glucosamine and cytotoxic drugs

Last edited 10/2019

Glucosamine is a naturally occurring sugar that is a basic building block of several important constituents of articular (joint) cartilage

• important for maintaining the elasticity, strength and resilience of cartilage in joints, which helps to reduce joint damage (1)
• administration of glucosamine is believed to stimulate production of cartilage components and allow rebuilding of damaged cartilage (1).

Glucosamine is commonly used for relief of pain and symptoms associated with osteoarthritis and other joint disorders

• available in the form of tablets, capsules and powders as glucosamine sulfate, glucosamine hydrochloride and N-acetyl-D-glucosamine (NAG)
• sometimes used in combination with chondroitin sulfate (1)
• glucosamine supplements are either produced synthetically or derived from the shells of shellfish - products vary in their content and strength of active ingredients (2)

Interactions between glucosamine and prescribed medication (3):

• glucosamine and warfarin
  • there are a number of reports describing enhanced anticoagulant effects when glucosamine has been taken with warfarin
    • mechanism of the interaction is unclear
    • MHRA recommend that patients on warfarin should not take glucosamine
    • has also been suggested that glucosamine should be used with caution in patients taking antiplatelet agents - no reports of interaction between glucosamine and the NOACs were located; until more is known, caution is warranted
      
      
• glucosamine and cytotoxic drugs
  • theoretically, glucosamine may induce resistance to some chemotherapy agents - may interact with doxorubicin and etoposide; because of the potential clinical significance of this interaction, glucosamine should not be used concomitantly
    
    
• glucosamine and blood glucose
  • glucosamine does not appear to adversely affect plasma blood glucose in patients without diabetes. However, data relating to its effects in patients with diabetes are limited. It would be prudent for patients with diabetes to monitor their blood glucose levels more closely if they start to take glucosamine, increase the dose or change the product being taken

Reference:

• Mason P. Dietary Supplements. 2nd ed. London: Pharmaceutical Press; 2001. Glucosamine p118-21
• Anon. Glucosamine for knee osteoarthritis - What's new? Drug Ther Bull 2008; 46: 81-4.
• NHS Specialist Pharmacy Service (September 2019). Glucosamine - what are its drug interactions?