Natural Standard® Patient Monograph, Copyright © 2014 (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. Common Brand Name(s) Ultra RX-Joint Joint plus Background Chondroitin sulfate is a molecule that is found naturally in the body. It has mostly been used to treat joint disorders, such as osteoarthritis, and problems with the chewing muscles and joints. Clinical trials on the use of chondroitin for osteoarthritis have found promising results. However, most of the studies are conducted for less than two years. Adequate assessment of long-term safety, side effects, and effectiveness is lacking. Early evidence suggests that chondroitin sulfate may improve the absorption of iron and measures of coronary artery disease. However, more research is needed in these areas. Related terms ACS4-ACS6, ADAMTS7B, aggrecan, agrin, biglycan, biostat, CDS, chondroitin 4-sulfate, chondroitin 6-sulfate, chondroitin sulfate A, chondroitin sulfate C, chondroitin sulfate proteoglycan (CSPG), chondroitin sulfate, chondroitin sulfates, chondroitin sulphate A, chondroitin sulphate A sodium, chondroitin sulphate E, chondroitin sulphate proteoglycans (NG2, neurocan, versican, phosphacan, neuroglycan C), chondroitin sulfuric acid, chondroitinase ABC, chondroprotective agents, chondrosine, chonsurid, CHST11, condroitin, Condrosulf®, Condrosulf 400®, CS, CSA, CSC, D-acetylgalactosamine, D-galactosamine, D-glucuronic acid, danaparoid, decorin, dentin sialoprotein, depolymerized holothurian glycosaminoglycan, dermatan sulfate, DexSol®, disease modifying osteoarthritis drugs (DMOAD), extended chondroitin sulfate/dermatan (CS/DS), fucosylated chondroitin sulfate, GAG, galacotosaminoglucuronoglycan sulfate, glucosamine hydrochloride, glucosamine salts, glucosamine sulfate, glucosaminoglycan, Integra®, Matrix®, mesoglycan, N-acetylglucosamine, neurocan, neuroglycan C (NGC), perineuronal nets (PNs), sodium chondroitin, sodium chondroitin sulphate, Structum®, sulfato de condroitina, symptomatic slow acting drug in osteoarthritis (SYSADOA), Syndecan, SYSADOA, uronic acid, Uropol®-S, versican. Combination products examples: CystoProtek® (chondroitin sulfate, sodium hyaluronate, quercetin), Mega-Gluflex (glucosamine sulfate and chondroitin sulfate), Optisol® (chondroitin sulfate and dextran), Viscoat® (chondroitin sulfate and sodium hyaluronate). Note: This bottom line monograph does not include in-depth information about glycosaminoglycans (GAGs). Dosing 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. Adults (18 years and older) In general, doses of 200-400 milligrams have been taken by mouth 2-3 times daily, or 800-1,200 milligrams once daily. Higher doses (up to 2,000 milligrams) may have similar effectiveness. For osteoarthritis, full effects may take several weeks to occur. To treat bone diseases, 600 milligrams of chondroitin sulfate (Green Pharmaceutical Factory of Chongqing, China) have been taken by mouth twice daily for six months. To treat coronary artery disease, 4.5 grams of chondroitin have been taken by mouth for 64 months. A dose of 1.5-10 grams has been taken by mouth daily for six years. Chondroitin sulfate A has been injected into the vein at a dose of 5 milligrams per kilogram of body weight. Chondroitin sulfate C has been injected into the vein at doses of 10-20 milligrams per kilogram of body weight. To treat osteoarthritis, the most common dose is 200-400 milligrams taken by mouth 2-3 times daily (daily dosages of 800-2,000 milligrams appear to have similar effectiveness). Treatment durations have ranged from three weeks to three years. A dose of 100 milligrams of Matrix® has been injected into the vein daily. Chondroitin has been injected into the muscle daily for six weeks or two 13-week intervals. Chondroitin has been injected into the muscle twice weekly. To treat psoriasis, 400-800 milligrams of chondroitin sulfate has been taken by mouth daily for two months. A dose of 800 milligrams of CS (Condrosan®) has been taken by mouth daily for three months. To treat bladder wall inflammation, a single dose of 20-40 milliliters of sodium chondroitin sulfate 0.2 percent (Uracyst®) has been inserted into the bladder weekly for up to six weeks and then once monthly for up to one year. A dose of 20 milliliters of sterile 2 percent sodium chondroitin sulfate has been inserted into the bladder for 30-60 minutes once weekly for seven weeks (for a total of eight treatments). To treat frequent urination, sodium chondroitin sulphate (Uropol® S) has been inserted with a catheter at a dose of 2 milligrams once a week for four weeks, then monthly for 11 months. To treat dry eye, eye drops containing chondroitin sulfate have been applied to the eyes. Note: Chondroitin sulfate products made for tube feeding are not available in the United States. Children (under 18 years old) There is no proven safe or effective dose for chondroitin in children. Safety 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. Allergies Avoid in people with a known allergy or sensitivity to chondroitin sulfate products or to shellfish, especially shrimp. Side Effects and Warnings Chondroitin is likely safe when taken by mouth appropriately for osteoarthritis. Safety information is lacking for chronic use lasting longer than three years. Chondroitin is likely safe when applied appropriately to the skin or to the eyes. Chondroitin is possibly safe when injected into the muscle or vein. Sources report that there may be a risk of acquiring mad cow disease from ingesting chondroitin that is derived from bovine tissue. The U.S. Food and Drug Administration (FDA) suggests caution when consuming bovine tissue from countries with mad cow disease. Chondroitin may increase the risk of bleeding. Caution is advised in people with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. Use cautiously in people who have asthma. Chondroitin may worsen asthma symptoms. Use cautiously in people who have heart disorders. Chondroitin may cause changes in heart rhythm, congestive heart failure, heart attack, and increased blood pressure. Use cautiously in people who have skin conditions. Chondroitin may cause hair loss, hives, rash, skin irritation, and sun sensitivity. Use cautiously in people who have swelling. Chondroitin may cause swelling in the lower limbs and eyelids. Use cautiously in people who have stomach disorders. Chondroitin may cause constipation, diarrhea, feeling of burning in the stomach, heartburn, indigestion, nausea, stomach inflammation, stomach pain, stomach ulcers, and vomiting. Use cautiously in people who have glaucoma. Chondroitin may increase eye pressure. Use cautiously in people who have weakened immune systems. Chondroitin may increase the risk of viral infection. Use cautiously in people who have nervous system disorders. Chondroitin may affect the nervous system, and cause headache or movement problems. Use cautiously in children and in pregnant or breastfeeding women, due to a lack of safety information. Use cautiously in people who have mental illnesses. Chondroitin may cause feelings of euphoria (intense happiness or well-being). Avoid in people who are at risk of or have prostate cancer. Chondroitin may promote spread or recurrence of prostate cancer. Avoid in people who have liver disorders. Chondroitin may cause changes in levels of liver enzymes or liver toxicity. Avoid in people with a known allergy or sensitivity to chondroitin sulfate products or to shellfish, especially shrimp. Chondroitin may also cause a burning sensation in the genitals, chest pain, ear inflammation, frequent or painful urination, hearing problems, pelvic pain, severe allergic reaction, sickliness, tightness in the throat or chest, urinary tract infection, and vaginal inflammation. Pregnancy and Breastfeeding There is a lack of scientific evidence on the use of chondroitin during pregnancy or breastfeeding. Interactions Interactions with Drugs Chondroitin may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (“blood thinners”) such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®). Chondroitin may affect blood pressure. Caution is advised in people taking drugs that may also affect blood pressure. Chondroitin may also interact with agents that may affect the immune system, agents that may affect the nervous system, agents that may dissolve easily in water, agents that may harm the liver, agents that may increase sun sensitivity, agents that may treat arthritis, agents that may treat asthma, agents that may treat malaria, agents that may treat osteoporosis, anticancer agents, anti-inflammatory agents, antiviral agents, birth control, calcium salts, cholesterol-lowering agents, diabetes agents, eye agents, gout agents, heart agents, hyaluronan, hyaluronidase, iron salts, non-steroidal anti-inflammatory agents (NSAIDs), polyethylene glycol, skin agents, and stomach agents. Interactions with Herbs and Dietary Supplements Chondroitin may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases. Chondroitin may affect blood pressure. Caution is advised in people taking herbs or supplements that affect blood pressure. Chondroitin may also interact with anticancer herbs and supplements, anti-inflammatory herbs and supplements, antioxidants, antiviral herbs and supplements, avocado, birth control, calcium, camphor, cholesterol-lowering herbs and supplements, fish oil, glucosamine, herbs and supplements that may affect the immune system, herbs and supplements that may affect the nervous system, herbs and supplements that may dissolve easily in water, herbs and supplements that may harm the liver, herbs and supplements that may increase sun sensitivity, herbs and supplements that may promote wound healing, herbs and supplements that may treat arthritis, herbs and supplements that may treat asthma, herbs and supplements that may treat diabetes, herbs and supplements that may treat gout, herbs and supplements that may treat heart disorders, herbs and supplements that may treat malaria, herbs and supplements that may treat osteoporosis, herbs and supplements that may treat stomach disorders, iron, peppermint oil, shark cartilage, and soybean.