Diacerein/Glucosamine/Methyl Sulfonyl Methane

Treatment of degenerative joint diseases (OA & related diseases). Relief or improvement of OA symptoms eg, pain, inflammation & joint impairment. Alternative in patients who present contraindications to joint surgery, NSAIDs & those w/ CV problems in whom NSAIDs are contraindicated & patients not responding to other OA treatment.

Tablet: The clinical efficacy of glucosamine/chondroitin combination has been established for the treatment of degenerative joint conditions. Symptomatic relief of pain and inflammation associated with degenerative joint conditions eg, osteoarthritis.

Gel: Instant relief of degenerative joint and muscle pain.

Glucosamine is sugar protein that helps your body build cartilage (the hard connective tissue located mainly on the bones near your joints).

Glucosamine is a naturally occurring substance found in bones, bone marrow, shellfish and fungus.

Glucosamine has been used in alternative medicine as an aid to relieving joint pain, swelling, and stiffness caused by arthritis.

Not all uses for glucosamine have been approved by the FDA. Glucosamine should not be used in place of medication prescribed for you by your doctor.

Glucosamine is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Glucosamine may also be used for purposes not listed in this product guide.

The usual dosage regimen is 1 cap taken orally twice a day with the main meals for prolonged periods (not less than 6 months).

However, as diacerein may cause acceleration intestinal transit time during the first 2 weeks of treatment, it is recommended that treatment be started with 1 cap/day taken orally with evening meal for 4 weeks.

Once the patient has become accustomed to the medication, the dose should be increased to 2 cap/day, taken orally with meals.

The physician should decide the duration of treatment as a function of the outcome. However, this should not be <6 months.

As with prolonged treatment with any other medication, a complete blood test, including liver enzymes and urine analysis should be conducted every 6 months.

Due to its late onset of action (after 2-4 weeks of treatment), diacerein may be associated with a nonsteroidal anti-inflammatory drug or analgesic for the first 2-4 weeks of treatment.

Children: No clinical studies have been conducted in children. As the safety and efficacy on the product have not been established in this age group, its use is not recommended.

Elderly: No change in the usual recommended dose is necessary in elderly subjects.

Renal Insufficiency: In subjects with moderate renal insufficiency, the daily dose should be decreased by 50% of the recommended dose for adults.

Diacerein is contraindicated in subjects with severe renal insufficiency.

Hepatic Insufficiency: No significant deviations were observed in any of the pharmacokinetic parameters in cirrhotic with mild or moderate hepatic insufficiency and therefore no dose adjustment is required in these patients.

However, the use of diacerein is contraindicated in patients with a severe deterioration of hepatic function.

Adults: The usual dose is 2 tablets once daily or as directed by physician or pharmacist. The tablets should be swallowed with some liquid and can be taken with or without a meal.

Glucosamine is not indicated for the treatment of acute painful symptoms. Relief of symptoms (especially pain relief) may not be experienced until after several weeks of treatment and in some cases even longer. If no relief of symptoms is experienced after 2-3 months, tell the physician because continued treatment with glucosamine should be re-evaluated.

Elderly: No dosage adjustment is required.

Patients with Impaired Renal and/or Liver Function: No dose recommendations can be given since no studies have been performed.

Children: Unless with the advice of a physician, Voltaflex should not be used in children and adolescents below the age of 18 years.

Missed Dose: Do not double dose to make up for a forgotten dose. If the patient has further questions on the use of this product, ask the physician or pharmacist.

Patients with known hypersensitivity to Diacerein or those with previous episodes of hypersensitivity to anthraquinone derivatives.

The benefit/risk ratio administering diacerein to patients with previous episode of enterocolic disturbances and IBS must be considered.

Combined use with laxatives is contraindicated.

See also:
What is the most important information I should know about Glucosamine?

Hypersensitivity to chondroitin sulphate, glucosamine sulphate or to any of the excipients of Glucosamine.

Glucosamine contains sorbitol 1163 mg as excipient. Therefore, patients with rare hereditary problems of fructose intolerance should not take Glucosamine.

Glucosamine is not indicated for the treatment of acute painful symptoms.

Since glucosamine is derived from seafood (shellfish), Glucosamine should not be given to patients who are allergic to shellfish.

Use glucosamine as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Dosing depends on the use and the source of the product.
• Use as directed on the package, unless instructed otherwise by your doctor.
• This product may take several weeks to months to work.
• If you miss taking a dose of glucosamine for 1 or more days, there is no cause for concern. If your doctor recommended that you take it, try to remember your dose every day.

Ask your health care provider any questions you may have about how to use glucosamine.

Diacerein is used for treating swelling and pain in the joints due to osteoarthritis.

Glucosamine is used in addition to other drugs to relieve joint pain, swelling and stiffness due to arthritis.

Dietary supplement, which has been lately used in the management of osteoarthritis in combination with Methyl Sulfonyl Methane and/or chondrotin.

Diacerein must not be administered as the same time as drugs that modify intestinal transit and/or the quality of intestinal content (eg, excess fibres or phytates). The concomitant administration of products containing aluminium hydroxide and/or magnesium hydroxide should be avoided in order to maximize the bioavailability of diacerein.

Treatment with diacerein may cause an increase in enterocolic events in patients undergoing antibiotic and/or chemotherapy which could affect the intestinal flora.

Incompatibilities: None.

See also:
What other drugs will affect Glucosamine?

No formal drug interaction studies have been performed, however, the physicochemical and pharmacokinetic properties of glucosamine sulphate suggest a low potential for interactions.

However, interactions between the active ingredients of Glucosamine and other drug substances may occur ie, between glucosamine sulphate and coumarinic anticoagulants, glucosamine sulphate and tetracyclines, chondroitin sulphate and platelet antiaggregant drugs.

Accelerated intestinal transit. Diarrhoea; epigastric pain & disturbances. Nausea & vomiting. Pruritus, eruptions & eczema. More intense yellow-coloration of urine.

See also:
What are the possible side effects of Glucosamine?

The clinical trials have shown the good tolerability of Glucosamine. Undesiderable effects have been observed in a low proportion of patients. They were transient, of minor entity and included: Cardiovascular: Peripheral oedema, tachycardia were reported in a few patients following larger clinical trials investigating oral administration in osteoarthritis. Causal relationship has not been established. Central Nervous System: Drowsiness, headache, somnolence, insomnia have been observed rarely during therapy. Gastrointestinal: Nausea, vomiting, diarrhoea, dyspepsia or epigastric pain, flatulence, constipation, heartburn and anorexia have been described rarely during oral therapy with glucosamine. Skin: Skin reactions eg, cutaneous rash, erythema, pruritus have been reported with therapeutic administration of glucosamine. Occasionally contact dermatitis, papular rash, urticaria and eczema may occur.

Isolated cases of hair loss, allergic reactions, visual disturbances and oedema were observed.

Nausea, Acute toxicity, Rash, Stomach upset

Each capsule also contains the following inactive ingredients: Lactose, croscarmellose sodium, anhydrous colloidal silica, povidone, magnesium stearate.

Diacerein has a molecular formula of C₁₉H₁₂O₈ and a molecular weight of 368.30.

Diacerein is a fine yellow powder.

Each tablet contains glucosamine sulfate KCl 1000 mg, chondroitin sulfate 400 mg, vitamin E 40 mg, vitamin D (as D3 400 IU) 10 mcg, vitamin C 60 mg, folacin (folic acid) 400 mcg, vitamin B12 20 mcg, zinc 10 mg, manganese 4 mg, copper 1000 mcg, selenium 120 mg, ginger root extract 80 mg.

Glucosamine tablet does not have artificial colours, gluten, preservatives, lactose or yeast.

Each tube of topical gel contains aqua, polyethylene glycol, monocetyl ether, lecithin, alcohol, glucosamine sulfate sodium, propylene glycol, Citrus dulcis (sweet orange) oil, cellulose gum, menthol, Lavandula angustifolia (lavander) oil, chondroitin sulfate sodium, Eucalyptus globulus (eucalyptus) oil, Foeniculum vulgare (fennel) oil, Zingiber officinalis (ginger) oil, phenoxyethanol, methylparaben, butylparaben, ethylparaben, propylparaben, Eugenia caryophyllus (clove) oil, disodium EDTA.