Schiff Move Free Advanced Joint Health Supplement 170Cap

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LiverTox: Clinical và Research Information on Drug-Induced Liver Injury . Bethesda (MD): National Institute of Diabetes và Digestive & Kidney Diseases; 2012-.


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Introduction

Move không tính phí is a proprietary line of multi-ingredient dietary supplements (MIDS) marketed as sida for joint health và “to help ease joint discomfort, maintain strength and flexibility & help support and nourish cartilage”. The major ingredients in the products include glucosamine, chondroitin, hyaluronic acid and methylsufonylmethane (MSM). There have been several reports of clinically apparent liver injury in patients taking Move không lấy phí products; however, the specific ingredient(s) in the various products that might cause liver injury has not been identified and these ingredients may no longer be included in currently available products.


Background

Move miễn phí is a proprietary product name for an array of multi-ingredient herbal and dietary supplements (MIDS) meant to ease joint discomfort. The Move miễn phí brand is currently produced by Reckitt Benckiser Group plc (Slough, England) which purchased its previous distributor, Schiff Nutrition International (Salt Lake City, UT), in 2012. The constituents of the various Move free products vary, but are largely glucosamine, chondroitin và hyaluronic acid with various combinations of vitamins (vitamin D3), minerals (boron) và selected nutritional supplements such as krill oil và astaxanthin (a keto-carotenoid anti-oxidant). The ingredients & their concentrations in some of the products have been modified over time. Previous Move miễn phí products have included mixtures of herbal agents including Chinese skullcap (Scutellaria baicalensis) & black catechu (Acacia catechu). Presently, however, Move không tính phí products bởi not các mục any herbal constituents although several mention “Uniflex (FruiteX-B Calcium Fructoborate)”.

The common Move miễn phí products that are currently marketed are given in the Table below with a listing of their ingredients as provided in the sản phẩm labels. Because the products are considered dietary supplements, they are not subject khổng lồ the usual efficacy and safety evaluation given lớn medications. However, all nutritional supplements are subject to rules regarding purity and good manufacturing practices. Dietary supplements are not recommended for specific medical conditions, but can be advertised as being supportive of general health or a specific tissue or organ health. These multi-ingredient products appear to lớn be generally safe và well tolerated, but prospective studies of their efficacy, tolerance & safety have not been published.


Product NameConditionMajor Listed Ingredients
Move miễn phí Joint Health, AdvancedJoint HealthGlucosamine (1.5 g), Chondroitin (200 mg), Hyaluronic acid (3.3 mg), “Uniflex” FruiteX-B Calcium Fructoborate (216 mg).
Move free Joint Health, Advanced Plus with MSMJoint HealthGlucosamine (1.5 g), Chondroitin (200 mg), Methylsulfonylmethane (MSM: 1.5 g), Hyaluronic acid (3.3 mg), “Uniflex” FruiteX-B Calcium Fructoborate (216 mg).
Move không tính phí Joint Health, Advanced Plus MSM & vitamin D3Joint HealthGlucosamine (1.5 g), Chondroitin (200 mg), Methylsulfonylmethane (MSM: 750 mg), vitamin D3 (2000 IU), Hyaluronic acid (3.3 mg), Uniflex” FruiteX-B Calcium Fructoborate (216 mg).
Move không lấy phí Joint Health, NightJoint HealthGlucosamine (1.5 g), Chondroitin (200 mg), Melatonin (6 mg)
Move không tính phí Ultra Faster Comfort JointJoint ComfortCalcium (35 mg), Calcium fructoborate (216 mg)
Move không lấy phí Ultra Tumeric & TamarindJoint ComfortProprietary Blend (250 mg): Tamarindus indicus (seed) extract and Curcuma longa (rhizome) extract, microcrystalline cellulose
Move miễn phí Ultra, Triple ActionJoint HealthCartilage Blend (40 mg), Hyaluronic acid (3.3 mg), Boron (5 mg)
Move không tính tiền Ultra, OmegaJoint HealthProprietary Blend (353 mg): Krill oil, Hyaluronic acid, Astaxanthin

Hepatotoxicity

The initial reports of liver injury attributed to lớn Move free were published in 2010, with subsequent reports in 2012 & 2013, all from the United States. These publications described an acute hepatocellular injury arising within 1 to 3 weeks of starting a Move không lấy phí product that contained glucosamine, chondroitin and a proprietary herbal mixture of Chinese skullcap (Scutellaria baicalensis) & black catechu (Acacia catechu). The injury was moderate in severity và resolved within 1 lớn 2 months of stopping the supplement. Immunoallergic and autoimmune features were not present, và the injury resolved without residual in all cases. One patient restarted the hàng hóa after at least partial recovery and redeveloped a similar pattern of liver injury. While further cases have not been described, prospective studies of drug induced liver injury from the United States mentioned 3 cases of acute liver injury linked lớn Move không lấy phí products, all from 2012-2013. At present, Move không tính phí products vày not menu a proprietary herbal component but vì chưng mention a proprietary mineral complex with a similar name: “Uniflex”.

Likelihood score: C (probable rare cause of clinically apparent liver injury).

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Mechanism of Injury

The liver injury attributed to Move không tính tiền products has been reported to lớn be due khổng lồ Chinese skullcap, but the mechanism by which this herb might cause liver injury is unexplained. Indeed, Chinese skullcap has hepatoprotective activity in animal models of liver disease. Contamination or misidentification of the herbal components is always a possibility in explaining the appearance of liver injury.


Outcome and Management

The liver injury that has been attributed to Move free products has usually been mild-to-moderate in severity and self-limited in course, resolving in 1 to lớn 2 months of stopping the preparations. Move không lấy phí has not been linked to instances of acute liver failure, chronic hepatitis or vanishing bile duct syndrome. In patients presenting with acute, unexplained liver injury, all HDS products should be discontinued & the case reported khổng lồ federal registries. It is also helpful to lớn carefully define what products were being taken và at what doses & for how long. Retrieval of the actual sản phẩm or products can also be helpful as progress is being made in the identification of ingredients by advanced chemical & biochemical methods.

Drug Class: Herbal và Dietary Supplements, Nutritional Supplements, Multi-Ingredient


Case 1. Repeated episodes of acute hepatitis after use of Move Free.(1)

A 78 year old woman osteoarthritis developed jaundice within 3 weeks of starting “Move không lấy phí Advanced”, a proprietary multi-ingredient nutritional supplement advertised khổng lồ be helpful for joint discomfort. She had no history of liver disease, but had a previous cholecystectomy. She denied alcohol abuse and risk factors for viral hepatitis. She was taking no other medications except for multivitamins. On presentation, serum bilirubin was 7.2 mg/dL, alternative text 1626 U/L, AST 1053 U/L, alkaline phosphatase 354 U/L & GGT 599 U/L. Tests for hepatitis A, B & C were negative. She was hospitalized và the Move không lấy phí product was stopped. She began lớn improve without specific therapy và was discharged after a few days (Table). Because her joint symptoms worsened, she restarted the Move không tính tiền product and redeveloped jaundice within two weeks. Her laboratory tests were again abnormal in a pattern similar to the initial episode. A liver biopsy showed acute hepatocellular injury with many eosinophils suggestive of drug induced liver injury. Tests for autoantibodies were negative & a CT scan of the abdomen showed no evidence of biliary obstruction or hepatic masses. At this point, the nutritional supplement was suspected khổng lồ be the cause & was found to be Move không tính tiền Advanced and have glucosamine, chondroitin và two herbal ingredients, Chinese skullcap and black catechu listed together as “Uniflex Proprietary Extract: 200 mg”. She was told to lớn avoid its further use and in follow up her symptoms resolved và liver tests improved.


Medication:Pattern:Severity:Latency:Recovery:Other medications:
Move không tính tiền Advanced
Hepatocellular (R=10)
3+ (jaundice, hospitalization)
3 weeks initially, 2 weeks on rechallenge
Not specified
Multivitamins

Time AfterStartingTime AfterStoppingALT(U/L)Alk P(U/L)Bilirubin(mg/dL)Other
3 weeks016263547.2Presentation
5 weeks2 weeks6782792.3Asymptomatic
Move không tính tiền Advanced restarted
2 weeks012062864.7Symptomatic
6 weeks4 weeks1201260.9Asymptomatic
Normal Values<60<132<1.2

Comment

An elderly woman with osteoarthritis developed an acute hepatitis a few weeks after starting an herbal & dietary supplement called “Move miễn phí Advanced” that was thought lớn contain glucosamine và chondroitin only, neither of which are considered hepatotoxic. No other cause for the hepatitis was identified, and her physicians assured her that glucosamine and chondroitin were not the reason for the liver injury. Upon restarting the multi-ingredient nutritional supplement, however, she redeveloped jaundice. On closer inspection, the hàng hóa label of Move free Advanced also listed a “proprietary” mixture of herbal agents which included Chinese skullcap (Scutellaria baicalensis) & black catechu (Acacia catechu). Chinese skullcap had been implicated in rare cases of drug induced liver injury, although the association was not completely convincing. The recurrence of injury with a similar latency and pattern of enzyme elevations is very convincing evidence that the nutritional supplement was the likely cause of the episode, but the specific ingredient responsible is somewhat unclear and the injury may have been due lớn a contaminant or misidentified constituent in the proprietary mixture. Current formulations of Move không lấy phí products vị not mention Chinese skullcap as an ingredient.


PRODUCT INFORMATION

REPRESENTATIVE TRADE NAMES

Move Free®

DRUG CLASS

Herbal & Dietary Supplements

COMPLETE LABELING

Product labeling at DailyMed, National Library of Medicine, NIH


DRUGCAS REGISTRY NUMBERMOLECULAR FORMULASTRUCTURE
Chondroitin9007-27-6(C14-H21-N-O12)n-
Glucosamine3416-24-8C6-H13-N-O5
Hyaluronic Acid9004-61-9Unspecified

Yang L, Aronsohn A, Hart J, Jensen D. Herbal hepatoxicity from Chinese skullcap: A case report. World J Hepatol. 2012;4:231–3.

ANNOTATED BIBLIOGRAPHY

References updated: 26 February 2020

Abbreviations: HDS, herbal và dietary supplements.


Zimmerman HJ. Unconventional drugs. Miscellaneous drugs & diagnostic chemicals. In, Zimmerman, HJ. Hepatotoxicity: the adverse effects of drugs và other chemicals on the liver. 2nd ed. Philadelphia: Lippincott 1999: pp. 731-4.
(Expert đánh giá of hepatotoxicity published in 1999; Move không tính phí products, glucosamine, chondroitin & hyaluronic acid are not discussed).
Seeff L, Stickel F, Navarro VJ. Hepatotoxicity of herbals và dietary supplements. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013, pp. 631-58.
(Review of hepatotoxicity of herbal and dietary supplements ; does not mention Move không lấy phí products, glucosamine, chondroitin or hyaluronic acid).

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