Original Article: http://www.mayoclinic.com/health/chondroitin-sulfate/NS_patient-chondroitin
Natural Standard® Patient Monograph, Copyright © 2013 (www.naturalstandard.com). All Rights Reserved. Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
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 supports the use of chondroitin and its common partner agent, glucosamine, for improving symptoms and stopping (or possibly reversing) the degenerative process of osteoarthritis.
ACS4-ACS6, ADAMTS7B, aggrecan, agrin, biglycan, biostat, CDS, chondroitin sulfate A, chondroitin sulfate C, chondroitin sulfate proteoglycan, chondroitin sulfates, chondroitin sulfuric acid, chondroitin sulphate, chondroitin sulphate A sodium, chondroitin-4-sulfate, chondroitin-6-sulfate, chondroitinase ABC, chondroprotective agents, chondrosine, chonsurid, CHST11, condroitin, Condrosulf®, Condrosulf 400®, CS, CS/DS, CSA, CSC, CSPG D-galactosamine, decorin, dentin sialoprotein, DexSol®, D-glucuronic acid, disease modifying osteoarthritis drugs, DMOAD, extended chondroitin sulfate/dermatan, fucosylated chondroitin sulfate, GAG, galacotosaminoglucuronoglycan sulfate (Matrix®), glucosamine hydrochloride, glucosamine salts, glucosamine sulfate, glucosaminoglycan, Matrix®, neurocan, neuroglycan C, NGC, Optisol®, perineuronal nets, PNs, sodium chondroitin sulfate 0.2%, sodium chondroitin, Structum®, sulphate, symptomatic slow acting drug in osteoarthritis type XV, Syndecan, SYSADOA type XV, Uropol®-S, Viscoat®.
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.
OsteoarthritisMultiple 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 (six month duration) with methodological weaknesses. 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. Early studies of chondroitin applied to the skin 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.
Bladder controlSeveral studies have shown promise for using chondroitin for interstitial cystitis, which is a chronic inflammation of the bladder. Chondroitin sulfate may also be helpful in patients with overactive bladder or unstable bladder control. Additional evidence is necessary before a firm conclusion can be drawn.
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 heart attack. 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 cystitisThere is preliminary research administering intravesicular chondroitin in patients diagnosed with interstitial cystitis. Additional evidence is necessary before a firm conclusion can be drawn.
Iron absorption enhancementEarly research suggests that taking chondroitin with iron may enhance iron absorption in healthy individuals. It is unclear whether taking chondroitin would help patients with iron deficiencies absorb more iron. More research needs to be done in this area before a strong recommendation can be made.
Ophthalmologic usesChondroitin 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. Additional study is needed in this area.
PsoriasisEarly study suggests that chondroitin may help treat psoriasis. Well-designed clinical trials are needed to confirm these results.
Muscle soreness (delayed onset)Chondroitin was thought to be beneficial for delayed onset muscle soreness because chondroitin sulfate is often used as an anti-inflammatory and pain reliever for osteoarthritis. However, early research does not support this use. More research is needed in this area to confirm these results.
A Strong scientific evidence for this use
B Good scientific evidence for this use
C Unclear scientific evidence for this use
D Fair scientific evidence against this use (it may not work)
F Strong scientific evidence against this use (it likely does not work)
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.
Aging, allergies, Alzheimer's disease, analgesic, angina (chest pain), anticoagulant (blood thinner), anti-inflammatory, antioxidant, antithrombotic, atherosclerosis, bone healing, breast cancer, cardiovascular health, chronic venous ulcers, deep intra-osseous defects, gonarthrosis, gum disease, headaches, heart attack (treatment and prevention), high cholesterol, HIV/AIDS, hyperglycemia/diabetes, iron deficiency anemia, joint pain, joint problems (cartilage repair, disc degeneration, synovial fluid productions), kidney stones, leukemia, malaria, nerve regeneration, osteoporosis, premature birth prevention, respiratory ailments, rheumatoid arthritis, snoring, soft tissue injury (torn ligaments and tendons), spinal cord injury, sports injuries, venous leg ulcers, wound healing.
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.
Adult (18 years and older)
Doses of 200-400 milligrams by mouth twice to three times daily, or 800-1,200 milligrams once daily have been used in studies. Higher doses (up to 2,000 milligrams) appear to have similar efficacy. In the treatment of osteoarthritis, full effects may take several weeks to occur.
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.
For osteoarthritis, 50-100 milligrams as a single daily injection or divided into two daily injections has been used. Medical supervision is recommended.
Children (younger than 18 years)
There is no proven effective dose for chondroitin in children.
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.
Use cautiously if allergic or hypersensitive to chondroitin sulfate products. Use cautiously in patients with shellfish allergy, due to the possibility of allergic reaction. Hives, rash, sun skin sensitivity, and worsening of previously well-controlled asthma have been reported.
Side Effects and Warnings
Chondroitin sulfate appears to be well tolerated for up to three years.
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), and eyelid edema.
Avoid in individuals with prostate cancer, or at increased risk for prostate cancer, due to a risk of increased spread or recurrence of prostate cancer.
Pregnancy and Breastfeeding
Avoid in pregnant or breastfeeding women as effects are unknown, and there is structural similarity to heparin, a blood thinner that is contraindicated during pregnancy.
This patient information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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