Move Free

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


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Introduction

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


Background

Move sầu Free is a proprietary sản phẩm name for an array of multi-ingredient herbal and dietary supplements (MIDS) meant lớn ease joint discomfort. The Move Free brvà 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 & hyaluronic acid with various combinations of vitamins (Vi-Ta-Min D3), minerals (boron) and selected nutritional supplements such as krill oil & astaxanthin (a keto-carotenoid anti-oxidant). The ingredients và their concentrations in some of the products have sầu been modified over time. Previous Move Free products have sầu included mixtures of herbal agents including Chinese skullcap (Scutellaria baicalensis) & blachồng catechu (Acacia catechu). Presently, however, Move sầu Free products vày not danh sách any herbal constituents although several mention “Uniflex (FruiteX-B Calcium Fructoborate)”.

The common Move sầu Free products that are currently marketed are given in the Table below with a listing of their ingredients as provided in the product labels. Because the products are considered dietary supplements, they are not subject khổng lồ the usual efficacy and safety evaluation given khổng lồ medications. However, all nutritional supplements are subject to lớn rules regarding purity và 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 khổng lồ be generally safe & well tolerated, but prospective sầu studies of their efficacy, tolerance and safety have not been published.


Product NameConditionMajor Listed Ingredients
Move sầu Free 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 Free 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 Free Joint Health, NightJoint HealthGlucosamine (1.5 g), Chondroitin (200 mg), Melatonin (6 mg)
Move Free Ultra Faster Comfort JointJoint ComfortCalcium (35 mg), Calcium fructoborate (216 mg)
Move Free Ultra Tumeric & TamarindJoint ComfortProprietary Blkết thúc (250 mg): Tamarindus indicus (seed) extract & Curcuma longa (rhizome) extract, microcrystalline cellulose
Move Free Ultra, Triple ActionJoint HealthCartilage Blover (40 mg), Hyaluronic acid (3.3 mg), Boron (5 mg)
Move sầu Free Ultra, OmegaJoint HealthProprietary Blkết thúc (353 mg): Krill oil, Hyaluronic acid, Astaxanthin

Hepatotoxicity

The initial reports of liver injury attributed to lớn Move sầu Free were published in 2010, with subsequent reports in 2012 and 2013, all from the United States. These publications described an ađáng yêu hepatocellular injury arising within 1 khổng lồ 3 weeks of starting a Move Free hàng hóa that contained glucosamine, chondroitin & a proprietary herbal mixture of Chinese skullcap (Scutellaria baicalensis) và blachồng catechu (Acacia catechu). The injury was moderate in severity và resolved within 1 lớn 2 months of stopping the supplement. Immunoallergic & autoimmune features were not present, and the injury resolved without residual in all cases. One patient restarted the hàng hóa after at least partial recovery và redeveloped a similar pattern of liver injury. While further cases have sầu not been described, prospective sầu studies of drug induced liver injury from the United States mentioned 3 cases of axinh đẹp liver injury linked to lớn Move Free products, all from 2012-2013. At present, Move Free products vị not danh sách a proprietary herbal component but vì 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 lớn Move Free products has been reported lớn be due lớn Chinese skullcap, but the mechanism by which this herb might cause liver injury is unexplained. Indeed, Chinese skullcap has hepatoprotective sầu 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 lớn Move Free products has usually been mild-to-moderate in severity and self-limited in course, resolving in 1 to 2 months of stopping the preparations. Move sầu Free has not been linked to lớn instances of adễ thương liver failure, chronic hepatitis or vanishing bile duct syndrome. In patients presenting with ađáng yêu, unexplained liver injury, all HDS products should be discontinued and the case reported lớn federal registries. It is also helpful khổng lồ carefully define what products were being taken & at what doses và 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 and biochemical methods.

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


Case 1. Repeated episodes of adễ thương hepatitis after use of Move sầu Free.(1)

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


Medication:Pattern:Severity:Latency:Recovery:Other medications:
Move sầu Free 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 sầu Free Advanced restarted
2 weeks012062864.7Symptomatic
6 weeks4 weeks1201260.9Asymptomatic
Normal Values<60<132<1.2

Comment

An elderly woman with osteoarthritis developed an adễ thương hepatitis a few weeks after starting an herbal & dietary supplement called “Move Free Advanced” that was thought to lớn contain glucosamine and chondroitin only, neither of which are considered hepatotoxic. No other cause for the hepatitis was identified, and her physicians assured her that glucosamine & 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 sầu Free Advanced also listed a “proprietary” mixture of herbal agents which included Chinese skullcap (Scutellaria baicalensis) và blachồng 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 & 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 và the injury may have sầu been due khổng lồ a contaminant or misidentified constituent in the proprietary mixture. Current formulations of Move sầu Free products vày not mention Chinese skullcap as an ingredient.


PRODUCT INFORMATION

REPRESENTATIVE TRADE NAMES

Move Free®

DRUG CLASS

Herbal và 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 hepatoxithành phố from Chinese skullcap: A case report. World J Hepatol. 2012;4:231–3.

ANNOTATED BIBLIOGRAPHY

References updated: 26 February 2020

Abbreviations: HDS, herbal & dietary supplements.


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