Glucosamine : Interactions

by MedlinePlus

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In theory glucosamine may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

In several human cases, abnormal increased amounts of protein were found in the urine of patients receiving glucosamine/chondroitin products. The clinical meaning of this is unclear. Glucosamine is removed from the body mainly in the urine, and elimination of glucosamine from the body is delayed in people with reduced kidney function. Increased blood levels of creatine phosphokinase may occur with glucosamine/chondroitin, which may be due to impurities in some products. This may alter certain laboratory tests measured by healthcare providers.

There are reported cases suggesting a link between glucosamine/chondroitin products and asthma exacerbations. Until more reliable data exists, patients with a history of asthma should not use glucosamine supplements except under the strict supervision of a physician.

Preliminary data suggest that glucosamine may modulate the immune system, although the clinical relevance of this is not clear.

Pregnancy and Breastfeeding

Glucosamine is not recommended during pregnancy or breastfeeding due to lack of scientific evidence.

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, glucosamine may decrease the effectiveness of insulin or other drugs used to control blood sugar levels. However, there is limited human research to suggest that glucosamine may not have significant effects on blood sugar. Nonetheless, caution is advised when using insulin or drugs for diabetes by mouth. Patients should be monitored closely by a qualified healthcare provider, and medication adjustments may be necessary. Based on limited evidence, the combination of glucosamine with diuretics (water pills) such as furosemide (Lasix®) may cause an increased risk of glucosamine side effects.

In theory glucosamine 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®).

Laboratory studies report that glucosamine may affect recombinant erythropoietin, although the clinical relevance of this is not clear.

Interactions with Herbs and Dietary Supplements

In theory, glucosamine may decrease the effectiveness of herbs or supplements that lower blood sugar levels. Caution is advised when using herbs or supplements that may alter blood sugar. Possible examples include: Aloe vera , American ginseng, bilberry, bitter melon, burdock,fenugreek, fish oil, gymnema, horse chestnut seed extract (HCSE), marshmallow, milk thistle, Panax ginseng, rosemary, Siberian ginseng, stinging nettle and white horehound. Agents that may raise blood sugar levels include: arginine, cocoa, and ephedra (when combined with caffeine).

Based on limited human study, side effects of glucosamine may be increased when used at the same time as diuretics herbs or supplements such as artichoke, celery, corn silk, couchgrass, dandelion, elder flower, horsetail, juniper berry, kava, shepherd's purse, uva ursi, and yarrow. Evidence is preliminary in this area.

In theory, glucosamine 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.

There are preliminary reports that use of glucosamine with vitamin C, bromelain, chondroitin sulfate, or manganese may lead to increased beneficial glucosamine effects on osteoarthritis. Simultaneous use with fish oil may have additive beneficial effects in the treatment of psoriasis, based on preliminary research.

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