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.

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.

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.

Evidence

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.

Key to grades

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)

Grading rationale

Evidence gradeCondition to which grade level applies
A

Osteoarthritis (general)

Chondroitin sulfate is considered a promising treatment for osteoarthritis. It is most often used to treat osteoarthritis of the finger, knee, hip joints, low back, and facial joints. Research has mostly focused on knee osteoarthritis, with fewer studies conducted on other joints. Clinical trials suggest that chondroitin may have significant effects when compared to placebo. Chondroitin is a slow-acting medication that may lead to reduced doses of other drugs. However, adequate assessment of long-term safety, side effects, and effectiveness is lacking.
A

Osteoarthritis (knee)

Chondroitin sulfate is considered a promising treatment for osteoarthritis of the knee. It is also most often used to treat osteoarthritis of the finger, hip joints, low back, and facial joints. Clinical trials suggest that chondroitin may have significant effects when compared to placebo. Chondroitin is a slow-acting medication that may lead to reduced doses of other drugs. However, adequate assessment of long-term safety, side effects, and effectiveness is lacking.
B

Frequent urination

Research suggests that chondroitin may benefit people who have overactive bladder. Sodium chondroitin sulfate may be as effective as overactive bladder drugs. More evidence is needed before firm conclusions can be made.
C

Bone diseases

A study reports that chondroitin sulfate may benefit people who have Kaschin-Beck disease, which affects the bone and causes joint pain or stiffness. Further study is needed in this area.
C

Coronary artery disease

Chondroitin is believed to improve symptoms and mortality of coronary artery disease. Long-term trials involving larger groups of people are needed. However, chondroitin may have benefits when used with conventional therapy.
C

Eye disorders

Chondroitin may be found in some products used to treat eye disorders, such as dry eyes and cornea inflammation. However, studies suggest that there may be a lack of difference between products that contain chondroitin and those that do not for dry eye treatment. More research is needed in this area.
C

Interstitial cystitis (bladder wall inflammation)

Early research suggests that chondroitin may benefit people who have inflammation of the bladder wall. More evidence is needed before a firm conclusion may be made.
C

Iron absorption enhancement

Early evidence suggests that taking chondroitin and iron together may help improve iron absorption in healthy people. More research is needed in this area.
C

Muscle soreness

Chondroitin sulfate may reduce pain and inflammation, and has been studied for sore muscles. However, one study found a lack of effect on soreness before and after exercise. More research is needed to confirm these results.
C

Psoriasis

Studies suggest that chondroitin sulfate may improve symptoms of psoriasis, a condition causing skin redness and irritation. More research is needed in this area before firm conclusions can be made.
C

Urinary tract infection

Early research suggests that a combination of hyaluronic acid and chondroitin may help prevent urinary tract infections in women with recurring infections. More research is needed in this field.

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, amyotrophic lateral sclerosis (disease of nerve cells that control muscle movement), antioxidant, antiviral, blood clots, bone healing, breast cancer, burns, cervical disc disease, chest pain, chronic venous ulcers, clogged arteries, colorectal cancer, diabetes, gout, gum disease, headaches, heart attack prevention, heart disease prevention, HIV/AIDS, hyperglycemia (high blood sugar levels), high cholesterol, inflammation, inflammatory bowel disease, joint problems, kidney stones, leukemia, lung cancer, malaria, mouth and throat infections, multiple sclerosis, nerve damage, nerve regeneration, neuroblastoma (nerve tissue tumor), osteoporosis, pain, Parkinson's disease, premature birth prevention, quality of life (osteoarthritis), rheumatoid arthritis, snoring, soft tissue injury, spinal cord injury, spine problems, surgery, systemic lupus erythematosus (disease leading to chronic inflammation), temporomandibular joint disorder (TMJ), transplants, wound healing.

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.

Methodology

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

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).

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.

Selected references

  1. Aubry-Rozier B. [Role of slow-acting anti-arthritic agents in osteoarthritis (chondroitin sulfate, glucosamine, hyaluronic acid)]. Rev.Med.Suisse 3-14-2012;8(332):571-2, 574, 576.
  2. Chen WC, Yao CL, Chu IM, et al. Compare the effects of chondrogenesis by culture of human mesenchymal stem cells with various type of the chondroitin sulfate C. J.Biosci.Bioeng. 2011;111(2):226-231.
  3. Coppa GV, Gabrielli O, Buzzega D, et al. Composition and structure elucidation of human milk glycosaminoglycans. Glycobiology 2011;21(3):295-303.
  4. De Vita D and Giordano S. Effectiveness of intravesical hyaluronic acid/chondroitin sulfate in recurrent bacterial cystitis: a randomized study. Int.Urogynecol.J. 2012;23(12):1707-1713.
  5. Furer V, Wieczorek RL, and Pillinger MH. Bilateral pinna chondritis preceded by glucosamine chondroitin supplement initiation. Scand.J.Rheumatol. 2011;40(3):241-243.
  6. Gabay C, Medinger-Sadowski C, Gascon D, et al. Symptomatic effects 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(11):3383-3391.
  7. Kanzaki N, Saito K, Maeda A, et al. Effect of a dietary supplement containing glucosamine hydrochloride, chondroitin sulfate and quercetin glycosides on symptomatic knee osteoarthritis: a randomized, double-blind, placebo-controlled study. J.Sci.Food Agric. 3-15-2012;92(4):862-869.
  8. Luhn S, Schiemann S, and Alban S. Simple fluorescence assay for quantification of OSCS in heparin. Anal.Bioanal.Chem. 2011;399(2):673-680.
  9. Martin M, Ott H, Merk HF, et al. Analysis of cytokine secretion from lymphocytes of patients with hypersensitivity reactions to contaminated heparins. Br.J.Dermatol. 2011;164(1):68-75.
  10. Nickel JC, Hanno P, Kumar K, et al. Second multicenter, randomized, double-blind, parallel-group evaluation of effectiveness and safety of intravesical sodium chondroitin sulfate compared with inactive vehicle control in subjects with interstitial cystitis/bladder pain syndrome. Urology 2012;79(6):1220-1224.
  11. Railhac JJ, Zaim M, Saurel AS, et al. Effect of 12 months treatment with chondroitin sulfate on cartilage volume in knee osteoarthritis patients: a randomized, double-blind, placebo-controlled pilot study using MRI. Clin.Rheumatol. 2012;31(9):1347-1357.
  12. Tsui T, Boon H, Boecker A, et al. Understanding the role of scientific evidence in consumer evaluation of natural health products for osteoarthritis an application of the means end chain approach. BMC.Complement Altern.Med. 2012;12:198.
  13. Van Vijven JP, Luijsterburg PA, Verhagen AP, et al. Symptomatic and chondroprotective treatment with collagen derivatives in osteoarthritis: a systematic review. Osteoarthritis.Cartilage. 2012;20(8):809-821.
  14. Wildi LM, Raynauld JP, Martel-Pelletier J, et al. Chondroitin sulphate reduces both cartilage volume loss and bone marrow lesions in knee osteoarthritis patients starting as early as 6 months after initiation of therapy: a randomised, double-blind, placebo-controlled pilot study using MRI. Ann.Rheum.Dis. 2011;70(6):982-989.
  15. Yue J, Yang M, Yi S, et al. Chondroitin sulfate and/or glucosamine hydrochloride for Kashin-Beck disease: a cluster-randomized, placebo-controlled study. Osteoarthritis.Cartilage. 2012;20(7):622-629.

This evidence-based monograph was prepared by The Natural Standard Research Collaboration

www.naturalstandard.com