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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...

  • Osteoarthritis. 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. Taking chondroitin sulfate might also reduce the progression of osteoarthritis.

    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. However, any symptom relief is most likely due to the camphor and not the other ingredients. There is no research showing that chondroitin is absorbed through the skin.

Insufficient evidence to rate effectiveness for...

  • Cataracts. Some early studies suggest that specific eye drops containing chondroitin and hyaluronate (Viscoat, DiCoVisc) can decrease pressure in the eye and improve overall eye health after a cataract is removed. However, the drops do not appear to be better than drops containing hyaluronate alone.
  • Dry eyes. Early evidence suggests that using chondroitin sulfate eye drops seems to decrease dry eyes. However, other evidence suggests that eye drops containing chondroitin sulfate are less effective than tear-replacement drops (Gel-Larmes).
  • Muscle soreness after exercise. Early evidence suggests that taking chondroitin sulfate daily does not reduce muscle soreness after exercise in men.
  • Bladder inflammation (interstitial cystitis). Several studies suggest that administering chondroitin sulfate into the bladder with or without hyaluronic acid can improve symptoms of bladder inflammation. Other early evidence suggests that taking a product containing chondroitin (CystoProtek) by mouth can improve bladder inflammation. However, other research shows that inserting chondroitin sulfate into the bladder does not improve symptoms.
  • Bone and joint disease (Kashin-Beck disease). Early evidence suggests that chondroitin, with or without glucosamine hydrochloride, can reduce pain in people with Kashin-Beck disease. Also, taking chondroitin with glucosamine can slow joint space narrowing in people with this bone disease. However, it is unclear if taking chondroitin alone slows joint space narrowing.
  • Heart attack. There is some early evidence that taking chondroitin sulfate by mouth might lower the risk of having a first or recurrent heart attack.
  • Skin redness and irritation (psoriasis). Early evidence suggests that taking chondroitin sulfate for 2-3 months decreases pain and improves skin conditions in people with psoriasis.
  • Overactive bladder. Early research suggests that inserting sodium chondroitin sulfate into the bladder through a urinary catheter improves quality of live in people with overactive bladder.
  • Urinary tract infections (UTIs). Early evidence suggests that administering a specific chondroitin sulfate and hyaluronic acid solution (IALURIL) through a catheter weekly for 4 weeks and then monthly for 5 months reduces UTIs in women with a history of UTIs.
  • Heart disease.
  • Osteoporosis (weak bones).
  • High cholesterol.
  • Other conditions.
More evidence is needed to rate chondroitin sulfate for these uses.

How does it work?

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?

Chondroitin sulfate is LIKELY SAFE when taken by mouth appropriately. It has been used safely in research for up to 6 years. However, 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. 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.

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

Chondroitin sulfate is POSSIBLY SAFE when injected into the muscle, when applied to the skin in the short-term, and when inserted into the bladder with a catheter by a physician.

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.

Blood clotting disorders: In theory, administering chondroitin sulfate might increase the risk of bleeding in people with blood clotting disorders.

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).

Are there interactions with medications?

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?

There are no known interactions with herbs and supplements.

Are there interactions with foods?

There are no known interactions with foods.

What dose is used?

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

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

To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.

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