Hepatotoxicity associated with glucosamine and chondroitin sulfate in patients with chronic liver disease

Table 1 Results of the liver function tests in cases of hypertransaminasemia related to glucosamine consumption

	1-yr prior to consumption	During consumption	1-yr after consumption
AST (UI/L) (normal < 40)
Case 1	25	182	71
Case 2	36	161	36
ALT (UI/L) (normal < 40)
Case 1	33	282	85
Case 2	53	162	37
GGT (UI/L) (normal < 40)
Case 1	32	150	77
Case 2	18	31	15
AP (U/L) (normal < 290)		229	219
Case 1	240	183	213
Case 2	144
Total bilirubin (mg/dL) (normal < 1.2)
Case 1	0.3	0.8	0.4
Case 2	0.8	0.9	0.9

The results of the two cases are compared with analyses performed 1-yr prior to and after the episode. AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma Glutamyl transpeptidase; AP: Alkaline phosphatase.

Table 2 Summary of the cases reported in the literature on hepatotoxicity by glucosamine and/or chondroitin sulfate

Ref.	Age (yr) Sex (F/M)	Drugconsumed	Length of consumption	Latency	Jaundice	Peak in AST/ALT (IU/L)	Hypersensitivity	Hepatic failure	Follow-up
Ossendza et al[4]	52/M	Glucosamine	3 wk	4 wk	Yes	263/63	Pruritus, eosinophilia	No	Complete recovery
Smith et al[5]	64/M	Glucosamine/chondroitin sulfate	4 wk	5 wk	Yes	-/1461	-	Yes	Death
	57/F	Glucosamine	4 wk	5 wk	Yes	-/1130	Pruriginous rash	No	Chronic hepatitis
	55/F	Glucosamine	6 mo	8 mo	No	-/175	-	No	Complete recovery
Linnebur et al[6]	71/F	Glucosamine/chondroitin sulfate	7 wk	3 wk	No	600-700/ 00-500	-	No	Complete recovery
	85/F	Glucosamine/chondroitin sulfate	3 wk	3 wk	No	54/37	-	No	Complete recovery
Authors’ cases	71/F	Glucosamine	1 yr	NA	No	182/282	-	No	Liver tests return to pretreatment (basal) values
	77/F	Glucosamine	3 mo	NA	No	161/162	Pruriginous rash	No	Liver tests return to (basa) values

M: Male; F: Female; AST/ALT: Aspartate aminotransferase/ alanine aminotransferase; NA: Not available.