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Printed from https://bottledhope.co/supplements/glucosamine/. Last reviewed 2026-10-03. Check the site for the latest version.

Glucosamine

An amino sugar found in cartilage, made for supplements from shellfish shells or grain, and taken for osteoarthritis and joint pain.

Explained simply · Last reviewed

What it is

Glucosamine is an amino sugar found naturally in cartilage, sold as a supplement for joint pain. LiverTox, the US government's liver-injury database, describes it as a natural component of cartilage and a popular supplement, often combined with chondroitin and used for osteoarthritis and joint pain. NCCIH, the US agency that studies complementary medicine, says glucosamine is a building block for molecules called glycosaminoglycans, which are part of the structure of cartilage.

More about Glucosamine

LiverTox, the US government's liver-injury database, describes it as a natural component of cartilage and a popular supplement, often combined with chondroitin and used for osteoarthritis and joint pain. NCCIH, the US agency that studies complementary medicine, says glucosamine is a building block for molecules called glycosaminoglycans, which are part of the structure of cartilage.

NCCIH states that in the United States glucosamine is sold as a dietary supplement, as glucosamine sulfate or glucosamine hydrochloride, alone or with chondroitin. In some other countries, it says, certain preparations are sold as prescription drugs. LiverTox states that the glucosamine in supplements is usually prepared from the shells of shellfish or from fermentation of grain. It adds that the purity of commercial products is not always clear.

In the Cochrane review cited below, 20 of 25 trials studied osteoarthritis of the knee alone, and more than half tested a single prescription glucosamine sulfate product made by Rotta Pharm, an Italian company. The summaries below keep that product apart from others where the sources do.

Also known as: glucosamine sulfate, glucosamine sulfate, glucosamine hydrochloride, glucosamine HCl

At a glance

Safety: known risks, 2 groups who should avoid it or take extra care and 1 documented interaction. See Safety ↓

Claims made about Glucosamine, and how strong the evidence is for each:

Longevity and aging claims

Claims made about Glucosamine and aging, and how strong the evidence is for each. A change in a marker is not the same as a longer life.

Each rating follows our published rules and the sources cited for it. We don’t add our own medical judgment. How we rate

Safety

Read this before the ratings below.

Risks

  • NCCIH, the US agency that studies complementary medicine, states that no major safety problems have been identified in large studies of glucosamine and chondroitin for osteoarthritis. It adds that glucosamine “may cause increases in blood glucose (sugar) levels in some people”. The 2019 US rheumatology guideline cited below says the potential toxicity of glucosamine is low, though some patients exposed to it may show raised blood glucose levels.
  • The European Food Safety Authority (EFSA) notes that its 2009 safety opinion covered glucosamine hydrochloride made with the fungus Aspergillus niger. That opinion found it safe as a food ingredient for adults at the proposed intake. It added that consumers with diabetes or glucose intolerance should be advised to seek medical advice.
  • In the Cochrane review, the share of people reporting side effects was about the same with glucosamine as with placebo, which the reviewers rate high certainty. Their plain-language summary says side effects mainly included stomach upset and other joint pain.
  • LiverTox, the US government’s liver-injury database, gives glucosamine a likelihood score of D, a “possible rare cause of clinically apparent liver injury”. It says case reports have linked glucosamine products to liver injury. But the role of glucosamine itself, rather than other herbs in the products or contaminants, has not been shown, and such injury “must be very rare if it occurs at all”.

Who should avoid it or take extra care

  • People taking warfarin or similar blood thinners: EFSA concludes there is evidence for a risk of interaction in some individuals that could raise the INR, a measure of how long blood takes to clot. It says this could lead to bleeding. NCCIH states that glucosamine and chondroitin have been associated with an increased risk of bleeding in people taking warfarin.
  • Pregnancy and breastfeeding: NCCIH states that little is known about the safety of using glucosamine and chondroitin during pregnancy or while breastfeeding.

Documented interactions

  • Warfarin (Coumadin) and similar anticoagulants: EFSA reports more than 40 case reports, collected by drug-monitoring agencies, in which the INR of people taking coumarin anticoagulants, mostly warfarin, rose after they began taking glucosamine; in some cases bleeding occurred, and in most cases the INR began to return to normal when glucosamine was stopped. It concludes that the level of risk cannot be worked out because the data are insufficient. NCCIH states that glucosamine and chondroitin have been associated with an increased risk of bleeding in people taking warfarin. Source [1]Source [2]

Safety sources: Source [1]Source [2]Source [3]Source [4]Source [5]

What the evidence says

Each claim is rated on its own evidence. Ratings follow the scale on our methodology page.

  • Eases pain or improves physical function in knee or hip osteoarthritis, taken on its own Evidence rating: Evidence against

    People with knee or hip osteoarthritis take it hoping it will ease their joint pain and help them move more easily.

    A US rheumatology guideline says data at the lowest risk of bias show no important benefit over placebo and strongly recommends against it; trials of one prescription product disagree.

    This claim is about glucosamine on its own; the combination with chondroitin is rated separately below. A 2010 review in the BMJ combined the large placebo-controlled trials of glucosamine, chondroitin or both in knee or hip osteoarthritis. On a 10 cm pain scale, pain was 0.4 cm lower with glucosamine than with placebo. The reviewers had set 0.9 cm as the smallest difference that matters to patients. They conclude that glucosamine does not reduce joint pain, and that trials independent of industry showed smaller effects than commercially funded ones.

    A Cochrane review, with a search run in January 2008, found 25 trials. Pooled together, they favored glucosamine for pain. In the trials that properly hid which treatment came next, pain did not differ significantly from placebo, which the reviewers rate moderate certainty (how sure they are). Function on the WOMAC scale did not differ significantly either (high certainty), though function on another scale, the Lequesne index, was better than placebo. Trials of one prescription product, made by Rotta Pharm, found less pain (low certainty) and slightly better function (high certainty). Trials of other products did not.

    A 2026 review of 19 earlier reviews in knee osteoarthritis found a small drop in pain on visual pain scales, but no significant change in WOMAC pain or function scores. It judged most of those reviews low or critically low in quality. It says the effects it found were at or below the size that matters to patients. The American College of Rheumatology and the Arthritis Foundation, in their 2019 guideline, strongly recommend against glucosamine for knee, hip or hand osteoarthritis. They write that the data with the lowest risk of bias “fail to show any important benefits over placebo”.

    NCCIH says it is “still uncertain” whether glucosamine and chondroitin help knee osteoarthritis symptoms. It describes a 2018 analysis in which glucosamine alone significantly reduced overall pain, with inconsistent individual studies. It adds that guidelines differ. It says a 2019 guideline from the Osteoarthritis Research Society International “strongly recommends against the use of glucosamine for knee osteoarthritis on the grounds of lack of efficacy”. A European society, ESCEO, strongly recommends prescription crystalline glucosamine sulfate and discourages other forms, and an orthopedic guideline lists glucosamine as possibly helpful while cautioning that the evidence is inconsistent. For the hip, NCCIH reports one two-year trial of 222 people in which glucosamine sulfate was no better than placebo for pain, function or joint structure.

    Three letters in the BMJ disputed the 2010 review, arguing among other things that it mixed prescription glucosamine sulfate with other products. The authors of two letters disclosed research funding and lecture fees from drug companies involved in treating osteoarthritis; the two authors of the third are scientists at Rottapharm, maker of the prescription product. The reviewers, who declared no competing interests, replied that the type and quality of the glucosamine did not explain their results. Because the reviews disagree, this page takes the lower reading.

    Sources: Source [1]Source [2]Source [3]Source [4]Source [5]Source [6]Source [7]Source [8]Source [9]

  • Slows joint space narrowing (cartilage loss seen on X-rays) in knee osteoarthritis, taken on its own Evidence rating: Evidence against

    People with knee osteoarthritis take it hoping it will stop the cartilage in their knees from wearing away.

    A 2010 review of large trials found only minute differences and NCCIH calls any effect on joint structure uncertain, though two trials of one prescription product found slower narrowing.

    Joint space narrowing is the loss of space between the bones of a joint on an X-ray, used as a sign of cartilage loss. The Cochrane review found two three-year trials of the Rotta prescription product in knee osteoarthritis. Pooled, they showed less narrowing than placebo, a difference of 0.32 mm, which the reviewers rate high certainty. The 2010 BMJ review's table lists both trials as funded by Rottapharm. A third trial, of a different glucosamine sulfate product in hip osteoarthritis, found inconsistent results across the four sites it measured, and none of its confidence intervals reached a clinically important change of 0.25 mm.

    The 2010 BMJ review combined the six large trials of glucosamine, chondroitin or both that measured joint space. It found differences between glucosamine and placebo that it calls minute, with a range of likely values that reached zero, and it concludes that glucosamine has no impact on joint space narrowing. A published letter from researchers who disclosed research funds and lecture fees from drug companies argued that effects of this size can be clinically meaningful.

    The 2026 review of reviews found a small, statistically significant slowing of narrowing. It says the signal comes mainly from long trials of the sulfate form, and it calls this indirect evidence for a possible effect that should be confirmed in long-term trials.

    NCCIH says it is uncertain whether glucosamine and chondroitin affect joint structure, and that studies conflict. It describes a two-year Australian trial in which glucosamine sulfate alone did not reduce narrowing, while glucosamine with chondroitin did. It also describes a two-year US trial, of glucosamine hydrochloride, in which no group differed from placebo. Because the sources disagree, this page takes the lower reading.

    Sources: Source [1]Source [2]Source [3]Source [4]Source [5]

  • Glucosamine combined with chondroitin eases knee or hip osteoarthritis pain Evidence rating: Evidence against

    People with arthritis take glucosamine with chondroitin hoping the pair will ease joint pain better than either alone.

    A 2010 review found no clinically meaningful pain relief from the combination, and a US rheumatology guideline strongly recommends against combination products.

    The 2010 BMJ review estimated the combination's effect on pain alongside glucosamine and chondroitin alone. Of the ten trials it included, the only one that tested the combination was a knee osteoarthritis trial funded by the US National Institutes of Health, using glucosamine hydrochloride. On a 10 cm pain scale, pain was 0.5 cm lower than with placebo, with a range of likely values that reached zero. That is less than the 0.9 cm the reviewers had set as the smallest difference that matters, and they conclude that the combination does not reduce joint pain.

    The 2019 US rheumatology guideline strongly recommends against combination products that include glucosamine and chondroitin sulfate for knee or hip osteoarthritis. NCCIH describes a 2018 analysis in which overall pain was not significantly reduced by the combination, though it was by each taken separately.

    The letter from researchers who disclosed industry funding, described above, disputed the 2010 review's choice of trials and of the smallest difference that matters. The reviewers replied that their threshold came from recent studies in osteoarthritis.

    Sources: Source [1]Source [2]Source [3]Source [4]Source [5]

  • Maintains healthy joints in people without osteoarthritis Evidence rating: Insufficient

    People without joint disease take it hoping it will keep their joints healthy as they age.

    EFSA found that a link between glucosamine and keeping normal joints in the general population has not been established, because every human study it was given was in osteoarthritis.

    The European Food Safety Authority (EFSA) assessed proposed “joint health” claims for glucosamine, as sulfate or hydrochloride, alone or with chondroitin. It concluded in 2009 that a cause and effect relationship “has not been established” between taking glucosamine and the maintenance of normal joints.

    EFSA explains that all the human studies it was given were in people diagnosed with osteoarthritis, mostly of the knee. It found no evidence that results in people with osteoarthritis can be applied to the general population. It adds that the animal and laboratory studies it was given do not predict an effect in humans.

    Sources: Source [1]

  • Eases chronic low back pain linked to spinal osteoarthritis Evidence rating: Limited

    People with long-lasting low back pain take it hoping it will ease the ache and help them move.

    A 2013 review found three small trials; the two at low risk of bias found no significant difference from placebo, and the reviewers rate the evidence very low to low certainty.

    A 2013 review in BMJ Open searched to March 2011 for randomized trials in adults with chronic low back pain and signs of spinal osteoarthritis. It found three, with 309 people in total. Only one tested glucosamine sulfate on its own against placebo, in 250 people in Norway; the review lists it as sponsored by Pharma Nord. It found no difference in pain or disability at six months.

    Of the other two trials, one gave a glucosamine complex with other ingredients on top of usual treatment, without blinding, and found less pain. The reviewers judged it at high risk of bias. The other gave glucosamine hydrochloride with chondroitin and manganese ascorbate and found no significant effect on back pain.

    The reviewers rate the pain evidence very low certainty and the function evidence low. They conclude that any benefit “can neither be demonstrated nor excluded” because the data are insufficient and the studies are of low quality. This page rates the claim on the lowest certainty, very low.

    Sources: Source [1]

  • Eases jaw pain or improves mouth opening in osteoarthritis of the jaw joint (temporomandibular joint) Evidence rating: Limited

    People with a painful jaw joint take it hoping it will ease the pain and let them open their mouth more easily.

    A 2023 review of eight small trials found too little evidence to confirm a benefit, though it reports less pain and wider mouth opening when glucosamine was taken for three months.

    A 2023 systematic review found eight randomized trials of glucosamine taken by mouth for osteoarthritis of the jaw joint. The trials differed a great deal. Some gave glucosamine alone and some with chondroitin; some used the sulfate and some the hydrochloride; some added it to injections into the joint. Two compared glucosamine sulfate with ibuprofen rather than with placebo. The reviewers judged four trials at low risk of bias and three at high risk.

    A six-week trial of glucosamine sulfate against placebo found no difference between the groups. Two trials that added glucosamine to joint injections found no extra benefit in the short term, but less pain and wider mouth opening in the long term; both came from the same university. The reviewers conclude that there is “not enough scientific evidence to unambiguously confirm” a benefit. They also write that taking glucosamine for a longer period, three months, led to a significant reduction in jaw-joint pain and a wider maximum mouth opening.

    NCCIH describes the same review as unable to reach definite conclusions, because the studies used different methods and types of glucosamine and some may have been biased. The review did not grade certainty. This page rates the claim on the small number of mixed trials.

    Sources: Source [1]Source [2]

Longevity and aging

What the cited sources report about lifespan, death from any cause, and markers studied in connection with aging. A change in a marker is not the same as a longer life. Each outcome is rated on its own evidence, on the same scale as the claims above.

  • Lowers the risk of death from any cause Evidence rating: Limited

    Some people hope a daily glucosamine supplement might also help them live longer.

    Pooling four cohort studies, a 2026 review found glucosamine users died less often from any cause, but the reviewers say bias and confounding could explain part or all of this.

    This is about death from any cause in people, measured in observational studies of the general population, not in trials. A 2026 meta-analysis pooled four prospective cohort studies. People who used glucosamine had a lower risk of death from any cause than people who did not (hazard ratio 0.84). The four studies differed (moderate heterogeneity), and one of them did not find a significant difference.

    The reviewers stress that these are associations and cannot show that glucosamine caused the difference. They write that healthy-user bias and residual confounding are “plausible and possibly major explanations”, and that even a small degree of unmeasured confounding could account for part or all of the associations. They describe a published bias analysis arguing that selection bias could produce false benefit signals in these studies.

    The reviewers describe their review as the first synthesis to isolate glucosamine from chondroitin. In the review's own reference list, three of the four cohorts in this result are titled as studies of glucosamine and chondroitin use. Glucosamine use was self-reported, usually once, and the cohorts rarely distinguished sulfate from hydrochloride. The review did not grade certainty. This page rates the claim on observational evidence alone.

    Sources: Source [1]

Which form the evidence used

Supplements are sold in several forms. This is what the sources on this page say about them — which form the research used, and any comparison those sources themselves made. Where they made none, this page does not rank the forms.

  • Glucosamine sulfate, including one prescription product, What the sources supportDetails

    Most trials in the cited Cochrane review used glucosamine sulfate, and 14 of its 25 trials tested only one prescription product made by Rotta Pharm, an Italian company. Those trials found less pain than placebo; trials of other products did not. NCCIH reports a 2014 analysis in which trials of the prescription formulation generally had more favorable results. It says this may reflect real differences between products, or bias, since most of those trials had a high risk of bias and were funded by the company. A 2010 review found no significant difference in its results by type of salt. A 2026 review of reviews calls its own salt comparisons hypothesis-generating. Source [1]Source [2]Source [3]Source [4]

  • Glucosamine hydrochloride, What the sources supportDetails

    NCCIH states that glucosamine is sold in the United States as glucosamine sulfate or glucosamine hydrochloride. The 2026 review of reviews states that over-the-counter supplements usually contain glucosamine hydrochloride. The Cochrane review found one trial that compared the two salts directly, and it found no significant difference in benefit or safety between them. The US rheumatology guideline cited below says there is a lack of a clear biologic understanding of how benefit would vary with the type of salt. Source [1]Source [2]Source [3]Source [4]

  • Glucosamine with chondroitin, What the sources supportDetails

    NCCIH states that glucosamine and chondroitin are sold separately or together. The combination is rated as its own claim below. The Cochrane review left out trials of combination products, so its findings are about glucosamine on its own. Source [1]Source [2]

Also documented elsewhere on this site

Other supplements we cover that document an interaction with the same thing. This is a pointer to what those pages say, not a statement about taking them together — we have no source reviewing these in combination.

Sources

  1. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis
    BMJ, 2010 · Meta-analysis · Primary source
  2. Glucosamine therapy for treating osteoarthritis
    Cochrane Database of Systematic Reviews, 2005 · Meta-analysis · Primary source · Certainty: low
    Some of its authors disclose ties to industry.
  3. Glucosamine for knee osteoarthritis: an umbrella review
    Frontiers in Nutrition, 2026 · Systematic review · Primary source
  4. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee
    Arthritis & Rheumatology, 2020 · Clinical practice guideline · Primary source
    Some of its authors disclose ties to industry.
  5. Glucosamine and Chondroitin for Osteoarthritis: What You Need To Know
    National Center for Complementary and Integrative Health, NIH, 2023 · Health authority summary · Primary source
  6. Glucosamine and osteoarthritis. Effect size is encouraging
    BMJ, 2010 · Published comment · Not counted toward ratings
    Some of its authors disclose ties to industry.
  7. Glucosamine and osteoarthritis. Prescribed regimen is effective
    BMJ, 2010 · Published comment · Not counted toward ratings
    Some of its authors disclose ties to industry.
  8. Glucosamine and osteoarthritis. Conclusions not supported by methods and results
    BMJ, 2010 · Published comment · Not counted toward ratings
    Some of its authors disclose ties to industry.
  9. Authors’ reply
    BMJ, 2010 · Published comment · Not counted toward ratings
  10. Scientific Opinion on the substantiation of health claims related to glucosamine alone or in combination with chondroitin sulphate and maintenance of joints (ID 1561, 1562, 1563, 1564, 1565) and reduction of inflammation (ID 1869) pursuant to Article 13(1) of Regulation (EC) No 1924/2006
    EFSA Panel on Dietetic Products, Nutrition and Allergies (EFSA Journal), 2009 · Health authority summary · Primary source
  11. The use of glucosamine for chronic low back pain: a systematic review of randomised control trials
    BMJ Open, 2013 · Systematic review · Primary source · Certainty: very low
  12. Oral Glucosamine in the Treatment of Temporomandibular Joint Osteoarthritis: A Systematic Review
    International Journal of Molecular Sciences, 2023 · Systematic review · Primary source
  13. Glucosamine Use and Its Association with Colorectal Cancer and Mortality: A Systematic Review and Meta-Analysis
    Journal of Cancer, 2026 · Meta-analysis · Primary source
  14. Statement on the safety of glucosamine for patients receiving coumarin anticoagulants
    EFSA Panel on Dietetic Products, Nutrition and Allergies (EFSA Journal), 2011 · Health authority summary · Primary source
  15. Glucosamine
    LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, National Institute of Diabetes and Digestive and Kidney Diseases, 2018 · Health authority summary · Primary source

Page history

Show all 2 changes to this page
  • — Published.
  • — First drafted. Glucosamine on its own for knee or hip osteoarthritis pain and function, for joint space narrowing, and glucosamine with chondroitin for pain all rated evidence against; joint health in people without osteoarthritis rated insufficient; chronic low back pain, jaw-joint osteoarthritis and death from any cause rated limited.