Skip navigation

Chondroitin sulfate


What is it?

Chondroitin sulfate is a chemical that is normally found in cartilage around joints in the body. Chondroitin sulfate is manufactured from animal sources, such as cow cartilage.

Chondroitin sulfate is used for osteoarthritis. It is often used in combination with other products, including manganese ascorbate, glucosamine sulfate, glucosamine hydrochloride, or N-acetyl glucosamine. Research from a couple of decades ago showed that chondroitin sulfate helped arthritis pain when taken with conventional medicines, such as aspirin, for pain and swelling. But later research wasn’t so positive. Now, scientists believe that, overall, chondroitin sulfate may reduce arthritis pain slightly.

Some people use chondroitin sulfate for heart disease, weak bones (osteoporosis), and high cholesterol. Chondroitin sulfate is also used in a complex with iron for treating iron-deficiency anemia.

Chondroitin sulfate is available as an eye drop for dry eyes. In addition, it is used during cataract surgery, and as a solution for preserving corneas used for transplants. It is approved by the FDA for these uses.

Some people with arthritis use ointments or skin creams for pain that contain chondroitin sulfate, in combination with glucosamine sulfate, shark cartilage, and camphor. But as far as we know, chondroitin sulfate isn’t absorbed through the skin. That would mean that any benefit from these creams and ointments is due to some other ingredient.

There is great variability among chondroitin and chondroitin plus glucosamine products. Some products contain no chondroitin despite label claims, while others contain more chondroitin than the label shows. Price isn’t always a guarantee of quality. Low-cost chondroitin products (less than $1 per 1200 mg chondroitin) seem to contain little chondroitin, but some higher-priced products may also contain less chondroitin than claimed.

Look out for chondroitin plus glucosamine combination products that also contain manganese (e.g., CosaminDS). Be sure to follow product directions. When taken at doses slightly higher than the recommended dose, these products can sometimes supply more than the safe daily intake of manganese, which is 11 mg per day. Taking more than 11 mg per day of manganese might significantly poison the central nervous system.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for CHONDROITIN SULFATE are as follows:

Possibly effective for...

  • Dry eyes as an eye drop.
  • Reducing pain from a type of arthritis called osteoarthritis, when taken by mouth. Clinical research on the effectiveness of chondroitin sulfate taken by mouth for osteoarthritis is inconsistent. The reason for contradictory findings is unclear, but could be due to differences in people studied, different products used, or other differences in study design. Overall, the evidence shows that some people with osteoarthritis of the knee or hand can experience some benefit from taking chondroitin; however, pain relief is likely to be modest or possibly insignificant.

    Some skin creams containing chondroitin sulfate are promoted for reducing osteoarthritis pain. There is some evidence that a skin cream containing chondroitin sulfate in combination with glucosamine sulfate, shark cartilage, and camphor seems to reduce arthritis symptoms. But any symptom relief is most likely due to the camphor and not the other ingredients. There’s no research showing that chondroitin is absorbed through the skin.

Insufficient evidence to rate effectiveness for...

  • Heart attack. There is some preliminary evidence that taking chondroitin sulfate by mouth might lower the risk of having a first or recurrent heart attack.
  • Heart disease.
  • Osteoporosis (weak bones).
  • High cholesterol.
  • Other conditions.
More evidence is needed to rate chondroitin sulfate for these uses.

How does it work?

Return to top
In osteoarthritis, the cartilage in the joints breaks down. Taking chondroitin sulfate, one of the building blocks of cartilage, might slow this breakdown.

Are there safety concerns?

Return to top
Chondroitin sulfate is LIKELY SAFE for most people. It can cause some mild stomach pain and nausea. Other side effects that have been reported are diarrhea, constipation, swollen eyelids, leg swelling, hair loss, and irregular heartbeat.

There is some concern about the safety of chondroitin sulfate because it comes from animal sources. Some people are worried that unsafe manufacturing practices might lead to contamination of chondroitin products with diseased animal tissues, including those that might transmit bovine spongiform encephalopathy (mad cow disease). So far, there are no reports of chondroitin causing disease in humans, and the risk is thought to be low.

Some chondroitin products contain excess amounts of manganese. Ask your healthcare professional about reliable brands.

Special precautions & warnings:

Pregnancy and breast-feeding: Not enough is known about the use of chondroitin sulfate during pregnancy and 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: 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).

Are there interactions with medications?

Return to top

Moderate

Be cautious with this combination.

Warfarin (Coumadin)
Warfarin (Coumadin) is used to slow blood clotting. There are several reports showing that taking chondroitin with glucosamine increases the effect of warfarin (Coumadin) on blood clotting. This can cause bruising and bleeding that can be serious. Don't take chondroitin if you are taking warfarin (Coumadin).

Are there interactions with herbs and supplements?

Return to top
There are no known interactions with herbs and supplements.

Are there interactions with foods?

Return to top
There are no known interactions with foods.

What dose is used?

Return to top
The following doses have been studied in scientific research:

BY MOUTH:
  • For osteoarthritis: the typical dose of chondroitin sulfate is 200-400 mg two to three times daily or 1000-1200 mg as a single daily dose.
APPLIED TO THE SKIN:
  • For osteoarthritis: a cream containing 50 mg/g of chondroitin sulfate, 30 mg/g of glucosamine sulfate, 140 mg/g of shark cartilage, and 32 mg/g of camphor has been used as needed for sore joints for up to 8 weeks.

Other names

Return to top
Calcium Chondroitin Sulfate, CDS, Chondroitin, Chondroitin Polysulfate, Chondroitin Polysulphate, Chondroitin Sulfate A, Chondroitin Sulfates, Chondroitin Sulfate B, Chondroitin Sulfate C, Chondroitin Sulphates, Chondroitin Sulphate A Sodium, Chondroïtine, Chondroïtine Sulfate A, Chondroïtine Sulfate B, Chondroïtine Sulfate C, Chondroïtine 4-sulfate, Chondroïtine 4- et 6- sulfate, Condroitin, CPS, CS, CSA, CSC, GAG, Galactosaminoglucuronoglycan Sulfate, Chondroitin 4-sulfate, Chondroitin 4- and 6-sulfate, Poly-(1->3)-N-aceltyl-2-amino-2-deoxy-3-O-beta-D-glucopyranurosyl-4-(or 6-), Polysulfate de Chondroïtine, Sulfate de Chondroïtine, Sulfate de Galactosaminoglucuronoglycane, Sulfates de Chondroïtine, Sulfato de Condroitina.

Methodology

Return to top
To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.methodology (http://www.nlm.nih.gov/medlineplus/druginfo/natural/methodology.html).

References

Return to top
To see all references for the Chondroitin sulfate page, please go to http://www.nlm.nih.gov/medlineplus/druginfo/natural/744.html.

  1. Gabay C, Medinger-Sadowski C, Gascon D, et al. Symptomatic effect 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;63:3383-91. View abstract.
  2. Yue QY, Strandell J, Myrberg O. Concomitant use of glucosamine may potential the effect of warfarin. The Uppsala Monitoring Centre. Available at: www.who-umc.org/graphics/9722.pdf (Accessed 28 April 2008).
  3. Knudsen J, Sokol GH. Potential glucosamine-warfarin interaction resulting in increased international normalized ratio: Case report and review of the literature and MedWatch database. Pharmacotherapy 2008;28:540-8. View abstract.
  4. Reichenbach S, Sterchi R, Scherer M, et al. Meta-analysis: chondroitin for osteoarthritis of the knee or hip. Ann Intern Med 2007;146:580-90. View abstract.
  5. Messier SP, Mihalko S, Loeser RF, et al. Glucosamine/chondroitin combined with exercise for the treatment of knee osteoarthritis: a preliminary study. Osteoarthritis Cartilage 2007;15:1256-66. View abstract.
  6. Kahan A. STOPP (STudy on Osteoarthritis Progression Prevention): a new two-year trial with chondroitin 4&6 sulfate (CS). Available at: www.ibsa-ch.com/eular_2006_amsterdam_vignon-2.pdf (Accessed 25 April 2007).
  7. Huang J, Olivenstein R, Taha R, et al. Enhanced proteoglycan deposition in the airway wall of atopic asthmatics. Am J Respir Crit Care Med 1999;160:725-9. View abstract.
  8. 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;354:795-808. View abstract.
  9. Uebelhart D, Malaise M, Marcolongo R, et al. Intermittent treatment of knee osteoarthritis with oral chondroitin sulfate: A one-year, randomize, double-blind, multicenter study versus placebo. Osteoarthritis Cartilage 2004;12:269-76. View abstract.
  10. Sakko AJ, Ricciardelli C, Mayne K, et al. Modulation of prostate cancer cell attachment to matrix by versican. Cancer Res 2003;63:4786-91. View abstract.
  1. Rozenfeld V, Crain JL, Callahan AK. Possible augmentation of warfarin effect by glucosamine-chondroitin. Am J Health Syst Pharm 2004;61:306-307. View abstract.
  2. Di Caro A, Perola E, Bartolini B, et al. Fractions of chemically oversulphated galactosaminoglycan sulphates inhibit three enveloped viruses: human immunodeficiency virus type 1, herpes simplex virus type 1 and human cytomegalovirus. Antivir Chem Chemother 1999;10:33-8.. View abstract.
  3. Cohen M, Wolfe R, Mai T, Lewis D. A randomized, double blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee. J Rheumatol 2003;30:523-8.. View abstract.
  4. Baici A, Horler D, Moser B, et al. Analysis of glycosaminoglycans in human serum after oral administration of chondroitin sulfate. Rheumatol Int 1992;12:81-8.. View abstract.
  5. Richy F, Bruyere O, Ethgen O, et al. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med 2003;163:1514-22.. View abstract.
  6. Henry-Launois B. Evaluation of the use of financial impact of Chondrosulf 400 in current medical practice. Part of the Proceedings of a Scientific Symposium held at the XIth EULAR Symposium: New approaches in OA: Chondroitin sulfate (CS 4&6) not just a symptomatic treatment. Geneva, 1998.
  7. Verbruggen G, Goemaere S, Veys EM. Systems to assess the progression of finger joint osteoarthritis and the effects of disease modifying osteoarthritis drugs. Clin Rheumatol 2002;21:231-43.. View abstract.
  8. Tallia AF, Cardone DA. Asthma exacerbation associated with glucosamine-chondroitin supplement. J Am Board Fam Pract 2002;15:481-4.. View abstract.
  9. Ricciardelli C, Quinn DI, Raymond WA, et al. Elevated levels of peritumoral chondroitin sulfate are predictive of poor prognosis in patients treated by radical prostatectomy for early-stage prostate cancer. Cancer Res 1999;59:2324-8. View abstract.
  10. Ylisastigui L, Bakri Y, Amzazi S, et al. Soluble glycosaminoglycans Do not potentiate RANTES antiviral activity on the infection of primary macrophages by human immunodeficiency virus type 1. Virology 2000;278:412-22. View abstract.
  11. Adebowale AO, Cox DS, Liang Z, et al. Analysis of glucosamine and chondroitin sulfate content in marketed products and the Caco-2 permeability of chondroitin sulfate raw materials. JANA 2000;3:37-44.
  12. Cao LC, Boeve ER, de Bruijn WC, et al. Glycosaminoglycans and semisynthetic sulfated polysaccharides: an overview of their potential application in treatment of patients with urolithiasis. Urology 1997;50:173-83. View abstract.
  13. Morrison LM. Treatment of coronary arteriosclerotic heart disease with chondroitin sulfate-A: preliminary report. J Am Geriatr Soc 1968;16:779-85. View abstract.
  14. Morrison LM, Bajwa GS, Alfin-Slater RB, Ershoff BH. Prevention of vascular lesions by chondroitin sulfate A in the coronary artery and aorta of rats induced by a hypervitaminosis D, cholesterol-containing diet. Atherosclerosis 1972;16:105-18. View abstract.
  15. Mazieres B, Combe B, Phan Van A, et al. Chondroitin sulfate in osteoarthritis of the knee: a prospective, double blind, placebo controlled multicenter clinical study. J Rheumatol 2001;28:173-81. View abstract.
  16. Das A Jr, Hammad TA. Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis. Osteoarthritis Cartilage 2000;8:343-50. View abstract.
  17. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002. Available at: www.nap.edu/books/0309072794/html/.
  18. Pipitone VR. Chondroprotection with chondroitin sulfate. Drugs Exp Clin Res 1991;17:3-7 . View abstract.
  19. Leffler CT, Philippi AF, Leffler SG, et al. Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study. Mil Med 1999;164:85-91. View abstract.
  20. Silvestro L, Lanzarotti E, Marchi E, et al. Human pharmacokinetics of glycosaminoglycans using deuterium-labeled and unlabeled substances: evidence for oral absorption. Semin Thromb Hemost 1994;20:281-92. View abstract.
  21. Ronca F, Palmieri L, Panicucci P, et al. Anti-inflammatory activity of chondroitin sulfate. Osteoarthritis Cartilage 1998;6 Suppl A:14-21. View abstract.
  22. Andermann G, Dietz M. The influence of the route of administration on the bioavailability of an endogenous macromolecule: chondroitin sulphate (CSA). Eur J Drug Metab Pharmacokinet 1982;7:11-6. View abstract.
  23. Conte A, de Bernardi M, Palmieri L, et al. Metabolic fate of exogenous chondroitin sulfate in man. Arzneimittelforschung 1991; 41:768-72. View abstract.
  24. McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 2000;283:1469-75. View abstract.
  25. Limberg MB, McCaa C, Kissling GE, Kaufman HE. Topical application of hyaluronic acid and chondroitin sulfate in the treatment of dry eyes. Am J Ophthalmol 1987;103:194-7. View abstract.
  26. Kelly GS. The role of glucosamine sulfate and chondroitin sulfates in the treatment of degenerative joint disease. Altern Med Rev 1998;3:27-39. View abstract.
  27. Bucsi 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:31-6. View abstract.
  28. 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;6:25-30. View abstract.
  29. Uebelhart D, Thonar EJ, Delmas PD, et al. Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study. Osteoarthritis Cartilage 1998;6:39-46. View abstract.
  30. Morrison LM, Enrick N. Coronary heart disease: reduction of death rate by chondroitin sulfate A. Angiology 1973;24:269-87. View abstract.
  31. Lewis CJ. Letter to reiterate certain public health and safety concerns to firms manufacturing or importing dietary supplements that contain specific bovine tissues. FDA. Available at: www.cfsan.fda.gov/~dms/dspltr05.html.
  32. Leeb BF, Schweitzer H, Montag K, Smolen JS. A meta-analysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol 2000;27:205-11. View abstract.
  33. Bagasra O, Whittle P, Heins B, Pomerantz RJ. Anti-human immunodeficiency virus type 1 activity of sulfated monosaccharides: comparison with sulfated polysaccharides and other polyions. J Infect Dis 1991;164:1082-90. View abstract.
  34. Jurkiewicz E, Panse P, Jentsch KD, et al. In vitro anti-HIV-1 activity of chondroitin polysulphate. AIDS 1989;3:423-7. View abstract.
  35. Chavez ML. Glucosamine sulfate and chondroitin sulfates. Hosp Pharm 1997;32:1275-85.
  36. Mazieres B, Loyau G, Menkes CJ, et al. [Chondroitin sulfate in the treatment of gonarthrosis and coxarthrosis. 5-months result of a multicenter double-blind controlled prospective study using placebo]. Rev Rhum Mal Osteoartic 1992;59:466-72. View abstract.
  37. Conrozier T. [Anti-arthrosis treatments: efficacy and tolerance of chondroitin sulfates]. Presse Med 1998;27:1862-5. View abstract.
  38. 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;23:1385-91. View abstract.
Show more references
Show fewer references
Last reviewed - 08/21/2014




Page last updated: 27 October 2014