Common dilemmas in kids

2015

Clinical

Your questions about complementary medicines answered: glucosamine

Volume 44, No.6, 2015 Pages 376-377

Sanne Kreijkamp-Kaspers

Treasure McGuire

Suzanne Bedford

Peter Loadsman

Marie Pirotta

Geraldine Moses

Mieke van Driel

This is the second article in a series providing evidence-based answers to common questions about complementary medicines from consumers and healthcare professionals.

What is glucosamine?

Glucosamine is an amino acid and precursor in the biochemical synthesis of glycosaminoglycans, which are structural components of cartilage. It is widely used to improve joint/bone health and osteoarthritis, although the evidence for its benefit is still limited.1

Sales of glucosamine supplements had reached a volume of over US$2 billion worldwide in 2009.2 In a recent Australian health study, 17% of Australians over the age of 50 years reported using glucosamine in the previous 24 hours.3

Who asks about glucosamine?

Glucosamine was, by far, the most frequently mentioned complementary medicine in this study, involving 1670 consumers’ queries (16.2% of all complementary medicine questions) and 620 healthcare professionals queries (11.5%).4

The average age of glucosamine callers was 63 years; 77% of callers were women and most consumer questions focused on adverse drug reactions (ADRs, 16%), efficacy (28%) and interactions (30%). Similarly, health professionals were also often concerned about interactions (43%), ADRs (22%) and efficacy (9.4%).

Common consumer questions

Is glucosamine safe to take while on blood pressure medication?

Glucosamine seems to be safe for people on blood pressure medication. In clinical studies, blood pressure was the same in participants taking glucosamine and placebo.5,6 However, some people taking glucosamine have been reported to have increased blood pressure.7 Therefore, it might be worthwhile to monitor blood pressure after starting glucosamine.

Is it safe to use fish oil and glucosamine together?

Yes, fish oil and glucosamine can be safely used together. If used for osteoarthritis, the combination of fish oil and glucosamine might be more effective than using glucosamine alone.8,9 However, both agents may have anticoagulant effects.10 Therefore, it is recommended to look out for unusual bleeding and, if this occurs, consider reducing the dose of one or both agents.

Common healthcare professional question

Can a patient with diabetes mellitus use glucosamine?

Yes, a patient with diabetes can use glucosamine. Although elevated blood sugar levels have been reported,11 available literature suggests that people with diabetes mellitus can safely use glucosamine.12–16 A recent meta-analysis report states: ‘…based on available evidence, we conclude that glucosamine has no effect on fasting blood glucose levels, glucose metabolism or insulin sensitivity at any oral dose level in healthy subjects, individuals with diabetes or those with impaired glucose tolerance.’13

Is it safe to use glucosamine when there is an allergy to shellfish?

It is not safe to use glucosamine when there is a history of anaphylactic reaction to seafood or shellfish. If the patient experiences an anaphylactic reaction after eating seafood or shellfish, it is recommended that glucosamine be avoided, as most glucosamine products are derived from shellfish. However, people with mild allergies only may be able to take glucosamine safely as shellfish allergies are usually a reaction to the flesh of seafood and glucosamine is made from the shells. Indeed, two studies showed no allergic reactions to glucosamine in people with confirmed shellfish allergies.17,18

Competing interests: The authors received an Integrative Medicine grant from the RACGP.
Provenance and peer review: Commissioned, externally peer reviewed.

References

  1. Wandel S, Juni 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.
  2. Heller L. US glucosamine grows slow, lags global sales. Available at www.nutraingredients-usa.com/Markets/US-glucosamine-grows-slow-lags-global-sales [Accessed 5 March 2014].
  3. Morgan TK, Williamson M, Pirotta M, Stewart K, Myers SP, Barnes J. A national census of medicines use: A 24-hour snapshot of australians aged 50 years and older. Med J Aust 2012;196:50–53.
  4. Kreijkamp-Kaspers S, McGuire T, Bedford S, et al. Your questions about complementary medicines answered. Aust Fam Physician 2015;44:373–74.
  5. Rozendaal RM, Koes BW, van Osch GJ, et al. Effect of glucosamine sulfate on hip osteoarthritis: A randomized trial. Ann Intern Med 2008;148:268–77.
  6. 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;55:3142–50.
  7. Danao-Camara T. Potential side effects of treatment with glucosamine and chondroitin. Arthritis Rheum 2000;43:2853.
  8. 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;26:858–71.
  9. Jerosch J. Effects of glucosamine and chondroitin sulfate on cartilage metabolism in oa: Outlook on other nutrient partners especially omega-3 fatty acids. Int J Rheumatol 2011;2011:969012.
  10. Natural Standard Professional Database. Available at: www.naturaldatabase.com [Accessed 19 September 2013].
  11. Adams ME. Hype about glucosamine. Lancet 1999;354:353–54.
  12. 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;43:187–201.
  13. 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;27:14–27.
  14. Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: A randomised, placebo-controlled clinical trial. Lancet 2001;357:251–56.
  15. Rovati LC, Annefeld M, Giacovelli G, Schmid K, Setnikar I. Glucosamine in osteoarthritis. Lancet 1999;354:1640; author reply 1641–42.
  16. Russell AI, McCarty MF. Glucosamine in osteoarthritis. Lancet 1999;354:1641; author reply 1641–42.
  17. Villacis J, Rice TR, Bucci LR, et al. Do shrimp-allergic individuals tolerate shrimp-derived glucosamine? Clin Exp Allergy 2006;36:1457–61.
  18. Gray HC, Hutcheson PS, Slavin RG. Is glucosamine safe in patients with seafood allergy? J Allergy Clin Immunol 2004;114:459–60.

Correspondence afp@racgp.org.au

03 June 2015 12:43

Re: Your questions about complementary medicines answered: glucosamine

Oliver Frank

GP

Oakden Medical Centre

One of the questions that I am asked fairly often by patients in relation to glucosamine is whether it would be better to buy it in any of the available combinations with chondroitin or other substances. Do the authors have any advice about this?

Yes     No

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Type

Clinical

2015