Friday, September 28, 2007

Glucosamine dilema: Which brand to choose?Hydrochloride or Sulphate?

You know you have osteoarthritis, then u must have taken glucosamine before...
Almost all known pharmaceutical company in Malaysia come out with their own glucosamine and claim theirs to be the best. So how do we choose which brand to buy?

Here is a list of glucosamine brands in Malaysia.

Different brands 1 tab
1 Apex Atronil 500mg
2 Artril 250 250mg
3 Artril Forte 500mg
4 Bio Life 500mg
5 Blackmores 500mg
6 CCM Catril-S 250mg
7 Donna Capsule 250mg
8 Glucosamine YSP 250mg
9 Gold Life 250mg
10 Hovid Cosamine 250mg
11 Move Free Advance (US only) 750mg
12 Quest Glucosamine 500mg
13 Rematril 250mg
14 Thomson Osteopro 250mg
15 Viartril-S capsule (brand) 250mg
16 Viartril-S powder (brand) 1500mg
17 Consulf Sulphate (taken together) 400mg
(not including Direct Selling products)
Total of 16 products in to choose?

Lets looks at the Evidence based support:
Based on the clinical studies done by Rottapharm Viartril-S (glucosamine sulphate) have proven to show not only an improvement in symptoms but also an improvement in joint space narrowing on radiograph.
But National Institute of Health study (not using glucosamine sulphate) concluded that there is no statistically significant improvements comparing to placebo.

This lead to the argument below, becoz glucosamine exist in the market in 2 forms, so
Sulfate vs hydrochloride: Which one better?

Group 1(support sulphate): Sulfate moiety in glucosamine sulphate might be responsible for the effect. Sulphate is required for articular cartilage glycosaminoglycan synthesis. That is why Viartril-S (sulphate) is proven to be effective.

Group2(support HCL): Glucosamine hydrochloride contains more glucosamine. A dose of 1500mg of glucosamine hydrochloride is equivalent to 1985mg of glucosamine sulphate. This is because HCL form carries 83.1% of glucosamine, where the sulphate form carries only 62.8%. Therefore glucosamine HCL is better and cheaper as well. Claim that Rotta use sulphate to protect their patent on the manufacture of Viartril-S.

Group3(support non): The counter anion of the glucosamine salt (i.e. chloride or sulfate) is unlikely to play any role in the action or pharmacokinetics of glucosamine.

**Panadol metabolism requires sulfur so if glucosamine sulphate is taken together with panadol, by right the patients will feel less effectiveness of the glucosamine sulphate. But the pain maybe relieved by panadol and not glucosamine.

Ask the pharmacist!
1) Glucosamine sulfate might not be effective for more severe, long standing, older, and heavier patients. So for heavy people having pain at the knee, loose weight should be the first option.

2) There is no research showing glucosamine is absorbed topically. Do not apply on the knee.

3) You are free to experience any brand you like. If u want the best, buy the one with proven clinical studies or buy the one with promotion/offer.

4)So far there is no head to head studies comparing glucosamine hydrochloride and glucosamine sulphate with placebo as it is still a question which one is actually better?Of all the products registered in Malaysia, all are using sulphate. How do we compare? Even the famous Move Free Glucosamine HCL Combinations (only available in US) also contains sulphate in the form of Chondroitin sulphate.

5)From what i heard from my good friend, Glucosamine HCL will be classed under Controlled Medicine if it is available. Reason? I also dont know.

6) Leave a comment here if u support HCL or sulphate. Correct me if i am wrong or u disagree. Pls share your experience here.


ws pang said...

very good write up, but seriously which one should we choose?

ws pang said...

Why classified under Control Medicine? i also dunno.

Anonymous said...

Dear Mr Lee,

You can easily obtain most of the answers you seek here: under the 'product monograph' and "FAQ" column.

Fyi, recent clinical study was conducted using the IC50 method to analyse the Bio-availability of Viartril-S and Bio-equivalent of other GS.

An earlier studies demonstrated that the Glucosamine Concentration required to decrease 50% IL-1β (an inflammatory agent in OA) stimulated gene expression (IC50) is 6.2µM.

GH (1500mg) in the GAIT study and GS (Viartril-S 1500mg) in the GUIDE study were tested. The result: GS has 8.9±0.7µM while GH has only 3.0±0.8µM.

This evidence has suggested that other glucosamine preparation is not bioequivalent to the excellent bio-availability of Viartril-S. And therefore unlikely to achieve the pharmacologically effective concentration for the desired therapeutic effect in the treatment of OA.

As such, we would be wise to note that “when a supplement has been studied with good results, find out which brand was used in the study, and buy that.”’

“Despite terms like “quality tested” appearing on labels, consumers and healthcare providers have no basis to compare one product against another or to judge the quality of the products they are purchasing or recommending.”

And there are evidence that the other GS brands continue to carbonize the good clinical evidence of Viartril-S due to their absense of bio-equivalency.

So, are all Glucosamine Sulfate the same?


pharmalogik said...

Of course all glucosamine sulfate are not the same. There is too many considerations we have to take note before choosing a brand over the other brand.

for eg. Branded glucosamine sulphate (VS) vs generic Glucosamine Sulphate
- lets say VS bioavaibility is 100% and generic GS is 60%
- Cost of VS is double the generic GS
- So is it true that by taking double the dose of generic GS would be better becos it will give 120% at the same price?

We must also understand that in-vitro studies does not really reflect in real world and each individual is different.

As i was saying, until we have head to head clinical studies comparing their effectiveness, customer's feedback is the best way for me to pass judgment on the quality of certain GS brand.

Anonymous said...

hi Mr Lee,
I accidentally saw this blog and I love and love it bcoz here probably has the ans that I'm looking for...
my mum was complaining abt her knee pain recently, and I think it is due to the 'wear & tear' form of OA as age increases...
so,she went to pharmacy and the pharmacist suggested her to take a 'Glucosamine powder' in sachet...they are expensive.
I have doubt abt the efficacy of them and also, isn't glucosamine will be better if it is combined with chondriotin? what is the main difference of taking powder over capsule aside more convenient?
You mentioned that glucosamine is not working well in topical form, but some studies actually showed that topical form works better as it is avoided from first pass metabolism, so more will be deposited into the join.
hope that you can help me to clear my doubts out of my mind!
good day!


Anonymous said...

Dear All ..

Here what a info I could give to help you.

Either Sulphate or Hydrochloride,no dose-response studies have been conducted with glucosamine supplements. Virtually all oral supplementation studies on glucosamine have used 1500mg per day - usually in 3 divided doses of 500mg each. While this level appears to be an effective dose, there is no information to suggest that a higher does would work better or faster - or that a lower dose would be less effective. A common supplementation strategy, which can decrease the daily cost of supplements, is to consume 1500mg of glucosamine per day for the first 60-90 days of your regimen, followed by a reduced intake of 250-750mg per day as a "maintenance level." Following the initial 60-90 day period, dosage levels can be increased or decreased based on individual pain and stiffness levels the effective dose a day.

I cant say The Rottapharm Viartril-S (frm Rotta lbs)its not good,but perhaps supplements with the best clinical substantion are: Dona (the trade name) from Rotta Labs also and Cosamin frm NutraMax Labs.This based what I find in many European ppl chosen brand for glucosamine supplements brand and also recommended by pharmacist.

Some free supplements like blackmores,yes they has either you want hydroclorine or sulphate.I think its free sell in all pharmacy store in Malaysia and round world .



Anonymous said...

No all joint pain can be attributed to OA, even though this is the most prevalent type of joint problems. Pharmacists have to be aware of s/sx of other types of arthritis in order to help their clients. Especially, if the joints involved are in the hands, symmetrical in nature, more than 3 joints are involved at the same time, associated with long period of morning stiffness (> 1 hour), relatively young age at onset, etc. Another thing to check is if the person who wants to start taking glucosamine is also on warfarin. regardless of what the reps told you there are case reports of glucosamine causing stable INR to become hay wire in patient on long-term warfarin. some of these case reports involved products that also contained chondroitin, which is known to have some anticoagualant effect (in fact chondroitin is part of the anticoagulant called danaparoid), but products containing glucosamine alone have been implicated as well.

Anonymous said...

hello mrlee, thanks for the information about these friend recommended donna pill years ago,but i was quite hesitant since i have a little problem with my heart,just in case it contains steroid. but when my knee became unbearable, the doctor gave me catril8 and it worked.Does catril has side-effect? i am 43, had hypertension since i was 18.

Anonymous said...

Consider the effect of taking Glucosamine HCL 1500g.

How much does it affect people people with gastric problems, stomach ulcers and gastric sensitivities.

I'm 40; I believe in my experience HCL causes gastric pain for me, and I didn't suffer from gastric pain previously. I stopped it after 2 months on the HCL version. This was when I had painful and popping, cracking sounds in my knee after a race. After that course, climbing up the stairs is bearable, but stiffness and pain remains.

Currently using Glucosamine Sulphate, this is after one year of not taking any form of Glucosamine and exercising for only 30mins once a week. Ensuring the body has been giving time to recuperate. The manufacturer or prescription note from the hospital doesn't require it to be taken after meals. But I use it at 1500mg a day for between 30 to 60 days to lessen the pain in both knees, caused by cycling and jogging. Notably, walking up the stairs without pain is normal again.

John said...

Thanks for your great advice, I will keep it in mind