National Academy of Sciences at 11 mg per day for adults. Higher amounts of manganese taken for long periods may result in symptoms such as confusion, drooling, hallucinations, memory loss, stiff muscles, trembling, and other symptoms similar to Parkinson's disease.

Summary

The major medical use of glucosamine--alone or with chondroitin--is to relieve joint pain and stiffness associated with osteoarthritis (OA). It may help wounds to heal and some forms of glucosamine may also alleviate inflammatory bowel diseases.

Risks

Taking glucosamine derived from sea creatures may cause allergic responses in individuals who are allergic to shellfish. Individuals with diabetes may experience elevated blood sugar levels if they inject glucosamine (not available in the U.S.), which may also raise blood sugar for individuals who do not have diabetes. Small children and pregnant or breast-feeding women may want to avoid taking glucosamine because little is known about its effects for these individuals.

Side Effects

During research studies, GI complaints such as constipation, diarrhea, and nausea were attributed to taking glucosamine. Some study participants who took glucosamine sulfate also reported drowsiness or headache.

Interactions

Glucosamine may increase the risk of excessive bleeding when it is taken with warfarin, other anticoagulant or antiplatelet drugs, aspirin, or herbal products that reduce the blood's ability to clot. Injecting it may also increase blood sugar levels, thereby interfering with insulin and drugs or herbals that lower blood sugar.

Last Revised July 18, 2008

References

Albert SG, Oiknine RF, Parseghian S, Mooradian AD, Haas MJ, McPherson T. The effect of glucosamine on Serum HDL cholesterol and apolipoprotein AI levels in people with diabetes. Diabetes Care. 2007;30(11):2800-2803.

Anon: Glucosamine. In: DerMarderosian A, Beutler JA, eds. Facts and Comparisons: The Review of Natural Products. St. Louis, MO, Facts and Comparisons. September 2002.

Bailey CJ, Turner SL. Glucosamine-induced insulin resistance in L6 muscle cells. Diabetes, Obesity and Metabolism. 2004;6(4):293-298.

Balkan B, Dunning BE. Glucosamine inhibits glucokinase in vitro and produces a glucose-specific impairment of in vivo insulin secretion in rats. Diabetes. 1994;43(10):1173-1179.

Barclay TS, Tsourounis C, McCart GM. Glucosamine. Annals of Pharmacotherapy. 1998;32(5):574-579.

Barrett S. Glucosamine for arthritis. January 23, 2002. QuackWatch. Available at: http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/glucosamine.html. Accessed September 27, 2004.

Biggee BA, Blinn CM, Nuite M, Silbert JE, McAlindon TE. Effects of oral glucosamine sulphate [sic] on serum glucose and insulin during an oral glucose tolerance test of subjects with osteoarthritis. Annals of Rheumatic Diseases. 2007;66(2):260-262.

Blaurock-Busch E. The clinical effects of manganese (Mn). Townsend Letter for Doctors and Patients. No date given. Available at: http://www.tldp.com/issue/180/Clinical%20Effects%20of%20Mn.html. Accessed September 23, 2003.

Braham R, Dawson B, Goodman C. The effect of glucosamine supplementation on people experiencing regular knee pain. British Journal of Sports Medicine. 2003;37(1):45-49.

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.

Bruyere O, Reginster JY. Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis. Drugs and Aging. 2007;24(7):573-580.

Chen JT, Liang JB, Chou CL, et al. Glucosamine sulfate inhibits TNF-alpha and IFN-gamma-induced production of ICAM-1 in human retinal pigment epithelial cells in vitro. Investigative Ophthalmology and Visual Science. 2006;47(2):664-672.

Chen WY, Abatangelo G. Functions of hyaluronan in wound repair. Wound Repair and Regeneration. 1999;7(2):79-89.

Christgau S, Henrotin Y, Tanko LB, et al. Osteoarthritic patients with high cartilage turnover show increased responsiveness to the cartilage protecting effects of glucosamine sulphate [sic]. Clinical and Experimental Rheumatology. 2004;22(1):36-42.

Chu SC, Yang SF, Lue KH, et al. Glucosamine sulfate suppresses the expressions of urokinase plasminogen activator and inhibitor and gelatinases during the early stage of osteoarthritis. Clinica Chimica Acta. 2006;372(1-2):167-172.

Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. New England Journal of Medicine. 2006;354(8):795-808.

Cole DJ, Connolly RJ, Chan MW, et al. A pilot study evaluating the efficacy of a fully acetylated poly-N-acetyl glucosamine membrane formulation as a topical hemostatic agent. Surgery. 1999;126(3):510-517.

Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheumatic Disease Clinics of North America. 1999;25(2):379-395.

Duan W, Paka L, Pillarisetti S. Distinct effects of glucose and glucosamine on vascular endothelial and smooth muscle cells: evidence for a protective role for glucosamine in atherosclerosis. Cardiovascular Diabetology. 2005;4:16.

Forsyth RK, Brigden CV, Northrop AJ. Double blind investigation of the effects of oral supplementation of combined glucosamine hydrochloride (GHCL) and chondroitin sulphate [sic] (CS) on stride characteristics of veteran horses. Equine Veterinary Journal Supplement 2006;(36):622-625.

Fox BA, Schmitz ED, Wallace R. FPIN's clinical inquiries. Glucosamine and chondroitin for osteoarthritis. American Family Physician. 2006;73(7):1245-1246.

Fraenkel L, Bogardus ST Jr, Concato J, Wittink DR. Treatment options in knee osteoarthritis: the patient's perspective. Archives of Internal Medicine. 2004;164(12):1299-1304.

Frech TM, Clegg DO. The utility of nutraceuticals in the treatment of osteoarthritis. Current Rheumatology Reports. 2007;9(1):25-30.

Gatti JC. Glucosamine treatment for osteoarthritis. American Family Physician. 2006;73(7):1189-1191.

Giaccari A, Morviducci L, Zorretta D, et al. In vivo effects of glucosamine on insulin secretion and insulin sensitivity in the rat: possible relevance to the maladaptive responses to chronic hyperglycaemia. Diabetologia. 1995;38(5):518-524.

Goa KL, Benfield P. Hyaluronic acid. A review of its pharmacology and use as a surgical aid in ophthalmology, and its therapeutic potential in joint disease and wound healing. Drugs. 1994;47(3):536-566.

Gregory PJ, Sperry M, Wilson AF. Dietary supplements for osteoarthritis. American Family Physician. 2008;77(2):177-184.

Han DH, Chen MM, Holloszy JO. Glucosamine and glucose induce insulin resistance by different mechanisms in rat skeletal muscle. American Journal of Physiology, Endocrinology and Metabolism. 2003;285(6):E1267-E1272.

Hathcock JN, Shao A. Risk assessment for glucosamine and chondroitin sulfate. Regulatory Toxicology and Pharmacology. 2007;47(1):78-83.

HealthNotes, Inc. Glucosamine. 2002. Available at: http://www.mycustompak.com/healthNotes/Supp/Glucosamine.htm Accessed September 23, 2003.

HealthNotes, Inc. Glucosamine/Chondroitin. 2002. Available at: http://www.mycustompak.com/healthNotes/Supp/Glucosamine_Chondroitin.htm. Accessed September 23, 2003.

Henderson CJ. Dietary Outcomes in Osteoarthritis Disease Management. Bulletin on the Rheumatic Diseases. 2003-2004;52(12): Available at: http://www.arthritis.org/research/bulletin/vol52no12/Printable.htm. Accessed September 27, 2004.

Herrero-Beaumont G, Rovati LC, Castaneda S, Alvarez-Soria MA, Largo R. The reverse glucosamine sulfate pathway: application in knee osteoarthritis. Expert Opinion in Pharmacotherapy. 2007;8(2):215-225.

Holmang A, Nilsson C, Niklasson M, et al. Induction of insulin resistance by glucosamine reduces blood flow but not interstitial levels of either glucose or insulin. Diabetes. 1999;48(1):106-111.

Homandberg GA, Guo D, Ray LM, Ding L. Mixtures of glucosamine and chondroitin sulfate reverse fibronectin fragment mediated damage to cartilage more effectively than either agent alone. Osteoarthritis and Cartilage. 2006;14(8):793-806.

Hopman WM, Towheed TE, Gao Y, et al. Prevalence of and factors associated with glucosamine use in Canada. Osteoarthritis and Cartilage. 2006;14(12):1288-1293.

Houpt JB, McMillan R, Wein C, Paget-Dellio SD. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee. Journal of Rheumatology. 1999;26(11):2423-2430.

Hughes R, Carr A. A randomized, double-blind, placebo-controlled trial of glucosamine sulphate [sic] as an analgesic in osteoarthritis of the knee. Rheumatology (Oxford). 2002;41(3):279-284.

Hungerford DS, Jones LC. Glucosamine and chondroitin sulfate are effective in the management of osteoarthritis. Journal of Arthroplasty. 2003;18(3 Suppl 1):5-9.

Ilic MZ, Martinac B, Samiric T, Handley CJ. Effects of glucosamine on proteoglycan loss by tendon, ligament and joint capsule explant cultures. Osteoarthritis and Cartilage. Epublished ahead of print. June 11, 2008.

Institute of Medicine. U.S. National Academy of Sciences. Dietary reference intakes for vitamin A, vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. http://www.nap.edu/books/0309072794/html. Accessed September 23, 2003.

Jellin JM, Gregory P, Batz F, Hitchens K, et al, eds. Pharmacist's Letter/Prescriber's Letter. Natural Medicines Comprehensive Database, 3rd Edition. Stockton CA: Therapeutic Research Facility, 2000.

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.

Liao YH, Jones SA, Forbes B, Martin GP, Brown MB. Hyaluronan: pharmaceutical characterization and drug delivery. Drug Delivery. 2005;12(6):327-342.

Lippiello L, Woodward J, Karpman R, Hammad TA. In vivo chondroprotection and metabolic synergy of glucosamine and chondroitin sulfate. Clinical Orthopedics. 2000;(381):229-240.

Lu-Suguro JF, Hua J, Sakamoto K, Nagaoka I. Inhibitory action of glucosamine on platelet activation in guinea pigs. Inflammation Research. 2005;54(12):493-499.

MacKay D, Miller AL. Nutritional support for wound healing. Alternative Medicine Review. 2003;8(4):359-377.

Matheson AJ, Perry CM. Glucosamine: a review of its use in the management of osteoarthritis. Drugs and Aging. 2003;20(14):1041-1060

McAlindon T. Glucosamine and chondroitin for rheumatoid arthritis? Bulletin on the Rheumatic Diseases. 2001;50(7):1-4.

McAlindon T. Why are clinical trials of glucosamine no longer uniformly positive? Rheumatic Disease Clinics of North America. 2003;29(4):789-801.

McAlindon TE. Nutraceuticals: do they work and when should we use them? Best Practice and Research. Clinical Rheumatology. 2006 ;20(1):99-115.

McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and Chondroitin for Treatment of Osteoarthritis. A Systematic Quality Assessment and Meta-analysis. Journal of the American Medical Association. 2000;283(11):1469-1475.

McCarty MF. Glucosamine for wound healing. Medical Hypotheses. 1996;47(4):273-275.

McCarty MF. Enhanced synovial production of hyaluronic acid may explain rapid clinical response to high-dose glucosamine in osteoarthritis. Medical Hypotheses. 1998;50(6):507-510.

McCarty MF, Russell AL, Seed MP. Sulfated glycosaminoglycans and glucosamine may synergize in promoting synovial hyaluronic acid synthesis. Medical Hypotheses. 2000;54(5):798-802.

McMillan DE. A brief history of the neurobehavioral toxicity of manganese: some unanswered questions. Neurotoxicology. 1999;20(2-3):499-507.

Messier SP, Mihalko S, Loeser RF, et al. Glucosamine/chondroitin combined with exercise for the treatment of knee osteoarthritis: a preliminary study. Osteoarthritis and Cartilage. 2007;15(11):1256-1266.

Miller DC, Richardson J. Does glucosamine relieve arthritis joint pain? Journal of Family Practice. 2003;52(8):645-647.

Monauni T, Zenti MG, Cretti A, et al. Effects of glucosamine infusion on insulin secretion and insulin action in humans. Diabetes. 2000;49:926-935.

Muller-Fassbender H, Bach GL, Haase W, Rovati LC, Setnikar I. Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis and Cartilage. 1994;2(1):61-69.

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.

Murad H, Tabibian MP. The effect of an oral supplement containing glucosamine, amino acids, minerals, and antioxidants on cutaneous aging: a preliminary study. Journal of Dermatology Treatment. 2001;12(1):47-51.

National Center for Complementary and Alternative Medicine. National Institutes of Health. Backgrounder. Questions and answers: NIH Glucosamine/chondroitin Arthritis Intervention Trial (GAIT). Updated August 2007. Available at: http://nccam.nih.gov/research/results/gait/D310_BKG.PDF. Accessed September 21, 2007.

Natural Medicines Comprehensive Database, Online Edition. Pharmacist's Letter/Prescriber's Letter. Stockton CA: Therapeutic Research Facility, 2006. Available at: http://www.pharmacistsletter.com/(Sulqz3s45omt3ag55um4kj345))/home.aspx?li=1&st=1&cs=&s=ND.

Nguyen P, Mohamed SE, Gardiner D, Salinas T. A randomized double-blind clinical trial of the effect of chondroitin sulfate and glucosamine hydrochloride on temporomandibular joint disorders: a pilot study. Cranio. 2001 Apr;19(2):130-139.

Nowlan C, Wetmore S. Short report: ibuprofen versus glucosamine sulfate. Treating osteoarthritis pain. Canadian Family Physician. 2003;49:1632-1634.

Nowak A, Szczesniak L, Rychlewski T, Dylewicz P, Przywarska I. Glucosamine levels in people with ischaemic [sic] heart disease with and without type II diabetes. Pol Arch Med Wewn. 1998;100(5):419-425.

Olszewski AJ, Szostak WB, McCully KS. Plasma glucosamine and galactosamine in ischemic heart disease. Atherosclerosis. 1990;82(1-20:75-83.

Pavelka K, Gatterova J, Olejarova M, Machacek S, Giacovelli G, Rovati LC. Glucosamine Sulfate Use and Delay of Progression of Knee Osteoarthritis: A 3-Year, Randomized, Placebo-Controlled, Double-blind Study. Archives of Internal Medicine. 2002;162(18):2113-2123.

Persiani S, Roda E, Rovati LC, Locatelli M, Giacovelli G, Roda A. Glucosamine oral bioavailability and plasma pharmacokinetics after increasing doses of crystalline glucosamine sulfate in man. Osteoarthritis and Cartilage. 2005;13(12):1041-1049.

Poolsup N, Suthisisang C, Channark P, Kittikulsuth W. Glucosamine long-term treatment and the progression of knee osteoarthritis: systematic review of randomized controlled trials. Annals of Pharmacotherapy. 2005;39(6):1080-1087.

Poustie MW, Carran J, McElerney K, Dixon SJ, Anastassiades TP, Bernier SM. N-butyryl glucosamine increases matrix gene expression by chondrocytes. Journal of Pharmacology and Experimental Therapeutics. July 7, 2004.

Priebe D, McDiarmid T, Mackler L, Tudiver F. Do glucosamine or chondroitin cause regeneration of cartilage in osteoarthritis? Journal of Family Practice. 2003;52(3):237-239.

Prototype monograph on glucosamine. Institute of Medicine and National Research Council of the National Academies. 2004. Available at: http://www.iom.edu/Object.File/Master/19/560/Introduction and Glucosamine Prototype Monograph.v2.pdf. Accessed: September 7, 2007.

Qiu GX, Gao SN, Giacovelli G, Rovati L, Setnikar I. Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee osteoarthritis. Arzneimittelforschung. 1998;48(5):469-474.

Qiu W, Avramoglu-Kohen R, Rutledge AC, Tsai J, Adeli K. Mechanisms of glucosamine-induced suppression of hepatic assembly and secretion of apolipoprotein B100-containing lipoproteins. Journal of Lipid Research. 2006;47(8):1749-1761.

Reginster JY, Bruyere O, Lecart MP, Henrotin Y. Naturocetic (glucosamine and chondroitin sulfate) compounds as structure-modifying drugs in the treatment of osteoarthritis. Current Opinion in Rheumatology. 2003;15(5):651-655.

Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate [sic] on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet. 2001;357(9252):251-256.

Reginster JY, Bruyere O, Neuprez A. Current role of glucosamine in the treatment of osteoarthritis. Rheumatology (Oxford). 2007;46(5):731-735.

Richy F, Bruyere O, Ethgen O, Cucherat M, Henrotin Y, Reginster JY. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Archives of Internal Medicine. 2003;163(13):1514-1522.

Rozenfeld V, Crain JL, Callahan AK. Possible augmentation of warfarin effect by glucosamine-chondroitin. American Journal of Health-System Pharmacists. 2004;61(3):306-307.

Russell AL. Glucosamine in osteoarthritis and gastrointestinal disorders: an exemplar of the need for a paradigm shift. Medical Hypotheses. 1998;51(4):347-349.

Samson DJ, Grant MD, Ratko TA, Bonnell CJ, Ziegler KM, Aronson N. Treatment of primary and secondary osteoarthritis of the knee. Evidence Report/Technology Assessment (Full Report). 2007;(157):1-157.

Sarzi-Puttini P, Cimmino MA, Scarpa R, et al. Osteoarthritis: an overview of the disease and its treatment strategies. Seminars in Arthritis and Rheumatism. 2005;35(1 Suppl 1):1-10.

Schwaitzberg SD, Chan MW, Cole DJ, et al. Comparison of poly-N-acetyl glucosamine with commercially available topical hemostats for achieving hemostasis in coagulopathic models of splenic hemorrhage. Journal of Trauma. 2004;57(1 Suppl):S29-S32.

Scott GN. Glucosamine-chondroitin interaction with warfarin. Pharmacist's Letter/Prescriber's Letter Detail Document #200305. March 2004.

Scroggie DA, Albright A, Harris MD. The effect of glucosamine-chondroitin supplementation on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial. Archives of Internal Medicine. 2003;163(13):1587-1590.

Setnikar I, Palumbo R, Canali S, Zanolo G. Pharmacokinetics of glucosamine in man. Arzneimittelforschung 1993;43(10):1109-1113.

Shankar RR, Zhu JS, Baron AD. Glucosamine infusion in rats mimics the beta-cell dysfunction of non-insulin-dependent diabetes mellitus. Metabolism. 1998;47(5):573-577.

Shankland WE 2nd. The effects of glucosamine and chondroitin sulfate on osteoarthritis of the TMJ: a preliminary report of 50 patients. Cranio. 1998;16(4):230-135.

Shaunak S, Thomas S, Gianasi E, et al. Polyvalent dendrimer glucosamine conjugates prevent scar tissue formation. Nature Biotechnology. 2004;22(8):977-984.

Soeken KL. Selected CAM therapies for arthritis-related pain: the evidence from systematic reviews. Clinical Journal of Pain. 2004;20(1):13-18.

Stumpf JL, Lin SW. Effect of glucosamine on glucose control. Annals of Pharmacotherapy. 2006;40(4):694-698.

Tallia AF, Cardone DA. Asthma exacerbation associated with glucosamine-chondroitin supplement. Journal of the American Board of Family Practice. 2002;15(6):481-484.

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 and Cartilage. 2004;12(6):506-511.

Tannock LR, Kirk EA, King VL, LeBoeuf R, Wight TN, Chait A. Glucosamine supplementation accelerates early but not late atherosclerosis in LDL receptor-deficient mice. Journal of Nutrition. 2006;136(11):2856-2861.

Thie NM, Prasad NG, Major PW. Evaluation of glucosamine sulfate compared to ibuprofen for the treatment of temporomandibular joint osteoarthritis: a randomized double blind controlled 3 month clinical trial. Journal of Rheumatology. 2001;28(6):1347-1355.

Towheed TE, Anastassiades TP, Shea B, Houpt J, Welch V, Hochberg MC. Glucosamine therapy for treating osteoarthritis. Cochrane Database System Review. 2001;(1):CD002946.

Uitterlinden EJ, Jahr H, Koevoet JL, et al. Glucosamine decreases expression of anabolic and catabolic genes in human osteoarthritic cartilage explants. Osteoarthritis and Cartilage. 2006;14(3):250-257.

Varghese S, Theprungsirikul P, Sahani S, Hwang N, Yarema KJ, Elisseeff JH. Glucosamine modulates chondrocyte proliferation, matrix synthesis, and gene expression. Osteoarthritis and Cartilage. 2007;15(1):59-68.

Villacis J, Rice TR, Bucci LR, et al. Do shrimp-allergic individuals tolerate shrimp-derived glucosamine? Clinical and Experimental Allergy. 2006;36(11):1457-1461.

Vlad SC, LaValley MP, McAlindon TE, Felson DT. Glucosamine for pain in osteoarthritis: why do trial results differ? Arthritis and Rheumatism. 2007;56(7):2267-2277.

Vournakis JN, Demcheva M, Whitson AB, Finkielsztein S, Connolly RJ. The RDH bandage: hemostasis and survival in a lethal aortotomy hemorrhage model. Journal of Surgical Research. 2003;113(1):1-5.

Wallis MG, Smith ME, Kolka CM, et al. Acute glucosamine-induced insulin resistance in muscle in vivo is associated with impaired capillary recruitment. Diabetologia. 2005;48(10):2131-2139.

Wells L, Vosseller K, Hart GW. A role for N-acetylglucosamine as a nutrient sensor and mediator of insulin resistance. Cellular and Molecular Life Sciences. 2003;60(2):222-228.

Werstuck GH, Khan MI, Femia G, et al. Glucosamine-induced endoplasmic reticulum dysfunction is associated with accelerated atherosclerosis in a hyperglycemic mouse model. Diabetes. 2006;55(1):93-101.

Winslet MC, Poxon V, Allan A, Keighley MR. Mucosal glucosamine synthetase activity in inflammatory bowel disease. Digestive Disease Science. 1994;39(3):540-544.

Xing R, Liu S, Guo Z, et al. The antioxidant activity of glucosamine hydrochloride in vitro. Bioorganic Medicinal Chemistry. 2006;14(6):1706-1709.

Yang S, Zou LY, Bounelis P, Chaudry I, Chatham JC, Marchase RB. Glucosamine administration during resuscitation improves organ function after trauma hemorrhage. Shock. 2006;25(6):600-607.

Yun J, Tomida A, Nagata K, Tsuruo T. Glucose-regulated stresses confer resistance to VP-16 in human cancer cells through a decreased expression of DNA topoisomerase II. Oncology Research. 1995;7(12):583-590.

Zerkak D, Dougados M. The use of glucosamine therapy in osteoarthritis. Current Rheumatology Reports. 2004;6(1):41-45.

Zhang GX, Yu S, Gran B, Rostami A. Glucosamine abrogates the acute phase of experimental autoimmune encephalomyelitis by induction of Th2 response. Journal of Immunology. 2005;175(11):7202-7208.

Last Revised July 18, 2008

Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.

In general, herbal products are not subject to review or approval by the U.S. Food and Drug Administration (FDA). They are not required to be standardized, meaning that the amounts of active ingredients or contaminants they contain may vary between brands or between different batches of the same brand. Not all of the risks, side effects, or interactions associated with the use of herbal products are known because few reliable studies of their use in humans have been done.

This information is provided for your education only. Please share this information with your healthcare provider and be sure that you talk to your doctor and pharmacist about all the prescription and non-prescription medicines you take before you begin to use any herbal product.

Back