glucosamine

Oral glucosamine is a dietary supplement and is not a prescription drug in the United States. Glucosamine is marketed as a supplement to support the structure and function of joints, and the marketing is targeted to people with osteoarthritis.

Commonly sold forms of glucosamine are glucosamine sulfate, glucosamine chondroitin, glucosamine hydrochloride, and N-acetylglucosamine. Of the three commonly available forms of glucosamine, only glucosamine sulfate is given a "likely effective" rating for treating osteoarthritis. Glucosamine is often sold in combination with other supplements such as chondroitin sulfate and methylsulfonylmethane.{{citation needed|date=January 2020}}

Glucosamine, along with commonly used chondroitin, is not routinely prescribed to treat people who have symptomatic osteoarthritis of the knee, as there is insufficient evidence that this treatment is helpful.{{Citation |author1 = American Academy of Orthopaedic Surgeons |author1-link = American Academy of Orthopaedic Surgeons |date = February 2013 |title = Five Things Physicians and Patients Should Question |publisher = American Academy of Orthopaedic Surgeons |work = Choosing Wisely: an initiative of the ABIM Foundation |url = http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-orthopaedic-surgeons/ |access-date = 19 May 2013}}{{tlg|dead link|2=date={{CURRENTMONTHNAME}} {{CURRENTYEAR}}}}{{cite journal |vauthors=Zhu X, Sang L, Wu D, Rong J, Jiang L |title=Effectiveness and safety of glucosamine and chondroitin for the treatment of osteoarthritis: a meta-analysis of randomized controlled trials |journal=J Orthop Surg Res |volume=13 |issue=1 |pages=170 |date=July 2018 |pmid=29980200 |pmc=6035477 |doi=10.1186/s13018-018-0871-5 |doi-access=free }}

As is common with heavily promoted dietary supplements, the claimed benefits of glucosamine are based principally on clinical and laboratory studies. Clinical studies on glucosamine efficacy are divided, with some reporting relief from arthritic pain and stiffness, while others report no benefit above placebo.{{cite journal|pmid=15846645|year=2005|last1=Towheed|first1=T. E.|title=Glucosamine for osteoarthritis|journal=The Cochrane Database of Systematic Reviews|issue=2|pages=CD002946|last2=Maxwell|first2=L|last3=Anastassiades|first3=T. P.|last4=Shea|first4=B|last5=Houpt|first5=J|last6=Robinson|first6=V|last7=Hochberg|first7=M. C.|last8=Wells|first8=G|volume=2005 |doi=10.1002/14651858.CD002946.pub2|pmc=8459392}}{{cite journal |vauthors=DiNubile N |title=Glucosamine and Chondroitin Sulfate: What Has Been Learned Since the Glucosamine/chondroitin Arthritis Intervention Trial |journal=Orthopedics |volume=41 |issue=4 |pages=200–207 |date=July 2018 |pmid=29771395 |doi=10.3928/01477447-20180511-06 |s2cid=21707977 }}

{{As of|2015}}, there is no evidence that consumption of glucosamine by sport participants prevents or limits joint damage after injury.{{Cite journal

| pmid = 16766503

| year = 2006

| last1 = Hespel

| first1 = P

| title = Dietary supplements for football

| journal = Journal of Sports Sciences

| volume = 24

| issue = 7

| pages = 749–61

| last2 = Maughan

| first2 = R. J.

| last3 = Greenhaff

| first3 = P. L.

| doi = 10.1080/02640410500482974

| s2cid = 25125456

}}

Glucosamine with or without chondroitin elevates the international normalized ratio (INR) in individuals who are taking the blood thinner, warfarin.{{cite journal|title=Potential glucosamine-warfarin interaction resulting in increased international normalized ratio: case report and review of the literature and MedWatch database|journal=Pharmacotherapy|date=April 2008|pmid=18363538|doi=10.1592/phco.28.4.540|volume=28|issue=4|pages=540–8|last1=Knudsen|first1=J. F.|last2=Sokol|first2=G. H.|s2cid=207233252|url=https://zenodo.org/record/1236349|type=Submitted manuscript}} It may also interfere with the efficacy of chemotherapy for treating cancer symptoms.

Adverse effects are mild and infrequent and may include stomach upset, constipation, diarrhea, headache, and rash.{{cite web|title=Complementary and alternative medicines for the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia|publisher=Arthritis Research UK|pages=34–5

|url=http://www.arthritisresearchuk.org/~/media/Files/Arthritis-information/Additional-items/CAM%20Report.ashx?la=en

|archive-url=https://web.archive.org/web/20170218150419/http://www.arthritisresearchuk.org/~/media/Files/Arthritis-information/Additional-items/CAM%20Report.ashx?la=en |archive-date=2017-02-18

|date=October 2012|access-date=17 February 2017}}

Since glucosamine is usually derived from the shells of shellfish, it may be unsafe for those with shellfish allergy.{{cite journal |author1=Gray HC|author2=Hutcheson PS|author3=Slavin RG |title=Is glucosamine safe in patients with seafood allergy? |journal=The Journal of Allergy and Clinical Immunology |volume=114 |issue=2 |pages=459–60 |date=August 2004 |pmid=15341031 |doi= 10.1016/j.jaci.2004.05.050|doi-access=free }} Many manufacturers of glucosamine derived from shellfish include a warning that those with a seafood allergy should consult a healthcare professional before taking the product.{{cite web |url=http://dietarysupplements.nlm.nih.gov/dietary/detail.jsp?name=Kirkland+Signature+Extra+Strength+Glucosamine+with+MSM&contain=11001019&pageD=brand |archive-url=https://web.archive.org/web/20100304095044/http://dietarysupplements.nlm.nih.gov/dietary/detail.jsp?contain=11001019&name=Kirkland+Signature+Extra+Strength+Glucosamine+with+MSM&pageD=brand |archive-date=4 March 2010 |access-date=23 April 2015 |title=Kirkland Signature Extra Strength Glucosamine with MSM |date=3 February 2010 |work=Dietary Supplements Labels Database |publisher=U.S. National Library of Medicine}} Alternatively, non-shellfish-derived forms of glucosamine are available.{{cite web|url=http://www.nutraingredients-usa.com/Industry/Another-vegetarian-glucosamine-launched-in-US |title=Another vegetarian glucosamine launched in US |date=January 25, 2008|work=NutraIngredients-USA.com |archive-url=https://web.archive.org/web/20090417035225/http://www.nutraingredients-usa.com/Industry/Another-vegetarian-glucosamine-launched-in-US |archive-date=April 17, 2009 |url-status=dead }}

Another concern has been that the extra glucosamine could contribute to diabetes by interfering with the normal regulation of the hexosamine biosynthesis pathway, but several investigations found no evidence that this occurs.{{cite journal |author1=Scroggie DA|author2=Albright A|author3=Harris MD |title=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 |journal=Archives of Internal Medicine |volume=163 |issue=13 |pages=1587–90 |date=July 2003 |pmid=12860582 |doi=10.1001/archinte.163.13.1587|doi-access= }}{{cite journal |author1=Tannis AJ|author2=Barban J|author3=Conquer JA |title=Effect of glucosamine supplementation on fasting and non-fasting plasma glucose and serum insulin concentrations in healthy individuals |journal=Osteoarthritis and Cartilage |volume=12 |issue=6 |pages=506–11 |date=June 2004 |pmid=15135147 |doi=10.1016/j.joca.2004.03.001|doi-access=free }} Other studies conducted in lean or obese subjects concluded that oral glucosamine at standard doses does not affect insulin resistance.{{cite journal |author=Muniyappa R |title=Oral glucosamine for 6 weeks at standard doses does not cause or worsen insulin resistance or endothelial dysfunction in lean or obese subjects |journal=Diabetes |volume=55 |issue=11 |pages=3142–50 |date=November 2006 |pmid=17065354 |doi=10.2337/db06-0714 |author2=Karne RJ |author3=Hall G |display-authors=3 |last4=Crandon |first4=S. K. |last5=Bronstein |first5=J. A. |last6=Ver |first6=M. R. |last7=Hortin |first7=G. L. |last8=Quon |first8=M. J. |doi-access=free }}{{cite journal |author1=Biggee BA|author2=Blinn CM|author3=Nuite M|author4=Silbert JE|author5=McAlindon TE |title=Effects of oral glucosamine sulphate on serum glucose and insulin during an oral glucose tolerance test of subjects with osteoarthritis |journal=Annals of the Rheumatic Diseases |volume=66 |issue=2 |pages=260–2 |date=February 2007 |pmid=16818461 |pmc=1798503 |doi=10.1136/ard.2006.058222}}

Glucosamine is naturally present in the shells of shellfish, animal bones, bone marrow, and fungi.{{cite journal |title=Scientific Opinion of the Panel on Dietetic Products Nutrition and Allergies on a request from the European Commission on the safety of glucosamine hydrochloride from Aspergillus niger as food ingredient |journal=The EFSA Journal |volume=1099 |pages=1–19 |year=2009 |url=http://www.efsa.europa.eu/en/efsajournal/pub/1099}}

D-Glucosamine is made naturally in the form of glucosamine-6-phosphate, and is the biochemical precursor of all nitrogen-containing sugars.{{cite journal | author = Roseman S | title = Reflections on glycobiology | journal = J Biol Chem | year = 2001 | volume = 276 | issue = 45 | pages = 41527–42 | pmid = 11553646 | doi = 10.1074/jbc.R100053200 | doi-access = free }} Specifically in humans, glucosamine-6-phosphate is synthesized from fructose 6-phosphate and glutamine by glutamine—fructose-6-phosphate transaminase as the first step of the hexosamine biosynthesis pathway.{{cite web |url=http://www.chem.qmul.ac.uk/iubmb/enzyme/reaction/polysacc/UDPGlcN.html |publisher=International Union of Biochemistry and Molecular Biology |title=UDP-N-acetylglucosamine Biosynthesis |work=Recommendations of the Nomenclature Committee of the International Union of Biochemistry and Molecular Biology on the Nomenclature and Classification of Enzymes by the Reactions they Catalyse |year=2002 |access-date=2012-09-10 }} The end-product of this pathway is uridine diphosphate N-acetylglucosamine (UDP-GlcNAc), which is then used for making glycosaminoglycans, proteoglycans, and glycolipids.

As the formation of glucosamine-6-phosphate is the first step for the synthesis of these products, glucosamine may be important in regulating their production; however, the way that the hexosamine biosynthesis pathway is actually regulated, and whether this could be involved in contributing to human disease remains unclear.{{cite journal | author = Buse MG | title = Hexosamines, insulin resistance, and the complications of diabetes: current status | journal = Am. J. Physiol. Endocrinol. Metab. | year = 2006 | volume = 290 | issue = 1 | pages = E1–E8 | pmid = 16339923 | doi = 10.1152/ajpendo.00329.2005 | pmc = 1343508}}

Most glucosamine is manufactured by processing chitin from the shells of shellfish including shrimp, lobsters, and crabs.{{cite book|last1=Murray|first1=Michael T.|editor1-last=Pizzorno|editor1-first=Joseph E. Jr.|editor2-last=Murray|editor2-first=Michael T.|title=Textbook of natural medicine|date=2012|publisher=Churchill Livingstone|location=Edinburgh|isbn=9781437723335|page=790|edition=4th|chapter-url=https://books.google.com/books?id=6cjgo1IixvEC&pg=PA790|chapter=Chapter 94: Glucosamine}} To meet the demands of vegetarians and others with objections to shellfish, manufacturers have brought glucosamine products to market made using fungus Aspergillus niger and from fermenting corn.

Glucosamine was first prepared in 1876 by Georg Ledderhose by the hydrolysis of chitin with concentrated hydrochloric acid.{{cite journal|author=Georg Ledderhose |year=1876 |url=https://zenodo.org/record/1425112 |title=Über salzsaures Glycosamin |trans-title=On glucosamine hydrochloride |journal=Berichte der Deutschen Chemischen Gesellschaft |volume=9 |issue=2 |pages=1200–1201|doi=10.1002/cber.18760090251}}{{cite journal |author = Ledderhose G |author-link =Georg Ledderhose|year = 1879|journal = Zeitschrift für Physiologische Chemie |title = Über Chitin und seine Spaltungs-produkte |trans-title=On chitin and its hydrolysis products |volume = ii |pages = 213–227 }}{{cite journal |author = Ledderhose G |author-link = Georg Ledderhose|year = 1880 |journal = Zeitschrift für Physiologische Chemie|title = Über Glykosamin|volume = iv |pages = 139–159}} The stereochemistry was not fully determined until the 1939 work of Walter Haworth.{{cite book

|vauthors=Pigman WW, Horton D, Wander JD | title =The Carbohydrates

| volume =IB

| publisher =Academic Press

| year =1980

| location =New York

| pages =727–728

| isbn =9780125563512 }}{{cite journal|author1=W. N. Haworth|author2=W. H. G. Lake|author3=S. Peat |year=1939 |title=The configuration of glucosamine (chitosamine) |journal=Journal of the Chemical Society |pages=271–274|doi=10.1039/jr9390000271}}

In the United States, glucosamine is not approved by the Food and Drug Administration (FDA) for medical use in humans.{{cite web | url=https://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm073400.htm | title=Letter Regarding the Relationship Between the Consumption of Glucosamine and/or Chondroitin Sulfate and a Reduced Risk of: Osteoarthritis; Osteoarthritis-related Joint Pain, Joint Tenderness, and Joint Swelling; Joint Degeneration; and Cartilage Deterioration (Docket No. 2004P-0059) | last=Hubbard | first = W. K. | date=7 October 2004 | publisher=U.S. Food and Drug Administration (FDA) | access-date=14 May 2014 | quote=FDA concludes that there is no credible evidence to support qualified health claims for glucosamine or chondroitin sulfate and reduced risk of osteoarthritis (OA), joint degeneration (JD), or cartilage deterioration (CD). | archive-url=https://wayback.archive-it.org/7993/20171115122116/https://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm073400.htm | archive-date=15 November 2017 | url-status=dead }} Since glucosamine is classified as a dietary supplement in the United States, evidence of safety is required by FDA regulations, but evidence of efficacy is not required so long as it is not advertised as a treatment for a medical condition.{{cite web|url=http://www.cfsan.fda.gov/~dms/supplmnt.html |title=Dietary Supplements |publisher=U.S. Food and Drug Administration (FDA) |access-date=December 10, 2009 |archive-url=https://web.archive.org/web/20090512085828/http://www.cfsan.fda.gov/~dms/supplmnt.html | archive-date=2009-05-12 | url-status=dead}}

In 2004, the FDA declared there was insufficient evidence for supplement manufacturers to state that glucosamine was effective for treating arthritis, joint degeneration, or cartilage deterioration, a position remaining in effect as of 2018.{{cite web |title=Qualified Health Claims: Letters of Denial, Osteoarthritis |url=https://www.fda.gov/food/food-labeling-nutrition/qualified-health-claims-letters-denial |archive-url=https://web.archive.org/web/20190926103206/https://www.fda.gov/food/food-labeling-nutrition/qualified-health-claims-letters-denial |url-status=dead |archive-date=September 26, 2019 |publisher=U.S. Food and Drug Administration (FDA) |access-date=14 September 2019 |date=13 December 2018}}

In most of Europe, glucosamine is approved as a medical drug and is sold in the form of glucosamine sulfate. In this case, evidence of safety and efficacy is required for the medical use of glucosamine and several guidelines have recommended its use as an effective and safe therapy for osteoarthritis.

The Task Force of the European League Against Rheumatism (EULAR) committee has granted glucosamine sulfate a level of toxicity of 5 in a 0-100 scale,{{cite journal |vauthors=Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Leeb B, Lequesne M, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Serni U, Swoboda B, Verbruggen G, Zimmerman-Gorska I, Dougados M, ((Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT)) | display-authors=3 |title=EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT) |journal=Ann. Rheum. Dis. |volume=62 |issue=12 |pages=1145–55 |date=December 2003 |pmid=14644851 |pmc=1754382 |doi= 10.1136/ard.2003.011742 }} and recent OARSI (Osteoarthritis Research Society International) guidelines for hip and knee osteoarthritis indicate an acceptable safety profile.{{cite journal |vauthors=Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P | display-authors=3 |title=OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence |journal=Osteoarthr. Cartil. |volume=15 |issue=9 |pages=981–1000 |date=September 2007 |pmid=17719803 |doi=10.1016/j.joca.2007.06.014 |doi-access=free }} By 2014, the OARSI did not recommend glucosamine for disease modification, and considered it "uncertain" for symptom relief, in knee osteoarthritis.{{cite journal|journal=Osteoarthritis and Cartilage|date=March 2014 |volume=22 |issue=3 |pages=363–88 |title=OARSI guidelines for the non-surgical management of knee osteoarthritis |vauthors=McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H, Kwoh K, Lohmander S, Rannou F, Roos EM, Underwood M | display-authors=3 |pmid=24462672 |doi=10.1016/j.joca.2014.01.003 |doi-access=free}}

In 2013, without admitting fault, manufacturer Rexall Sundown and NBTY agreed to pay up to {{US$|2 million}} to settle consumer claims related to the wording of certain claims on the packaging of glucosamine bottles sold at Costco under the Kirkland label.{{cite web|url= http://glucosaminesettlement.com/ |title=Glucosamine Settlement |publisher=www.glucosaminesettlement.com |access-date=June 17, 2013 |archive-url=https://web.archive.org/web/20130710215836/http://glucosaminesettlement.com/ | archive-date=2013-07-10 | url-status=dead}}

In August 2012, a class-action lawsuit was filed in New York claiming that 21st Century Healthcare, Inc. had falsely advertised that its "Glucosamine 750 Chondroitin 600 Triple Strength" dietary supplements would restore lost cartilage.{{cite web|url=http://www.topclassactions.com/lawsuit-settlements/lawsuit-news/2452-21st-century-glucosaminechondroitin-triple-strength-class-action-lawsuit |title=21st Century Glucosamine/Chondroitin Triple Strength Class Action Lawsuit |publisher=www.topclassactions.com |access-date=June 17, 2013|date=2012-09-14 }} In April 2013, a San Diego man launched a proposed class-action lawsuit in California Federal Court accusing Nutramax Laboratories, Walmart and Rite Aid of falsely advertising the effectiveness of glucosamine.{{cite web|url=http://www.law360.com/articles/432329/wal-mart-rite-aid-face-suit-over-glucosamine-promises |title=Wal-Mart, Rite Aid Face Suit Over Glucosamine Promises|publisher=www.law360.com |access-date=June 17, 2013}}

{{main|Clinical trials on glucosamine and chondroitin}}

Because glucosamine is a precursor for glycosaminoglycans, and glycosaminoglycans are a major component of cartilage, research has focused on the potential for supplemental glucosamine to improve cartilage structure and alleviate arthritis, but there is little evidence from clinical trials that it is effective for alleviating arthritis pain.{{Failed verification|date=September 2021}}

Two studies measured the concentrations of glucosamine in the synovial fluid and plasma after oral administration of glucosamine sulfate to both healthy volunteers and people with osteoarthritis.{{cite journal |author=Persiani S |title=Synovial and plasma glucosamine concentrations in osteoarthritic patients following oral crystalline glucosamine sulphate at therapeutic dose |journal=Osteoarthritis and Cartilage |volume=15 |issue=7 |pages=764–72 |date=July 2007 |pmid=17353133 |doi=10.1016/j.joca.2007.01.019 |author2=Rotini R |author3=Trisolino G |display-authors=3 |last4=Rovati |first4=L.C. |last5=Locatelli |first5=M. |last6=Paganini |first6=D. |last7=Antonioli |first7=D. |last8=Roda |first8=A.|doi-access=free }}{{cite journal |author1=Persiani S|author2=Roda E|author3=Rovati LC|author4=Locatelli M|author5=Giacovelli G|author6=Roda A |title=Glucosamine oral bioavailability and plasma pharmacokinetics after increasing doses of crystalline glucosamine sulfate in man |journal=Osteoarthritis and Cartilage |volume=13 |issue=12 |pages=1041–9 |date=December 2005 |pmid=16168682 |doi=10.1016/j.joca.2005.07.009|doi-access=free }}

In the first study, glucosamine sulfate was given to healthy volunteers in doses of 750, 1,500, or 3,000 mg once daily. In the second study, oral glucosamine sulfate capsules (1,500 mg) were given daily for two weeks to 12 people with osteoarthritis. Glucosamine concentrations in plasma and synovial fluid increased significantly from baseline levels, and the levels in the two fluids were highly correlated. The authors interpreted that these levels could be biologically advantageous to articular cartilage, but the levels are still ten to one hundred times lower than required to positively influence the cartilage (chondrocytes) to build new tissue.{{Cite journal

| pmid = 15529373

| year = 2004

| vauthors = Mroz PJ, Silbert JE

| title = Use of 3H-glucosamine and 35S-sulfate with cultured human chondrocytes to determine the effect of glucosamine concentration on formation of chondroitin sulfate

| journal = Arthritis Rheum.

| volume = 50

| issue = 11

| pages = 3574–9

| doi = 10.1002/art.20609

| doi-access =

}} Glucosamine sulfate uptake in synovial fluid may be as much as 20%, or it could be negligible, indicating no biological significance.{{cite book |vauthors=Cohen MJ, Braun L |title=Herbs & natural supplements: an evidence-based guide |publisher=Elsevier Australia |location=Marrickville, New South Wales |year=2007 |isbn=978-0-7295-3796-4 }}

{{expand section|date=December 2013}}

Some studies have shown efficacy of glucosamine supplementation for dogs with osteoarthritis pain, particularly in combination with other nutraceuticals like chondroitin,{{Cite journal

| pmid = 21623931

| year = 2012

| last1 = Gupta

| first1 = R. C.

| title = Comparative therapeutic efficacy and safety of type-II collagen (UC-II), glucosamine and chondroitin in arthritic dogs: Pain evaluation by ground force plate

| journal = Journal of Animal Physiology and Animal Nutrition

| volume = 96

| issue = 5

| pages = 770–7

| last2 = Canerdy | first2 = T. D.

| last3 = Lindley | first3 = J

| last4 = Konemann | first4 = M

| last5 = Minniear | first5 = J

| last6 = Carroll | first6 = B. A.

| last7 = Hendrick | first7 = C

| last8 = Goad | first8 = J. T.

| last9 = Rohde | first9 = K

| last10 = Doss | first10 = R

| last11 = Bagchi | first11 = M

| last12 = Bagchi | first12 = D

| doi = 10.1111/j.1439-0396.2011.01166.x

}}{{Cite journal

| pmid = 20020968

| year = 2007

| last1 = d'Altilio

| first1 = M

| title = Therapeutic Efficacy and Safety of Undenatured Type II Collagen Singly or in Combination with Glucosamine and Chondroitin in Arthritic Dogs

| journal = Toxicology Mechanisms and Methods

| volume = 17

| issue = 4

| pages = 189–96

| last2 = Peal | first2 = A

| last3 = Alvey | first3 = M

| last4 = Simms | first4 = C

| last5 = Curtsinger | first5 = A

| last6 = Gupta | first6 = R. C.

| last7 = Canerdy | first7 = T. D.

| last8 = Goad | first8 = J. T.

| last9 = Bagchi | first9 = M

| last10 = Bagchi | first10 = D

| doi = 10.1080/15376510600910469

| s2cid = 36796044

}} while others have not.{{Cite journal

| pmid = 12665145

| year = 2003

| last1 = Moreau

| first1 = M

| title = Clinical evaluation of a nutraceutical, carprofen and meloxicam for the treatment of dogs with osteoarthritis

| journal = The Veterinary Record

| volume = 152

| issue = 11

| pages = 323–9

| last2 = Dupuis

| first2 = J

| last3 = Bonneau

| first3 = N. H.

| last4 = Desnoyers

| first4 = M

| doi=10.1136/vr.152.11.323

| s2cid = 40196882

}} A trial of oral combination capsules (glucosamine, chondroitin, and manganese ascorbate) in dogs with osteoarthritis found no benefit on either gait analysis or subjective assessments by the veterinarian or owner.

The use of glucosamine in equine medicine exists, but one meta-analysis judged extant research too flawed to be of value in guiding treatment of horses.{{cite journal|pmid=19927591|year=2009|last1=Pearson|first1=W|last2=Lindinger|first2=M|title=Low quality of evidence for glucosamine-based nutraceuticals in equine joint disease: Review of in vivo studies|volume=41|issue=7|pages=706–12|journal=Equine Veterinary Journal |doi=10.2746/042516409X424153}}

A number of studies have measured the bioavailability of glucosamine after oral administration to horses. When given as a single oral dose (9 g) with or without chondroitin sulfate (3 g) to ten horses, glucosamine (hydrochloride) was detected in the blood with a maximum level of {{val|10.6|6.9|u=μg/mL}} at two hours after dosing.{{Cite journal

| pmid = 15083499

| year = 2004

| last1 = Du

| first1 = J

| title = The bioavailability and pharmacokinetics of glucosamine hydrochloride and chondroitin sulfate after oral and intravenous single dose administration in the horse

| journal = Biopharmaceutics & Drug Disposition

| volume = 25

| issue = 3

| pages = 109–16

| last2 = White

| first2 = N

| last3 = Eddington

| first3 = N. D.

| doi = 10.1002/bdd.392

| s2cid = 39668131

| doi-access = free

}} Another study examined both the serum and the joint synovial fluid after nasogastric (oral) or intravenous administration of 20 mg/kg glucosamine hydrochloride to eight adult horses.{{Cite journal

| pmid = 15641100

| year = 2005

| last1 = Laverty

| first1 = S

| title = Synovial fluid levels and serum pharmacokinetics in a large animal model following treatment with oral glucosamine at clinically relevant doses

| journal = Arthritis and Rheumatism

| volume = 52

| issue = 1

| pages = 181–91

| last2 = Sandy

| first2 = J. D.

| last3 = Celeste

| first3 = C

| last4 = Vachon

| first4 = P

| last5 = Marier

| first5 = J. F.

| last6 = Plaas

| first6 = A. H.

| doi = 10.1002/art.20762

| doi-access =

}} Although joint fluid concentrations of glucosamine reached 9–15 μmol/L following intravenous dosing, it was only 0.3–0.7 μmol/L with nasogastric dosing. The authors calculated that these glucosamine synovial fluid levels achieved by the oral route were 500 times lower than that required to have a positive effect on the metabolism of cartilage cells. A follow-up study by the same research group compared glucosamine sulfate with glucosamine hydrochloride at the same dose (20 mg/kg) in eight horses and found a higher fluid concentration with the sulfate preparation (158 ng/mL compared to 89 ng/mL one hour post oral dose).{{Cite journal

| pmid = 18295513

| year = 2008

| last1 = Meulyzer

| first1 = M

| title = Comparison of pharmacokinetics of glucosamine and synovial fluid levels following administration of glucosamine sulphate or glucosamine hydrochloride

| journal = Osteoarthritis and Cartilage

| volume = 16

| issue = 9

| pages = 973–9

| last2 = Vachon

| first2 = P

| last3 = Beaudry

| first3 = F

| last4 = Vinardell

| first4 = T

| last5 = Richard

| first5 = H

| last6 = Beauchamp

| first6 = G

| last7 = Laverty

| first7 = S

| doi = 10.1016/j.joca.2008.01.006

| doi-access = free

}} They concluded that these higher synovial fluid levels obtained with the sulfate derivative were still too low to have a relevant biological effect on articular cartilage.

A three-month trial of an oral dosage regime of a commercial preparation of glucosamine sulfate, chondroitin sulfate and methylsulfonylmethane was performed in veteran horses with no effect on gait stiffness, with exercise alone in the control group being effective.{{Cite journal

| pmid = 24011144

| year = 2013

| last1 = Higler

| first1 = M. H.

| title = The effects of three-month oral supplementation with a nutraceutical and exercise on the locomotor pattern of aged horses

| journal = Equine Veterinary Journal

| last2 = Brommer | first2 = H

| last3 = l'Ami | first3 = J. J.

| last4 = De Grauw | first4 = J. C.

| last5 = Nielen | first5 = M

| last6 = Van Weeren | first6 = P. R.

| last7 = Laverty | first7 = S

| last8 = Barneveld | first8 = A

| last9 = Back | first9 = W

| doi = 10.1111/evj.12182

| volume=46

| issue = 5

| pages=611–7

}} The intravenous use of a combination of N-acetylglucosamine, pentosan polysulfate and sodium hyaluronate in horses with surgically-induced osteoarthritis saw improvements in X-ray changes to the cartilage but not histologically or in biochemical outcomes,{{Cite journal

| pmid = 24819506

| year = 2014

| last1 = Koenig

| first1 = T. J.

| title = Treatment of Experimentally Induced Osteoarthritis in Horses Using an Intravenous Combination of Sodium Pentosan Polysulfate, N-Acetyl Glucosamine, and Sodium Hyaluronan

| journal = Veterinary Surgery

| pages = 612–22

| last2 = Dart | first2 = A. J.

| last3 = McIlwraith | first3 = C. W.

| last4 = Horadagoda | first4 = N

| last5 = Bell | first5 = R. J.

| last6 = Perkins | first6 = N

| last7 = Dart | first7 = C

| last8 = Krockenberger | first8 = M

| last9 = Jeffcott | first9 = L. B.

| last10 = Little | first10 = C. B.

| doi = 10.1111/j.1532-950X.2014.12203.x

| volume=43

| issue=5

}} suggesting more evidence is needed for this combination and route of administration.

• Chitobiose

{{Reflist|colwidth=30em}}

• [https://www.arthritis.org/health-wellness/treatment/complementary-therapies/supplements-and-vitamins/glucosamine-chondroitin-osteoarthritis-pain Glucosamine and Chondroitin for Osteoarthritis Pain, Arthritis Foundation]
• [https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=Glucosamine&searchdb=all&labeltype=all&pagesize=200&audience=professional&page=1&sortby=packager Glucosamine], DailyMed, U.S. National Library of Medicine
• {{drugs.com|npp|glucosamine}}

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