I would like to see an analysis of recent studies of glucosamine/chondroitin sulfate use. Is it safe to use these agents in patients with chronic renal insufficiency?
—Jennifer L. Lewis, MD, Pittsburgh

At this time, there are no known contraindications to the use of glucosamine or chondroitin sulfate other than allergy to these substances, and the current evidence suggests they can be safely administered to patients with renal insufficiency. The Cochrane Library recently conducted a comprehensive review on the safety and efficacy of glucosamine. In 2005, an updated search of MEDLINE, PREMEDLINE, EMBASE, AMED, ACP Journal Club, DARE, CDSR, and the CCTR collectively identified 20 randomized controlled trials enrolling a total of 2,570 patients and found that the safety profile of glucosamine was equivalent to that of placebo (Cochrane Database Syst Rev. 2005;[2]:CD002946). A similar Cochrane review is currently in progress regarding the use of chondroitin, but the results are not yet available. An excellent, newly published review of these medications similarly found a very low incidence of adverse effects but called into question the efficacy of these medications for osteoarthritis (N Engl J Med. 2006;354:795-808). However, the subgroup of patients with moderate-to-severe osteoarthritis of the knee did have a significant response to these agents, and this may be an appropriate target group for therapy. I would direct interested readers to that article for more detailed information.
—Daniel G. Tobin, MD (100-17)

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