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Glucosamine

Biochemistry

Glucosamine was first prepared in 1876 by Dr. Georg Ledderhose by the hydrolysis of chitin with concentrated hydrochloric acid. The stereochemistry was not fully defined until the 1939 work of Walter Haworth. D-Glucosamine is made naturally in the form of glucosamine-6-phosphate, and is the biochemical precursor of all nitrogen-containing sugars. Specifically, glucosamine-6-phosphate is synthesized from fructose 6-phosphate and glutamine as the first step of the hexosamine biosynthesis pathway. The end-product of this pathway is UDP-N-acetylglucosamine (UDP-GlcNAc), which is then used for making glycosaminoglycans, proteoglycans, and glycolipids.

As the formation of glucosamine-6-phosphate is the first step for the synthesis of these products, glucosamine may be important in regulating their production; however, the way that the hexosamine biosynthesis pathway is actually regulated, and whether this could be involved in contributing to human disease remains unclear.

Indications

Oral glucosamine is marketed as a treatment of osteoarthritis. Commonly sold forms of glucosamine are glucosamine sulfate and glucosamine hydrochloride. Glucosamine is often sold in combination with other supplements such as chondroitin sulfate and methylsulfonylmethane.

Glucosamine may take weeks to months before improvements in symptoms are noticed.

Restoration of cartilage

A 2009 review concluded that "Little evidence suggests that glucosamine is superior to a placebo treatment in restoring articular cartilage."

Osteoarthritis pain

A 2009 scientific review of available studies concluded that glucosamine sulfate, glucosamine hydrochloride, and chondroitin sulfate have individually shown inconsistent efficacy in decreasing OA pain, but many studies confirmed OA pain relief with glucosamine and chondroitin sulfate in combined use.

Health effects

Since glucosamine is a precursor for glycosaminoglycans, and glycosaminoglycans are a major component of joint cartilage, supplemental glucosamine may help to prevent cartilage degeneration and treat arthritis. Its use as a therapy for osteoarthritis appears safe, but there is conflicting evidence as to its effectiveness. A Cochrane 2005 meta-analysis of glucosamine for osteoarthritis found that only "Rotta" preparations (including older studies) found beneficial effects for pain and functional impairment. It also found that when only the studies using the highest-quality design were considered, there was no effect above placebo. In addition, in vitro analysis of glucosamine has revealed that glucosamine inhibits cartilage cell characteristics. Studies reporting beneficial effects have generally used glucosamine sulfate. Chondroitin sulfate is sometimes used in conjunction, and animal studies suggest that chondroitin may increase its efficacy. Two recent randomized, double-blind controlled trials have found no effect beyond placebo in reducing pain, while one found an effect beyond placebo.

Use

A typical dosage of glucosamine salt is 1,500 mg per day. Glucosamine contains an amino group that is positively charged at physiological pH. The anion included in the salt may vary. The amount of glucosamine present in 1500 mg of glucosamine salt will depend on which anion is present and whether additional salts are included in the manufacturer's calculation. Glucosamine and chondroitin are "apparently poor candidates for transdermal [through the skin] absorption", but glucosamine's metabolite N-acetyl-D-glucosamine (NAG) appears to be a better candidate. The ability of NAG to permeate the skin is enhanced by ethanol and dimethyl sulfoxide (DMSO). DMSO is used to help deliver drugs in veterinary care, but is not approved for use on humans.

Glucosamine is a popular alternative medicine used by consumers for the treatment of osteoarthritis. Glucosamine is also extensively used in veterinary medicine as an unregulated but widely accepted supplement.

Contraindications

Clinical studies have consistently reported that glucosamine appears safe.

Allergy

Since glucosamine is usually derived from shellfish, those allergic to shellfish may wish to avoid it; however, since glucosamine is derived from the shells of these animals while the allergen is within the flesh of the animals, it is probably safe even for those with shellfish allergy. Alternative sources using fungal fermentation of corn are available.

Some commercially sold glucosamine supplements have other questionable ingredients added such as chinese skullcap, in addition to the more typical chondroitin, and MSM which is often seen too. "Allergic" type reaction may well be to these other ingredients and not the shellfish. People with reactions to these concoctions should also look at such things as red dyes and other needless additives. As noted above, the shellfish warning is just that warningresumably done by the lawyers and not because of a real problem.[citation needed] First hand experience with these since they first appeared in the USA has shown that the "red" pills are much more likely to cause a reaction, and the white ones do not unless chinese skullcap or other herbal additives are also included.[original research?]

Glucose metabolism

Another concern has been that the extra glucosamine could contribute to diabetes by interfering with the normal regulation of the hexosamine biosynthesis pathway, but several investigations have found no evidence that this occurs. A review conducted by Anderson et al. in 2005 summarizes the effects of glucosamine on glucose metabolism in in vitro studies, the effects of oral administration of large doses of glucosamine in animals and the effects of glucosamine supplementation with normal recommended dosages in humans, concluding that glucosamine does not cause glucose intolerance and has no documented effects on glucose metabolism. It should be mentioned that the authors of the above mentioned review paper (Anderson et. al.) were financially supported by Cargill, Incorporated, Eddyville, IA, a manufacturer of glucosamine as mentioned in the acknowledgments section of the paper. Other studies conducted in lean or obese subjects concluded that oral glucosamine at standard doses does not cause or significantly worsen insulin resistance or endothelial dysfunction.

Legal status

United States

In the United States, glucosamine is not approved by the Food and Drug Administration for medical use in humans. Since glucosamine is classified as a dietary supplement in the US, safety and formulation are solely the responsibility of the manufacturer; evidence of safety and efficacy is not required as long as it is not advertised as a treatment for a medical condition. The U.S. National Institutes of Health is currently conducting a study of supplemental glucosamine in obese patients, since this population may be particularly sensitive to any effects of glucosamine on insulin resistance.

Europe

In Europe, glucosamine is approved as a medical drug and is sold in the form of glucosamine sulphate. In this case, evidence of safety and efficacy is required for the medical use of glucosamine and several guidelines have recommended its use as an effective and safe therapy for osteoarthritis. The Task Force of the European League Against Rheumatism (EULAR) committee has granted glucosamine sulphate a level of toxicity of 5 in a 0-100 scale, and recent OARSI (OsteoArthritis Research Society International) guidelines for hip and knee osteoarthritis also confirm its excellent safety profile.

Bioavailability and pharmacokinetics

Two recent studies confirm that glucosamine is bioavailable both systemically and at the site of action (the joint) after oral administration of crystalline glucosamine sulfate in osteoarthritis patients. Steady state glucosamine concentrations in plasma and synovial fluid were correlated and in line with those effective in selected in vitro studies.

The bioavailability of glucosamine sulfate is around 20%.

Natural sources

Glucosamine is naturally present in the shells of shellfish, animal bones and bone marrow. It is also present in some fungi, such as Aspergillus niger.

Pharmacodynamics

The possible effects of glucosamine sulfate in patients with osteoarthritis may be the result of its anti-inflammatory activity, the stimulation of the synthesis of proteoglycans, and the decrease in catabolic activity of chondrocytes inhibiting the synthesis of proteolytic enzymes and other substances that contribute to damage cartilage matrix and cause death of articular chondrocytes.

Glucosamine is an essential substrate in the natural formation of the GAG matrix.

Glucosamine is thought to stimulate synovial production of hyaluronic acid and is also claimed to inhibit cartilage degrading liposomal enzymes.

Clinical studies

There have been multiple clinical trials of glucosamine as a medical therapy for osteoarthritis, but results have been conflicting. The evidence both for and against glucosamine's efficacy has led to debate among physicians about whether to recommend glucosamine treatment to their patients.

Multiple clinical trials in the 1980s and 1990s, all sponsored by the European patent-holder, Rottapharm, demonstrated a benefit for glucosamine. However, these studies were of poor quality due to shortcomings in their methods, including small size, short duration, poor analysis of drop-outs, and unclear procedures for blinding. Rottapharm then sponsored two large (at least 100 patients per group), three-year-long, placebo-controlled clinical trials of the Rottapharm brand of glucosamine sulfate. These studies both demonstrated a clear benefit for glucosamine treatment. There was not only an improvement in symptoms but also an improvement in joint space narrowing on radiographs. This suggested that glucosamine, unlike pain relievers such as NSAIDs, can actually help prevent the destruction of cartilage that is the hallmark of osteoarthritis. On the other hand, several subsequent studies, independent of Rottapharm, but smaller and shorter, did not detect any benefit of glucosamine.

Due to these controversial results, some reviews and meta-analyses have evaluated the efficacy of glucosamine. Richie et al. performed a meta-analysis of randomized clinical trials in 2003 and found efficacy for glucosamine on VAS and WOMAC pain, Lequesne index and VAS mobility and good tolerability.

Recently, a review by Bruyere et al. about glucosamine and chondroitin sulfate for the treatment of knee and hip osteoarthritis concludes that both products act as valuable symptomatic therapies for osteoarthritis disease with some potential structure-modifying effects.

This situation led the National Institutes of Health to fund a large, multicenter clinical trial (the GAIT trial) studying reported pain in osteoarthritis of the knee, comparing groups treated with chondroitin sulfate, glucosamine, and the combination, as well as both placebo and celecoxib. The results of this 6-month trial found that patients taking glucosamine HCl, chondroitin sulfate, or a combination of the two had no statistically significant improvement in their symptoms compared to patients taking a placebo. The group of patients who took celecoxib did have a statistically significant improvement in their symptoms. These results suggest that glucosamine and chondroitin did not effectively relieve pain in the overall group of osteoarthritis patients, but it should be interpreted with caution because most patients presented only mild pain (thus a narrow margin to appraise pain improvement) and because of an unusual response to placebo in the trial (60%). However, exploratory analysis of a subgroup of patients suggested that the supplements taken together (glucosamine and chondroitin sulfate) may be significantly more effective than placebo (79.2% versus 54%; p = 0.002) and a 10% higher than the positive control, in patients with pain classified as moderate to severe (see testing hypotheses suggested by the data).

In an accompanying editorial, Dr. Marc Hochberg also noted that "It is disappointing that the GAIT investigators did not use glucosamine sulfate ... since the results would then have provided important information that might have explained in part the heterogeneity in the studies reviewed by Towheed and colleagues" But this concern is not shared by pharmacologists at the PDR who state, "The counter anion of the glucosamine salt (i.e. chloride or sulfate) is unlikely to play any role in the action or pharmacokinetics of glucosamine". Thus the question of glucosamine's efficacy will not be resolved without further updates or trials.

In this respect, a 6-month double-blind, multicenter trial has been recently performed to assess the efficacy of glucosamine sulfate 1500 mg once daily compared to placebo and acetaminophen in patients with osteoarthritis of the knee (GUIDE study). The results showed that glucosamine sulfate improved the Lequesne algofunctional index significantly compared to placebo and the positive control. Secondary analyses, including the OARSI responder indices, were also significantly favorable for glucosamine sulfate.

A subsequent meta-analysis of randomized controlled trials, including the NIH trial by Clegg, concluded that hydrochloride is not effective and that there was too much heterogeneity among trials of glucosamine sulfate to draw a conclusion. In response to these conclusions, Dr. J-Y Reginster in an accompanying editorial suggests that the authors failed to apply the principles of a sound systematic review to the meta-analysis, but instead put together different efficacy outcomes and trial designs by mixing 4-week studies with 3-year trials, intramuscular/intraarticular administrations with oral ones, and low-quality small studies reported in the early 1980s with high-quality studies reported in 2007.

However, currently OARSI (OsteoArthritis Research Society International) is recommending glucosamine as the second most effective treatment for moderate cases of osteoarthritis. Likewise, recent European League Against Rheumatism practice guidelines for knee osteoarthritis grants to glucosamine sulfate the highest level of evidence, 1A, and strength of the recommendation, A.

A 2009 small study has concluded that glucosamine reduces cartilage turnover in osteoarthritis patients in response to physical training.

See also

Chitosan

Chitobiose

Methylsulfonylmethane

References

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^ Scientific Opinion of the Panel on Dietetic Products Nutrition and Allergies on a request from the European Commission on the safety of glucosamine hydrochloride from Aspergillus niger as food ingredient The EFSA Journal (2009) 1099, 1-19

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^ Cibere J, Kopec JA, Thorne A, et al. (October 2004). "Randomized, double-blind, placebo-controlled glucosamine discontinuation trial in knee osteoarthritis". Arthritis and Rheumatism 51 (5): 73845. doi:10.1002/art.20697. PMID 15478160. 

^ Richy F, Bruyere O, Ethgen O, Cucherat M, Henrotin Y, Reginster JY (July 2003). "Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis". Archives of Internal Medicine 163 (13): 151422. doi:10.1001/archinte.163.13.1514. PMID 12860572. 

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^ Clinicaltrials.gov

^ Towheed TE, Maxwell L, Anastassiades TP, et al. (2005). "Glucosamine therapy for treating osteoarthritis". Cochrane Database of Systematic Reviews (Online) (2): CD002946. doi:10.1002/14651858.CD002946.pub2. PMID 15846645. 

^ Hochberg MC (February 2006). "Nutritional supplements for knee osteoarthritis--still no resolution". The New England Journal of Medicine 354 (8): 85860. doi:10.1056/NEJMe058324. PMID 16495399. 

^ Vlad SC, LaValley MP, McAlindon TE, Felson DT (July 2007). "Glucosamine for pain in osteoarthritis: why do trial results differ?". Arthritis and Rheumatism 56 (7): 226777. doi:10.1002/art.22728. PMID 17599746. 

^ a b Reginster JY (July 2007). "The efficacy of glucosamine sulfate in osteoarthritis: financial and nonfinancial conflict of interest". Arthritis and Rheumatism 56 (7): 210510. doi:10.1002/art.22852. PMID 17599727. 

^ Petersen, G.; Saxne, T.; Heinegard, D.; Hansen, M.; Holm, L.; Koskinen, S.; Stordal, C.; Christensen, H. et al. (Jul 2009). "Glucosamine but not ibuprofen alters cartilage turnover in osteoarthritis patients in response to physical training1". Osteoarthritis and Cartilage 18: 34. doi:10.1016/j.joca.2009.07.004. ISSN 1063-4584. PMID 19679221.  edit

External links

Glucosamine article, Mayo Clinic

General Glucosamine and Chondroitin Sulfate information from the Arthritis Foundation.

"UDP-N-acetylglucosamine Biosynthesis," Diagram including IUBMB nomenclature and links.

PDR Health Summary of drug information on glucosamine from the publishers of the Physician's Desk Reference.

"Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT)," ClinicalTrials.gov registration and information.

"Effects of Oral Glucosamine on Insulin and Blood Vessel Activity in Normal and Obese People," ClinicalTrials.gov information.

"NIH News: Efficacy of Glucosamine and Chondroitin Sulfate May Depend on Level of Osteoarthritis Pain," Wednesday, February 22, 2006.

"Glucosamine and Chondroitin for Arthritis: Benefit is Unlikely," Summary of and commentary on research findings, including GAIT.

v  d  e

Dietary supplements

Types

Amino acids Bodybuilding supplement Energy drink Energy bar Fatty acids Herbal Supplements Minerals Prebiotics Probiotics (Lactobacillus, Bifidobacterium) Vitamins

Vitamins and minerals

Retinol (Vitamin A) B vitamins: Thiamine (B1) Riboflavin (B2) Niacin (B3) Pantothenic acid (B5) Pyridoxine (B6) Biotin (B7) Folic acid (B9) Cyanocobalamin (B12) Ascorbic acid (Vitamin C) Ergocalciferol and Cholecalciferol (Vitamin D) Tocopherol (Vitamin E) Naphthoquinone (Vitamin K) Calcium Choline Chlorine Chromium Cobalt Copper Fluorine Iodine Iron Magnesium Manganese Molybdenum Phosphorus Potassium Selenium Sodium Sulfur Zinc

Other common ingredients

AAKG Carnitine Chondroitin sulfate Cod liver oil Copper gluconate Creatine/Creatine supplements Dietary fiber Echinacea Elemental calcium Ephedra Fish oil Folic acid Ginseng Glucosamine Glutamine Grape seed extract Iron supplements Japanese Honeysuckle Krill oil Lingzhi Linseed oil Milk thistle Melatonin Red yeast rice Royal jelly Saw palmetto Spirulina St John's wort Taurine Wheatgrass Wolfberry Yohimbine Zinc gluconate

Related articles

Codex Alimentarius Enzyte Metabolife Hadacol Nutraceutical Multivitamin Nutrition

v  d  e

Anti-inflammatory products (M01A)

Pyrazolidine/Butylpyrazolidines

Ampyrone  Clofezone  Kebuzone  Metamizole  Mofebutazone  Oxyphenbutazone  Phenazone  Phenylbutazone  Sulfinpyrazone

Acetic acid derivatives

and related substances

Aceclofenac  Acemetacin  Alclofenac  Bromfenac  Bumadizone  Bufexamac  Diclofenac  Difenpiramide  Etodolac  Fentiazac  Indometacin  Ketorolac  Lonazolac  Oxametacin  Proglumetacin  Sulindac  Tolmetin  Zomepirac

Oxicams

Ampiroxicam  Droxicam  Lornoxicam  Meloxicam  Piroxicam  Tenoxicam

Propionic acid derivatives

Alminoprofen  Benoxaprofen  Dexibuprofen  Dexketoprofen  Fenbufen  Fenoprofen  Flunoxaprofen  Flurbiprofen  Ibuprofen  Ibuproxam  Indoprofen  Ketoprofen  Naproxen  Oxaprozin  Pirprofen  Suprofen  Tiaprofenic acid

Fenamates

Flufenamic acid  Meclofenamic acid  Mefenamic acid  Tolfenamic acid

Coxibs

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Wort $229.99 Jan Tormi Wort - Limited Edition

The Boiling of the Wort $11.92 An expert in the field writes an article about boiling wort in the beer-making process. This book contains classic material dating back to the 1900s and before. The content has been carefully selected for its interest and relevance to a modern audience.

Saint-John'S-Wort, 1613 $19.99 Basilius Besler Saint-John'S-Wort, 1613 - Giclee Print

Blackstonia Perfoliata, or Yellow-Wort $39.99 Stephen Sharnoff Blackstonia Perfoliata, or Yellow-Wort - Photographic Print

Wort Hotel $60.54 High Quality Content by WIKIPEDIA articles The Wort Hotel was built in downtown Jackson, Wyoming by brothers John and Jess Wort, who were significant figures in the transformation of the economy of Jackson Hole from ranching to tourism. The somewhat Tudorstyle building was the first luxury hotel in Jackson. The two story building features brick facing, with halftimbering and stucco on the second floor and a series of gables facing the street. Author: Surhone, Lambert M./ Tennoe, Mariam T./ Henssonow, Susan F. Binding Type: Paperback Number of Pages: 68 Publication Date: 2010/12/09 Language: English Dimensions: 6.00 x 9.02 x 0.16 inches

St. John Wort 100 Caps $6.82 St. John's Wort promotes a positive mood.

St Johns Wort 60 TABS $29.99 St Johns Wort Promotes emotional wellbeing.

St. John's Wort .3% 90 Cap $14.19 St. John's Wort .3%(St. John'S Wort by Kroeger Herbs).

The Wort Hotel $139 The Wort Hotel > JAC > 50 N Glenwood Rd > Jackson > WY > 83001>Location. This city center property is located in Jackson, close to Jackson Hole Historical Society and Museum and Playmill Theater. Also nearby are Jackson Town Square and Snow King Resort. Features. The Wort Hotel has a spa tub and a fitness facility. Business amenities include wireless Internet access, meeting rooms for small groups, and business services. The Wort Hotel has a restaurant, a bar/lounge, and a coffee shop/café. Room service is available during limited hours. Event facilities consist of a ballroom, exhibit space, conference rooms, and banquet facilities. This property provides a ski shuttle. This is a smoke free property (fines may apply for violations). Guestrooms. Amenities featured in guestrooms include air conditioning, coffee/tea makers, and free local calls. In addition, amenities available on request include refrigerators, microwaves, and hypo allergenic bedding. Guestrooms have televisions with premium TV channel(s). Business friendly amenities include multi line phones, desks, and voice mail. Complimentary bottled water is provided. Bathrooms feature shower/tub combinations, bathrobes, and designer toiletries. Guestroom services include a turndown service, in room massage, and housekeeping. Rollaway beds are available on request. All guestrooms at The Wort Hotel are non smoking. Notifications:Additional fees and deposits may be charged by the property at time of service, check in, or check out. >The preferred airport for The Wort Hotel is Jackson Hole, WY (JAC) 13.9 km / 8.6 mi. Distances are calculated in a straight line from the property’s location to the point of interest or airport and may not reflect actual travel distance. Distances are displayed to the nearest 0. 1 mile and kilometre.

Beim ersten klaren Wort, c.1923 $36.99 Max Ernst Beim ersten klaren Wort, c.1923 - Art Print

Field of St. John's Wort, Oregon $24.99 Inga Spence Field of St. John's Wort, Oregon - Photographic Print

Nature's Life's St Johns Wort 300mg 50Vcaps $10.59 Nature's Life's St Johns Wort 300mg 50Vcaps

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Nature's Way St. Johns Wort 180Caps $16.49 Nature's Way St. Johns Wort 180Caps

Source Naturals St. John's Wort 450� 45Tabs $9.98 Source Naturals St. John's Wort 450� 45Tabs

Source Naturals St. John's Wort 450� 90Tabs $18.5 Source Naturals St. John's Wort 450� 90Tabs

Source Naturals St. John's Wort 450� 180Tabs $34.98 Source Naturals St. John's Wort 450� 180Tabs

Source Naturals St. John's Wort 300mg 120Tabs $15.98 Source Naturals St. John's Wort 300mg 120Tabs

Aboca St. John Wort Flower 90 caps $14.49 Aboca St. John Wort Flower 90 caps

St. John's Wort Caps 180 Caps $10.39 St. John's Wort promotes a positive mood. St. John's Wort is very popular today in this stressful world.

St. Johns Wort T120 $11.99 St. Johns WortSt. John's Wort (Hypericum Perforatum) is suggested for the therapy of mild to moderate depression, viral infections, bacterial infections, menstrual cramps, AIDS/ HIV, and wound healing, and may take a few days to take effect as the body needs to load up on the constituents. St. John's Wort is one of today's most highly-recognized herbs. Research from Europe indicates that St. John's Wort plays a role in mood enhancement and maintaining a healthy, positive mental outlook.* *The FDA has not evaluated these statements.. (ST. JOHNS WRT BONUS by Natrol (incl Laci Le Beau Teas)).

JUMBO Wort Rummikub $19.99 JUMBO Wort RummikubJumbo Wort-Rummikub. das Buchstabenspiel mit dem bekannten Rummikub- Spielregeln ist beliebt bei allen, die gerne Kreuzworträtsel lösen oder mit den Wörtern spielen. durch die Vielfalt der Sprache wird dieses Spiel garantiert nie langweilig. für 2 bis 4 Spieler ab 8 Jahre. Achtung! Nicht für Kinder unter 3 Jahren geeignet, da Kleinteile verschluckt werden können. Erstickungsgefahr!

St. John's Wort 50 Vcaps $9.58 VegLife St. John's Wort extract contains 0.3% hypericin, the potency recommended in current research.

Mood Aid with St. John's Wort 60 Caps $9.74 Mood Aid with 5-HTP and St. John's Wort promotes a positive mood.

St. John's Wort Oil 1 OZ $9 St. John's Wort OilSt John's Wort - (Hypericum perforatum) - hypericum, the active compound, is now recognized as helping to improve mood. St John's Wort may indirectly influence serotonin levels in the brain. . (St. John's Wort Oil by Eclectic Institute Inc.).

St. Johns Wort STANDARDIZED , 50 VCAP $8.99 St. Johns WortSt John's Wort (Hypericum Perforatum) Promotes Emotional Balance.

Raindrop Clings To a Saint John's Wort Flower $39.99 White & Petteway Raindrop Clings To a Saint John's Wort Flower - Photographic Print

FoodScience's St John's Wort 90Caps $13.6 Description: St John's Wort 90Caps.--- An herbal supplement to support positivemood balance.*St. John?s Wort is standardized to yield 1 mg(3.33%) Hypericin per capsule.About St. John?s Wort? St. John?s Wort (hypericum perforatum) is aperennial shrubby plant with golden flowers? The term wort is an old English term forplant? St. John?s wort is cultivated worldwide, butgrows quite well in Northern California andSouthern Oregon? Contains flavanoids, tannins, and hypercinthat help to support Seratonin andNorepinepherine levels*? The maintenance of these brain chemicalshelps to keep proper mood balance*Supplements Facts:Serving Size: 1 CapsuleAmount Per ServingSt. John?s Wort (Hypericum perforatum)(aerial portions) Extract 333 mgYielding: Hypericin 1 mgOther ingredients: St. John?s Wort herb powder,gelatin, silicon dioxide, vegetable stearate.Directions: As a dietary supplement, take 1capsule, 1-3 times daily with meals.Warning: Do not take this product if you are takingany MAO inhibitors or antidepressants.Caution: Consumption of Hypericin may renderthe skin photosensitive. Care should be taken duringexposure to sunlight, tanning lights or UV sources. Ifyou are pregnant or lactating consult your health carepractitioner before taking this product.Sold Exclusively Through Retailers.

St. Johns Wort Tea 20bg $5.99 St. Johns Wort TeaSt. John's Wort Herb Tea is made of wild St. John's wort and Siberian ginseng. They contain hypericin, flavonoids, vitamins A, B2, selenium, cardiac glycoside, aromatic aglycone, etc. They tonify the nervous system, ease anxiety and depression, support the immune system and help maintain normal functions of the stomach, kidney, liver and heart, thus ideal for general well-being and vitality.. . (ST.JOHNS WRT by Health King).

Enzymatic's St.Johns Wort 60Caps $16.95 For Mental Well-Being Description : Your Most Trusted Source for St. John's WortPeople throughout the world rely on St. John's wort for mental well-being. More than 25 double-blind, controlled trials have confirmed the herb's support for stress and mood. Its two unique compounds, hypericins and hyperforin, are key to the extract's potent, beneficial effects.Clinically proven for overall well-beingPromotes positive moodEnzymatic Therapy's St. John's Wort Extract is standardized to deliver the same powerful effectiveness in each convenient, twice-per-day dose.This formula was developed in accordance with the safety and efficacy standards set forth by the German Commission E, which is the worldwide recognized authority for effective herbal remedies.Suggested Use Recommendations: One tablet twice daily.Supplement Facts Supplement FactsServing Size 1 tablet Amount per tablet%DVSt. John's Wort (Hypericum perforatum) Flower Head Extract standardized to contain a minimum of 0.3% hypericins450 mg****Daily Value not established. Supplement Facts: Serving Size 1Servings Per Container 60 Amount PerServing % DailyValue St. John'S Wort (Hypericum Perforatum) Flower Head Extract Standardized To Contain A Minimum Of 0.3% Hypericin And 3% Hyperforin 300 Mg N/A* * Daily value not established Other Ingredients: Gelatin, magnesium stearate, silicon dioxide, and titanium dioxide Directions: One capsule three times daily. Notes: Free of Sugar, salt, yeast, wheat, gluten, corn, soy, dairy products, artificial flavoring, or preservatives. Warning: Due to the St. John's wort extract, in extremely rare cases, light-skinned people may experience a sensitivity to excessive sun exposure. If taking prescription drug, consult your physician prior to use. This product is not intended to diagnose, treat, cure, or prevent any disease

St. John' s Wort 1 Oz with Alcohol $10.4 St. John' s WortSt John's Wort - (Hypericum perforatum) - hypericum, the active compound, is now recognized as helping to improve mood. St John's Wort may indirectly influence serotonin levels in the brain.. (St. John's Wort Extract by Eclectic Institute Inc.).

St. John' s Wort 2 Oz with Alcohol $20 St. John' s WortSt John's Wort - (Hypericum perforatum) - hypericum, the active compound, is now recognized as helping to improve mood. St John's Wort may indirectly influence serotonin levels in the brain.. (St. John's Wort Extract by Eclectic Institute Inc.).

Solaray's St. Johns Wort 325mg 100Caps $10.49 St. John's Wort beautiful yellow flowers bloom around St. John's Day, hence its name. Wort is an old English word for plant.Directions: As a dietary supplement, take 1 or 2 capsules two times a day with meals or a glass of water.Ingredients: St. John's Wort (Hypericum perforatum) (aerial) 325 mg

Solaray's St. Johns Wort 325mg 180Caps $17.49 St. John's Wort beautiful yellow flowers bloom around St. John's Day, hence its name. Wort is an old English word for plant.Directions: As a dietary supplement, take 1 or 2 capsules two times a day with meals or a glass of water.Ingredients: St. John's Wort (Hypericum perforatum) (aerial) 325 mg