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Effects on glucose metabolism and antidiabetic agents: It has been hypothesised that glucosamine may impair insulin secretion through competitive inhibition of glucokinase in pancreatic beta cells and/or alteration of peripheral glucose uptake. Glucosamine may increase insulin resistance and consequently affect glucose tolerance. It may reduce antidiabetic agent effectiveness e.g. when used with these antidiabetic agents: acarbose, acetohexamide, chlorpropamide, glipizide, glyburide, metformin, miglitol, pioglitazone, repaglinide, rosiglitazone, glimepiride, tolbutamide and troglitazone. Glucosamine is likely safe in patients with well-controlled diabetes (HbA1c less than 6.5%) taking one or two oral antidiabetic medications or controlled by diet only. In patients with higher HbA1c levels or those taking insulin, monitor blood sugar levels closely or more frequently.
Reduced effectiveness when used with glucosamine: doxorubicin, etoposide and teniposide.
Warfarin: Elevations of International Normalized Ratio (INR) serum values and potentiation of anticoagulant effects. If concomitant therapy is necessary, the patient's INR should be more closely monitored. There is a possibility that chondroitin may have anti-thrombotic activity.
Those taking warfarin and those with haemophilia should exercise caution in its use.
Chondroitin should not be used concomitantly with chitosan.
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