Cosamin Asu

Drug overview for COSAMIN ASU (glucosamine hcl/chondroitin sulfate a sodium/herbal no.270):

Generic name: GLUCOSAMINE HCL/CHONDROITIN SULFATE A SODIUM/HERBAL NO.270
Drug class:
Therapeutic class: Alternative Therapy

No enhanced Introduction information available for this drug.

No enhanced Uses information available for this drug.

DRUG IMAGES

No Image Available

The following indications for COSAMIN ASU (glucosamine hcl/chondroitin sulfate a sodium/herbal no.270) have been approved by the FDA:

Indications:
None.

Professional Synonyms:
None.

The following drug interaction information is available for COSAMIN ASU (glucosamine hcl/chondroitin sulfate a sodium/herbal no.270):

Contraindicated
Severe
Moderate

There are 0 contraindications.

There are 1 severe interactions. These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.

Drug Interaction	Drug Names
Vincristine/P-glycoprotein (P-gp) Inducers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Inducers of P-glycoprotein (P-gp) may reduce systemic exposure to vincristine.(1) CLINICAL EFFECTS: Concurrent or recent use of P-gp inducers may result in decreased effectiveness of vincristine.(1) PREDISPOSING FACTORS: Induction effects may be more likely with regular use of the inducer for longer than 1-2 weeks. PATIENT MANAGEMENT: The US manufacturer of vincristine states that concurrent use of P-gp inducers should be avoided.(1) Consider the use of agents with no or minimal induction potential if possible. Monitor patients for decreased response to therapy. DISCUSSION: Vincristine is transported by P-gp and inducers of this transporter are expected to decrease levels of vincristine.(1) Inducers of P-gp include linked to this monograph include: efavirenz, green tea, and lorlatinib.(2,3)	VINCASAR PFS, VINCRISTINE SULFATE

Drug Interaction

Drug Names

Vincristine/P-glycoprotein (P-gp) Inducers

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Inducers of P-glycoprotein (P-gp) may reduce systemic exposure to vincristine.(1)

CLINICAL EFFECTS: Concurrent or recent use of P-gp inducers may result in decreased effectiveness of vincristine.(1)

PREDISPOSING FACTORS: Induction effects may be more likely with regular use of the inducer for longer than 1-2 weeks.

PATIENT MANAGEMENT: The US manufacturer of vincristine states that concurrent use of P-gp inducers should be avoided.(1) Consider the use of agents with no or minimal induction potential if possible. Monitor patients for decreased response to therapy.

DISCUSSION: Vincristine is transported by P-gp and inducers of this transporter are expected to decrease levels of vincristine.(1) Inducers of P-gp include linked to this monograph include: efavirenz, green tea, and lorlatinib.(2,3)

VINCASAR PFS, VINCRISTINE SULFATE

There are 5 moderate interactions. The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.

Drug Interaction	Drug Names
Orlistat/Fat Soluble Vitamins SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The acetate ester forms of vitamin A and vitamin E must undergo hydrolysis for absorption from the gastrointestinal tract.(1) The enzyme responsible for this hydrolysis is inhibited by orlistat.(2) CLINICAL EFFECTS: Orlistat may reduce absorption of fat soluble vitamins, leading to a deficiency state. PREDISPOSING FACTORS: A pre-existing deficiency of fat soluble vitamins (A,D,E and K) or chronic malabsorption syndrome. PATIENT MANAGEMENT: The inhibition of fat soluble vitamin absorption by orlistat should be borne in mind during implementation of a vitamin supplementation strategy. Patients should be strongly encouraged to take a multivitamin supplement which contains fat soluble vitamins, particularly Vitamin D as it appears most susceptible to this interaction.(4,5) Multivitamin supplements should be taken at least two hours before or after the dose of orlistat, or at bedtime.(4) Patients with chronic malabsorption syndromes should not receive orlistat.(4) DISCUSSION: Adult patients taking orlistat without supplementation showed a greater reduction in vitamin A,D,E and beta-carotene levels compared to placebo during two or more consecutive visits in studies of 1-2 years duration; these patients had normal baseline values prior to orlistat therapy. Low vitamin values in orlistat patients were as follows: low Vitamin D 12%, low beta-carotene 6.1%, low Vitamin E 5.8%, low Vitamin A 2.2%.(4) A pharmacokinetic interaction study showed a 30% reduction in beta-carotene supplement absorption and a 60% decreased in vitamin E acetate absorption with concomitant orlistat.(4) In a study, orlistat produced the vitamin net concentration by approximately 43%.(1) In a study, no statistically significant decrease in vitamin A absorption was observed with concurrent orlistat.(2) In a study, mean vitamin D levels were significantly reduced compared with baseline after one month of orlistat therapy despite multivitamin supplementation.(5)	ORLISTAT, XENICAL
Coumarin Anticoagulants/Glucosamine and-or Chondroitin SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The exact mechanism is unknown, but may be the result of additive or synergistic effects on coagulation. Glucosamine is a component of heparin(1) and chondroitin is a component of danaparoid.(2) Glucosamine has been shown not to inhibit CYP2C9,(3) thus inhibition of warfarin metabolism is thought to be unlikely. CLINICAL EFFECTS: Concurrent use of glucosamine-chondroitin may result in increased effects on coagulation, including elevated International Normalized Ratio (INR) and bleeding. PREDISPOSING FACTORS: The risk for bleeding episodes may be greater in patients with disease-associated factors (e.g. thrombocytopenia). Drug associated risk factors include concurrent use of multiple drugs which inhibit anticoagulant/antiplatelet metabolism and/or have an inherent risk for bleeding (e.g. NSAIDs). PATIENT MANAGEMENT: Use caution with adding or discontinuing glucosamine-chondroitin to warfarin therapy. Monitor patients receiving concurrent therapy closely for elevated INR and signs of bleeding. Patients who discontinue glucosamine-chondroitin may need their warfarin dosage adjusted to maintain therapeutic INRs. If concurrent therapy is warranted, monitor patients receiving concurrent therapy for signs of blood loss, including decreased hemoglobin, hematocrit, fecal occult blood, and/or decreased blood pressure and promptly evaluate patients with any symptoms. When applicable, perform agent-specific laboratory test (e.g. INR, aPTT) to monitor efficacy and safety of anticoagulation. Discontinue anticoagulation in patients with active pathologic bleeding. Instruct patients to report any signs and symptoms of bleeding, such as unusual bleeding from the gums or nose; unusual bruising; red or black, tarry stools; red, pink or dark brown urine; acute abdominal or joint pain and/or swelling. The time of highest risk for a coumarin-type drug interaction is when the precipitant drug is initiated or discontinued. Contact the prescriber before initiating, altering the dose or discontinuing either drug. DISCUSSION: There have been numerous reports of increased INR following the addition of glucosamine, glucosamine-chondroitin, or chondroitin alone to warfarin therapy, including 20 from the United States Food Drug Administration (US FDA), 22 from the World Health Organization (WHO), 3 from the Australian Therapeutic Goods Association (TGA), and 2 published reports. INR values typically increased between two and 20 days after the addition of glucosamine and/or chondroitin to warfarin therapy. In most cases, patients were asymptomatic; however, there were at least two reports of bleeding.(4-8) There has also been one report involving glucosamine and acenocoumarol.(9)	DICUMAROL, JANTOVEN, WARFARIN SODIUM
Nadolol/Green Tea SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Nadolol is a substrate of OATP1A2, an influx transporter found in intestinal epithelium. Green tea catechins inhibit several drug transporters, including OATP1A2, leading to decreased absorption of nadolol. P-glycoprotein may also be involved, however no studies have confirmed its role. CLINICAL EFFECTS: Concomitant use of nadolol with green tea or green tea catechins may decrease the effectiveness of nadolol.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Advise patients maintained on nadolol to avoid green tea and green tea supplements. DISCUSSION: In a randomized crossover study in 10 healthy subjects, concurrent use of nadolol (30 mg daily) and green tea (700 mL/day), decreased the maximum concentration (Cmax) and area-under-curve (AUC) of nadolol by 85.3% and 85%, respectively. Pharmacodynamic parameters assessed included pulse rate, systolic blood pressure, and diastolic blood pressure. Although all parameters were affected slightly, nadolol's systolic blood pressure lowering effect was significantly suppressed (p = 0.042).(1)	CORGARD, NADOLOL
Colesevelam/Fat Soluble Vitamins SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Colesevelam may decrease the absorption of fat-soluble vitamins A, D, E, and K.(1) CLINICAL EFFECTS: Colesevelam may reduce absorption of fat soluble vitamins, leading to a deficiency state. PREDISPOSING FACTORS: A pre-existing deficiency of fat soluble vitamins (A,D,E and K) or chronic malabsorption syndrome. PATIENT MANAGEMENT: The inhibition of fat soluble vitamin absorption by colesevelam should be borne in mind during implementation of a vitamin supplementation strategy. Oral multivitamin supplements should be taken at least four hours before the dose of colesevelam.(1) DISCUSSION: Colesevelam may decrease the absorption of fat-soluble vitamins A, D, E, and K.(1)	COLESEVELAM HCL, WELCHOL
Migalastat/Caffeine-Containing Products SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The mechanism of this interaction is unknown. CLINICAL EFFECTS: Concurrent use of a caffeine-containing product may result in decreased levels and effectiveness of migalastat.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Avoid coadministration of migalastat with caffeine-containing products. Do not administer caffeine-containing products within 2 hours before and 2 hours after taking migalastat.(1) DISCUSSION: Coadministration of migalastat with caffeine 190 mg decreased the migalastat maximum concentration (Cmax) by 60% and area-under-curve (AUC) by 55%.(1)	GALAFOLD

The following contraindication information is available for COSAMIN ASU (glucosamine hcl/chondroitin sulfate a sodium/herbal no.270):

Overview
Contraindicated
Severe
Moderate

Drug contraindication overview.

No enhanced Contraindications information available for this drug.

There are 0 contraindications.

There are 1 severe contraindications. Adequate patient monitoring is recommended for safer drug use.

Severe List
Insomnia

There are 4 moderate contraindications. Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.

Moderate List
Anxiety disorder
Disease of liver
Hypertension
No disease contraindications

More Frequent	Less Frequent
Abdominal pain with cramps Diarrhea Gastric acid hypersecretory conditions Heartburn Nausea	None.

Rare/Very Rare
Abdominal distension Constipation Diarrhea Dyspepsia Loose stools Nausea

The following precautions are available for COSAMIN ASU (glucosamine hcl/chondroitin sulfate a sodium/herbal no.270):

Pediatric
Pregnant
Lactation
Geriatric

No enhanced Pediatric Use information available for this drug.

Contraindicated

None

Severe Precaution

None

Management or Monitoring Precaution

None

No enhanced Pregnancy information available for this drug.

No enhanced Lactation information available for this drug.

No enhanced Geriatric Use information available for this drug.