Chondroitin Sulfate

by MedlinePlus

Chondroitin was first extracted and purified in the 1960s. It is currently manufactured from natural sources (shark/beef cartilage or bovine trachea) or by synthetic means. The consensus of expert and industry opinions support the use of chondroitin and its common partner agent, glucosamine, for improving symptoms and arresting (or possibly reversing) the degenerative process of osteoarthritis.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidence

Osteoarthritis

Multiple controlled clinical trials since the 1980s have examined the use of oral chondroitin in patients with osteoarthritis of the knee and other locations (spine, hips, finger joints). Most of these studies have reported significant benefits in terms of symptoms (such as pain), function (such as mobility), and reduced medication requirements (such as anti-inflammatories). However, most studies have been brief (6 months duration) with methodological weaknesses: a wide variety of patient classifications and outcome variables have been used resulting in heterogeneity between trials; most analyses are not on an intention-to-treat basis; relationships between investigators and manufacturers are often not clarified; and blinding and randomization are frequently not well described. Despite these weaknesses and potential for bias in the available results, the weight of scientific evidence points to a beneficial effect when chondroitin is used for 6-24 months. Longer term effects are not clear. Preliminary studies of topical chondroitin have also been conducted.Chondroitin is frequently used with glucosamine. Glucosamine has independently been demonstrated to benefit patients with osteoarthritis (particularly of the knee). It remains unclear if there is added benefit of using these two agents together compared to using either alone.

Ophthalmologic uses

Chondroitin is sometimes used as a component of eye solutions used for keratoconjunctivitis, corneal preservation and intraocular pressure. These solutions should only be used under the supervision of an ophthalmologist.

Coronary artery disease (secondary prevention)

Several studies in the early 1970s assessed the use of oral chondroitin for the prevention of subsequent coronary events in patients with a history of heart disease or myocardial infarction. Although favorable results were reported, due to methodological weaknesses in this research and the widespread current availability of more proven drug therapies for patients in this setting, a recommendation cannot be made in this area.

Interstitial cystitis

There is preliminary research administering intravesicular chondroitin in patient diagnosed with interstitial cystitis. Additional evidence is necessary before a firm conclusion can be drawn.

Psoriasis

Early study suggests that chondroitin may help treat psoriasis. Well-designed clinical trials are needed to confirm these results.

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Angina, anti-inflammatory, anti-thrombotic, breast cancer, chronic venous ulcers, deep intra-osseous defects, dry eye syndrome, gonarthrosis, hyperlipidemia, iron deficiency anemia, kidney stones, leukemia, malaria, myocardial infarction, osteoporosis, premature labor prevention.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Standardization:

Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients.

Adult (18 years and older):

Oral:

Monotherapy: Doses of 200-400mg twice to three times daily, or 800-1200mg once daily have been used in studies. Higher doses (up to 2000mg) appear to have similar efficacy. In the treatment of osteoarthritis, full effects may take several weeks to occur.

Combination with glucosamine: It is not clear what dose is optimal when used in combination with glucosamine or whether the combination is as effective as or more effective than either agent alone.

Intravenous/Intramuscular:

For osteoarthritis, 50-100mg as a single daily injection or divided into two daily injections has been used. Medical supervision is recommended.

Children (younger than 18 years):

Insufficient evidence.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies:

Use cautiously if allergic or hypersensitive to chondroitin sulfate products. Hives, rash, sun skin sensitivity, and worsening of previously well-controlled asthma have been reported.

Side Effects and Warnings:

There is limited long-term safety data on chondroitin, although it appears to be well tolerated in most trials.

Adverse effects that have been rarely reported or are theoretical include: headache, motor uneasiness, euphoria, hives, rash, photosensitivity, hair loss, breathing difficulties, subjective tightness in the throat or chest, exacerbation of previously well-controlled asthma, chest pain, elevated blood pressure, lower extremity edema, gastrointestinal pain/dyspepsia, nausea, diarrhea, constipation, transaminitis, increased risk of bleeding (theoretical), bone marrow suppression (animal research), eyelid edema.

Use with caution in patients with bleeding disorders or taking anticoagulant medications. Avoid in pregnant or breastfeeding women.

Pregnancy and Breastfeeding:

Avoid in pregnant or breastfeeding women as effects are unknown, and there is structural similarity to heparin, which is contraindicated during pregnancy.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs:

In theory, chondroitin may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

Interactions with Herbs and Dietary Supplements:

In theory, chondroitin may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba , and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases. Some examples include: alfalfa, American ginseng, angelica, anise, Arnica montana , asafetida, aspen bark, bilberry, birch, black cohosh, bladderwrack, bogbean, boldo, borage seed oil, bromelain, capsicum, cat's claw, celery, chamomile, chaparral, clove, coleus, cordyceps, dandelion, danshen, devil's claw, dong quai, EPA (eicosapentaenoic acid, found in fish oils), evening primrose oil, fenugreek, feverfew, fish oil, flaxseed/flax powder (not a concern with flaxseed oil), ginger, grapefruit juice, grapeseed, green tea, guggul, gymnestra, horse chestnut, horseradish, licorice root, lovage root, male fern, meadowsweet, melatonin, nordihydroguairetic acid (NDGA), omega-3 fatty acids, onion, papain, panax ginseng, parsley, passionflower, poplar, prickly Ash, propolis, quassia, red clover, reishi, Siberian ginseng, sweet clover, rue, sweet birch, sweet clover, turmeric , vitamin E, white willow, wild carrot, wild lettuce, willow, wintergreen, and yucca. Based on preliminary data, chondroitin may increase iron absorption.

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