Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews

Overview

Chondroitin sulfate is a chemical found in human and animal cartilage. It is commonly used by mouth with glucosamine or other ingredients for osteoarthritis.

Chondroitin sulfate is one of the building blocks of cartilage. In osteoarthritis, the cartilage in the joints breaks down. Taking chondroitin sulfate might slow this breakdown. It is usually manufactured from animal sources, such as shark and cow cartilage. It can also be made in a lab.

Chondroitin sulfate is used for osteoarthritis and cataracts. It is often used together with other ingredients, including manganese ascorbate, hyaluronic acid, collagen peptides, or glucosamine. Chondroitin sulfate is also used for many other conditions, but there is no good scientific evidence to support these uses.

Uses & Effectiveness ?

Possibly Effective for

• Cataracts. An injectable solution containing chondroitin sulfate and sodium hyaluronate is approved by the FDA to protect the eye during cataract surgery. It is not clear if using it in a different form will help.
• Osteoarthritis. Taking chondroitin sulfate by mouth seems to provide some relief from osteoarthritis pain and improve function. High quality, pharmaceutical-grade products have shown the most benefit. Chondrosulf (IBSA Institut Biochimique SA), Chondrosan (Bioiberica, S.A.) and Structum (Laboratoires Pierre Fabre) are examples of these products.

There is interest in using chondroitin sulfate for a number of other purposes, but there isn’t enough reliable information to say whether it might be helpful.

Side Effects

When taken by mouth: Chondroitin sulfate is likely safe when used for up to 6 years. It can cause some mild stomach pain and nausea. Other possible side effects include bloating, diarrhea, and constipation.

When placed into the eye: Chondroitin sulfate is possibly safe when used together with other ingredients in an eye drop.

Special Precautions and Warnings

Pregnancy and breast-feeding: There isn’t enough reliable information to know if chondroitin sulfate is safe to use when pregnant or breast-feeding. Stay on the safe side and avoid use.

Asthma: There is some concern that chondroitin sulfate might make asthma worse. If you have asthma, use chondroitin sulfate cautiously.

Prostate cancer: Early research suggests that chondroitin might cause the spread or recurrence of prostate cancer. This effect has not been shown with chondroitin sulfate supplements. However, until more is known, do not take chondroitin sulfate if you have prostate cancer or are at high risk for developing it (you have a brother or father with prostate cancer).

Interactions ?

Moderate Interaction

Be cautious with this combination

• Warfarin is used to slow blood clotting. There are several reports showing that taking chondroitin with glucosamine increases the effects of warfarin. This can cause bruising and bleeding that can be serious. Don’t take chondroitin if you are taking warfarin.

Dosing

Chondroitin sulfate is most commonly used by adults in doses of 800-1200 mg per day, for up to 2 years.

There is concern that some chondroitin sulfate products are not labeled accurately. Some products might contain no chondroitin, while other products might contain more than the amount stated on the product’s label. Because of these issues, the effects of different chondroitin products may vary. Speak with a healthcare provider to find out what dose or product might be best.

View References

CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

This copyrighted material is provided by Natural Medicines Comprehensive Database Consumer Version. Information from this source is evidence-based and objective, and without commercial influence. For professional medical information on natural medicines, see Natural Medicines Comprehensive Database Professional Version. © Therapeutic Research Faculty 2018.

Chondroitin Information | Mount Sinai

Chondroitin is a molecule that occurs naturally in the body. It is a major component of cartilage, the tough, connective tissue that cushions the joints. Commercial chondroitin comes from natural sources, such as shark and bovine cartilage, or synthetic production. Chondroitin helps keep cartilage healthy by absorbing fluid (particularly water) into the connective tissue. It may also block enzymes that break down cartilage, and it provides the building blocks for the body to produce new cartilage.

A number of scientific studies suggest that chondroitin may be an effective treatment for osteoarthritis (OA). OA is a type of arthritis characterized by the breakdown and eventual loss of cartilage, either due to injury or to normal wear and tear. It commonly occurs as people age. In some studies, chondroitin supplements have decreased the pain of OA. Not all studies are positive, though, and several have not shown any beneficial effect from taking chondroitin. It is not clear why the studies have different findings, and experts disagree on whether chondroitin is helpful in treating OA.

In the past, some researchers thought chondroitin may actually slow progression of the disease, unlike other current medical treatments for OA. (Many people take either acetaminophen or nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen, for OA pain). So far studies have not shown conclusively that chondroitin helps repair or grow new cartilage, or stops cartilage from being further damaged. Chondroitin is often taken with glucosamine, another supplement that has been studied along with chondroitin for OA. Like chondroitin, glucosamine also has conflicting results.

Therapeutic Uses

Treatment

Osteoarthritis

Results from several well-designed scientific studies suggest that chondroitin supplements may be an effective treatment for OA, particularly OA of the knee or hip, though one recent review of several studies found no benefit from use of chondroitin alone. In general, findings from these studies suggest that chondroitin:

• Reduces OA pain
• Improves functional status of people with hip or knee OA
• Reduces joint swelling and stiffness
• Provides relief from OA symptoms for up to 3 months after treatment is stopped

However, the largest clinical trial so far, the 2006 Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), sponsored by the National Institutes of Health, showed conflicting and somewhat confusing results. The study of about 1,600 people with OA of the knee found that glucosamine and chondroitin did not reduce pain in the overall group, although it did appear to reduce pain among those with moderate-to-severe OA of the knee. The study has raised questions for further research. Since glucosamine and chondroitin were combined in this study, it is not possible to determine the effect of chondroitin alone. In addition, researchers are now studying whether the glucosamine chondroitin combination may help those with more severe OA.

A second phase of the study in 2008 looked at some participants who continued with the study for another 28 months. They were tested to see whether glucosamine or chondroitin (together or alone) slowed the loss of cartilage in their knees. They showed no difference in cartilage loss compared with people who took placebo. But all groups, those taking placebo, those taking both supplements, and those taking only one supplement, lost less cartilage than expected.

Results continue to be mixed. One analysis of a number of studies found smaller trials tended to find that chondroitin was effective, while larger, more thorough studies tended to find that it was not.

Most studies show that chondroitin needs to be taken for 2 to 4 months before subjects experience benefits, although you may notice some improvement sooner. Glucosamine and chondroitin can be used along with NSAIDs to treat OA.

Bladder Conditions

One study found that intravesicular chondroitin (irrigating the bladder with chondroitin) may help relieve symptoms of interstitial cystitis. Another single study found that chondroitin, taken orally, might help reduce symptoms of overactive bladder.

Other

Other conditions for which chondroitin has been suggested include preterm labor, Alzheimer disease, heart disease, some cancers, including colorectal and breast cancers, and osteoporosis. However, no studies have evaluated these claims.

Dietary Sources

There are no major dietary sources of chondroitin, so people who want to take it must take supplements.

Dosage and Administration

Chondroitin is commonly sold as chondroitin sulfate in capsules or tablets. It is often combined with glucosamine and sometimes manganese as well. Manganese is a trace mineral necessary for bone health. The total amount of manganese from foods and supplements should not exceed 11 mg per day, but several combination supplements for arthritis (containing glucosamine, chondroitin, and manganese) have more than that. Read labels carefully, and consider choosing a supplement without manganese.

Pediatric

Chondroitin is not recommended for children. It is mainly used for treatment of osteoarthritis (OA), a condition that affects adults, and its safety for children has not been studied.

Adult

400 mg, 3 times a day or 600 mg, 2 times a day, taken by mouth.

Precautions

In the past, researchers have found that some chondroitin supplements did not contain the amount of chondroitin stated on the label. The same was true of some combination glucosamine and chondroitin supplements. Ask your doctor to recommend a brand, or choose a brand you trust.

Many chondroitin supplements are made from cow cartilage. If you are a vegetarian, look for a supplement made from algae instead.

Asthma. There is some concern that chondroitin may worsen asthma symptoms. Use with caution.

Prostate Cancer. Preliminary research suggests that chondroitin may cause the spread or recurrence of prostate cancer. This effect has not been shown with chondroitin sulfate supplements. Still, until more is known, don’t take chondroitin sulfate if you have prostate cancer, or are at high risk for developing it (you have a brother or father with prostate cancer).

Diabetes. Chondroitin supplements may affect blood sugar levels. If you have diabetes, check with your doctor or health care professional before you change your diet or the dose of your diabetic medicine.

Bleeding. Due to its similarity to heparin, people with bleeding disorders should only use chondroitin under medical supervision.

Side Effects

Chondroitin is safe and relatively free of side effects when used at the recommended daily dosage, at least for short periods of time. Some people may experience mild stomach upset, allergic reactions, drowsiness, and headaches. Few studies have investigated the safety and effectiveness of chondroitin when used for long periods of time.

Pregnancy and Breastfeeding

Pregnant and breastfeeding women should not take chondroitin, since it has not been studied for safety in these groups.

Interactions and Depletions

If you are being treated with any of the following medications, you should talk to your doctor before taking chondroitin:

Anticoagulants (blood thinners): Because chondroitin is similar to heparin, a drug used to thin the blood, it is theoretically possible for chondroitin to enhance the effects of blood-thinning medications. Chondroitin could also enhance the blood-thinning effects of vitamins and supplements such as fish oil and vitamin E.

Nonsteroidal anti-inflammatory drugs (NSAIDs): If you take NSAIDs to relive the pain of OA, taking chondroitin may reduce the dose of NSAIDs you need to take. Since NSAIDs can cause stomach bleeding, reducing the dosage can be helpful. Talk to your doctor, however, before taking chondroitin, since it can take several months before you feel any improvements.

Supporting Research

Bourgeois P, Chales G, Dehais J, et al. Efficacy and tolerability of chondroitin sulfate 1200 mg/day vs chondroitin sulfate 3 x 400 mg/day vs placebo. Osteoarthritis Cartilage. 1998;6(suppl A):25-30.

Brown KE, Leong K, Huang C, et al. Gelatin/chondroitin 6-sulfate microspheres for the delivery of therapeutic proteins to the joint. Arthritis and Rheum. 1998;41(12):2185-2195.

Busci L, Poor G. Efficacy and tolerability of oral chondroitin sulfate as a symptomatic slow-acting drug for osteoarthritis (SYSADOA) in the treatment of knee osteoarthritis. Osteoarthritis Cartilage. 1998;6(suppl A):31-36.

Chavez ML. Glucosamine sulfate and chondroitin sulfates. Hosp Pharm. 1997;32(9):1275-1285.

Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006 Feb 23;354(8):795-808.

Das A, Hammond TA. Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRh222 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis. Osteoarthritis Cartilage. 2000;8(5):343-350.

Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clin North Am. 1999;25:379-395.

Firestein: Kelley’s Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012.

Fransen M, Agaliotis M, Nairn L, et al. Clucosamine and chondroitin for knee osteoarthritis: a double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens. Ann. Rheum. Dis. 2015;74(5):851-8.

Gabay C, Medinger-Sadowski C, Gascon D, Kolo F, Finckh A. Symptomatic effects of chondroitin 4 and chondroitin 6 sulfate on hand osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial at a single center. Arthritis Rheum. 2011;63(11):3383-91.

Gaby AR. Natural treatments for osteoarthritis. Altern Med Rev. 1999;4(5):330-341.

Goedert MR, Jakes R, Spillantini MG, et al. Assembly of microtubule-associated protein tau into Alzheimer-like filaments induced by sulphated glycosaminoglycans. Nature. 1996;383:550-553.

Hochberg MC, Clegg DO. Potential effects of chondroitin sulfate on joint swelling: a GAIT report. Osteoarthritis Cartilage. 2008;16 Suppl 3:S22-4.

Iida J, Dorchak J, Clancy R, et al. Role for chondroitin sulfate glycosaminoglycan in NEDD9-mediated breast cancer cell growth. Exp Cell Res. 2015;330(2):358-70.

Kantor ED, Lampe JW, Peters U, Shen DD, Vaughan TL, White E. Use of glucosamine and chondroitin supplements and risk of colorectal cancer. Cancer Causes Control. 2013;24(6):1137-46.

Kelly GS. The role of glucosamine sulfate and chondroitin sulfates in the treatment of degenerative joint disease. Alt Med Rev. 1998;3(1):27-39.

Kubo M, Ando K, Mimura T, Matsusue Y, Mori K. Chondroitin sulfate for the treatment of hip and knee osteoarthritis: current status and future trends. Life Sci. 2009;85(13-14):477-83.

Lamari FN. The potential of chondroitin sulfate as a therapeutic agent. Connect Tissue Res. 2008;49(3):289-92. Review.

Leeb BF, Schweitzer H, Montag K, et al. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol. 2000;27:205-211.

Lippiello L, Woodward J, Karpman R, et al. In vivo chondroprotection and metabolic synergy of glucosamine and chondroitin sulfate. Clin Orthop. 2000;6(381):229-240.

McAlindon TE, Driban JB, Lo GH. Osteoarthritis year 2011 in review: clinical. Osteoarthritis Cartilage. 2012;2(3):197-200.

McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA. 2000;283(11):1469-1475.

Miller K, Clegg D. Glucosamine and Chondroitin. Rheumatic Diseases Clinics of North America. Philadelphia, PA: Elsevier Saunders. 2012;37(1).

Morreale P, Manopulo R, Galati M, et al. Comparison of the anti-inflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis. J Rheumatol. 1996;23:1385-1391.

Muller G, Kramer A. In vitro action of a combination of selected antimicrobial agents and chondroitin sulfate [abstract]. Chem Biol Interact. 2000;124(2):77-85.

National Center for Complimentary and Alternative Medicine. The NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT). J Pain Palliat Care Pharmacother. 2008;22(1):39-43.

Obara M, Hirano H, Ogawa M, et al. Does chondroitin sulfate defend the human uterine cervix against ripening in threatened premature labor? Am J Obstet Gynecol. 2000;182:334-339.

Rakel. Integrative Medicine. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012.

Ronca F, Palmieri L, Panicucci P, et al. Anti-inflammatory activity of chondroitin sulfate. Osteoarthritis Cartilage. 1998;6(suppl A):14-21.

Sawitzke AD, Shi H, Finco MF, Dunlop DD, Bingham CO 3rd, Harris CL, Singer NG, et al. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial. Arthritis Rheum. 2008 Oct;58(10):3183-91.

Towheed TE, Anastassiades TP. Glucosamine and chondroitin for treating symptoms of osteoarthritis. JAMA. 2000;283(11):1483-1484.

Uebelhart D. Clinical review of chondroitin sulfate in osteoarthritis. Osteoarthritis Cartilage. 2008;16 Suppl 3:S19-21. Review.

Van Vijven JP, Luijsterburg PA, Verhagen AP, et al. Symptomatic and chondroprotective treatment with collagen derivatives in osteoarthritis: a systematic review. Osteoarthritis Cartilage. 2012;20(8):809-21.

Zhang JS, Imai T, Otagiri M. Effects of a cisplatin-chondroitin sulfate A complex in reducing the nephrotoxicity of cisplatin [abstract]. Arch Toxicol. 2000;74(6):300-307.

Chondroitin-Vertex instructions for use: indications, contraindications, side effects – description of Chondroitin-Vertex caps. 250 mg: 30, 50, 60 or 100 pcs. (30395)

Chondroitin sulfate – description of the substance, pharmacology, use, contraindications, formula

Contents

• Structural formula

• Russian name

• English name

• Latin name

• chemical name

• Gross formula

• Pharmacological group of the substance Chondroitin sulfate

• Nosological classification

• CAS code

• pharmachologic effect

• Characteristic

• Pharmacology

• Application of the substance Chondroitin sulfate

• Contraindications

• Application restrictions

• Use during pregnancy and lactation

• Side effects of the substance Chondroitin sulfate

• Dosage and administration

• Precautionary measures

• Trade names with the active substance Chondroitin sulfate

• List of dietary supplements

Structural formula

Russian name

Chondroitin sulfate

English name

Chondroitin sulfate

Latin name

genus Chondroitini sulfatis)

Chemical name

Chondroitin-4-(hydrogen sulfate) (as sodium salt)

Gross formula

[C ₁₄ H ₂₁ NO ₁₄ S]n

9 0020 Pharmacological group of substance Chondroitin sulfate

Bone and cartilage metabolism correctors

Nosological classification

ICD-10 code list

• K05. 2 Acute periodontitis

• K05.3 Chronic periodontitis

• K05.4 Periodontal disease

• M15-M19 Arthrosis

• M25. 9 Disorder of joint, unspecified

• M42 Spinal osteochondrosis

• M81 Osteoporosis without pathological fracture

• T14.2 Fracture in body region unspecified

CAS code

25967-93-9

Pharmacological action

Pharmacological action –

stimulating regeneration , chondroprotective , chondrostimulating .

Feature

High molecular weight mucopolysaccharide. White or almost white with a yellowish tint powder or white, odorless, lyophilized amorphous powder. Hygroscopic.

Pharmacology

Participates in the construction of the basic substance of cartilage and bone tissue. It improves phosphorus-calcium metabolism in cartilage tissue, inhibits enzymes that disrupt the structure and function of articular cartilage, and inhibits the degeneration of cartilage tissue. Stimulates the synthesis of glycosaminoglycans, normalizes the metabolism of hyaline tissue, promotes the regeneration of cartilage surfaces and the joint bag. Prevents compression of the connective tissue, increases the production of intra-articular fluid, increases the mobility of the affected joints. It slows down the resorption of bone tissue, reduces the loss of calcium and accelerates the processes of bone tissue repair, inhibits the progression of osteoarthritis. It has an analgesic effect, reduces joint pain, pain at rest and when walking, the severity of inflammation, and helps reduce the need for NSAIDs.

After oral administration, it is rapidly absorbed from the gastrointestinal tract. max”>C _max is reached in 3-4 hours. Accumulates in the synovial fluid of the joints. Bioavailability is 13%. Excreted by the kidneys.

The use of Chondroitin sulfate

osteoarthritis, osteoporosis, periodontal disease, bone fractures (to accelerate callus formation)

Contraindications

Hypersensitivity, bleeding tendency, thrombophlebitis.

Restrictions for use

Pregnancy, lactation, children.

Use during pregnancy and lactation

During pregnancy and lactation, only after consulting a doctor.

Side effects of the substance Chondroitin sulfate

Allergic reactions (skin itching, erythema, urticaria, dermatitis), hemorrhages at the injection site; rarely – nausea, vomiting.

Dosage and administration

Inside, with a small amount of water. Adults: 750 mg 2 times a day for the first 3 weeks, then 500 mg 2 times a day. Children under 1 year – 250 mg / day, from 1 year to 5 years – 500 mg / day, over 5 years – 500 – 750 mg / day.

V/m (after dissolving the lyophilisate in 1 ml of water for injection) – 100 mg every other day, from the fourth injection the single dose is increased to 200 mg. The course is 25–35 injections, repeated after 6 months.

Externally, is applied to the skin over the lesion 2-3 times a day and rubbed in for 2-3 minutes until completely absorbed. The course of treatment is 2-3 weeks. If necessary, the course is repeated.

Precautions

Treatment should be discontinued in the event of allergic reactions or bleeding.

Contact with mucous membranes and open wounds should be avoided.

Trade names with active substance Chondroitin sulfate

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Lek. form
All lek. gel for external use capsules lyophilisate for solution for intramuscular injection lyophilisate for solution for intramuscular and intraarticular injection ointment for external use solution for intramuscular injection solution for intramuscular and intraarticular injection substance-liquid substance-lyophilisate substance-powder tablets

Dosage
All dosages 100 mg 100 mg/mL 200 mg 250 mg 470 mg 5% 500 mg No dosage

Manufacturer
All manufacturers of APS-HD AMS LIFE Science Co. , Ltd. Bioiberica S.A.U. Biosynthesis PJSC Biochemist JSC Biochemist JSC Biochemist PJSC Bryntsalov-A JSC Bryntsalov-A PJSC VERTEKS JSC Welfarm LLC GILS and NP FBU State Institute of Blood Substitutes and Medical Preparations Grotex LLC Zelenaya Dubrava CJSC Ivanovskaya Pharmaceutical Factory K.O. Rompharm Company S.R.L. Qingdao Jiulong Biopharmaceutical Co. Kursk biofactory-firm “BIOK” Federal State Unitary Enterprise Kursk biofactory-firm BIOK (FKP Kursk biofactory) Laboratories Derivati ​​Organichi S.p. A. Lekpharm SOOO Mefar Ilach Sanayii A.Sh. Microgen NPO AO (NPO Biomed) Microgen NPO AO (NPO Virion) Microgen NPO AO (Immunopreparat) Microgen NPO FSUE (Immunopreparat) Microgen NPO FSUE (NPO Biomed) Microgen NPO FSUE (NPO Virion) Moscow Endocrine Institute FSUE NIZHFARM AO New Zealand Pharmaceuticals Ltd Ozone OOO Ozone Pharm OOO Pierre Fabre Medication Production Samaramedprom Synthesis JSC Syntex Sotex PharmFirma M. P. Chumakov RAS (FGBNU “Chumakov Federal Scientific Research Institute of Informatics RAS”) Hemofarm LLC Ellara LLC Yantai Dongcheng Biochemicals Co.