Pycnogenol® is the patented trade name for a water extract of the bark of the French maritime pine ( Pinus pinaster ssp. atlantica ), which is grown in coastal southwest France. Pycnogenol® contains oligomeric proanthocyanidins (OPCs) as well as several other bioflavonoids: catechin, epicatechin, phenolic fruit acids (such as ferulic acid and caffeic acid), and taxifolin. Procyanidins are oligometric catechins found at high concentrations in red wine, grapes, cocoa, cranberries, apples, and some supplements such as Pycnogenol®.
There has been some confusion in the U.S. market regarding OPC products containing Pycnogenol® or grape seed extract (GSE) because one of the generic terms for chemical constituents ("pycnogenols") is the same as the patented trade name (Pycnogenol®). Some GSE products were formerly erroneously labeled and marketed in the U.S. as containing "pycnogenols." Although GSE and Pycnogenol® do contain similar chemical constituents (primarily in the OPC fraction), the chemical, pharmacological, and clinical literature on the two products are distinct. The term Pycnogenol® should therefore only be used to refer to the specific proprietary pine bark extract. Scientific literature regarding this product should not be referenced as a basis for the safety or effectiveness of GSE.
Synonyms
Cocklebut, condensed tannins, Evelle® (vitamins C and E, carotenoids, selenium, zinc, amino acids, glycosaminoglycans, blueberry extract, Pycnogenol®), French maritime pine bark extract, French Pinus maritime bark, grape marc extract, leucoanthocyanidins, Pinus pinaster , Pinus maritima , oligomeric proanthocyanidin complexes (OPCs), Pinaceae (family), proanthocyanidins, PYC, pygenol, stickwort, Zinopin® (Pycnogenol® and Standardized Ginger Root Extract (SGRE)).
Evidence
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Uses based on scientific evidence
Grade*
AsthmaPycnogenol® may offer clinical benefit to both children and adults with asthma. Additional study is needed before a strong recommendation can be made.
B
Chronic venous insufficiencyChronic venous insufficiency (CVI) is a syndrome that includes leg swelling, varicose veins, pain, itching, skin changes, and skin ulcers. The term is more commonly used in Europe than in the United States. Pycnogenol® used in people with chronic venous insufficiency is reported to reduce edema and pain. Pycnogenol® may also be used in the management of other CVI symptoms.
B
AntioxidantDue to conflicting study results, it is unclear if Pycnogenol® has significant antioxidant effects in humans. Further research is necessary.
C
Attention deficient hyperactivity disorder (ADHD)Pycnogenol® has been used in adult patients with ADHD to improve concentration, but does not appear to be more effective than placebo. Further research is necessary in this area before a firm conclusion can be reached.
C
Cramps (muscular pain)Pycnogenol® may effectively prevent cramps, muscular pain at rest, and pain after/during exercise in normals, in athletes prone to cramps, in patients with venous disease, in claudicants, and in diabetics with microangiopathy. Further high quality trails are needed to make a firm recommendation.
C
DiabetesSupplementation of Pycnogenol® with conventional diabetes treatment may lower glucose levels and improve endothelial function. Further research is needed to confirm these results.
C
Diabetic microangiopathySupplementation with Pycnogenol® may improve symptoms associated with diabetic microangiopathy. Further research is needed to confirm these results.
C
Dysmenorrhea (painful menstruation)Preliminary human data shows that Pycnogenol® may have a potential analgesic (pain relieving) effect on menstrual pain. Further research is needed to confirm these results.
C
Edema (in patients with high blood pressure)Edema occurs when fluid builds up in body tissues causing swelling. Some drugs used to treat high blood pressure may cause edema. Early research suggests that Pycnogenol® may help treat edema linked to calcium antagonist (nifedipine) or angiotensin-converting enzyme inhibitors. More research is needed in this area.
C
Erectile dysfunctionPycnogenol®, in combination with L-arginine, may cause an improvement in sexual function in men with erectile dysfunction. It is not known what effect each of the individual compounds may have directly on this condition. Further research is needed.
C
Gingival bleeding / plaqueChewing gum containing Pycnogenol® is reported to minimize gingival bleeding and plaque formation. Pycnogenol® has also been added to toothpaste for a potential antioxidant effect. Further research is needed to confirm these results.
C
High blood pressureUse of Pycnogenol® may reduce the need for nifedipine and decrease systolic blood pressure in patients with high blood pressure. Further research is needed to confirm these results.
C
High cholesterolPycnogenol® may reduce low-density lipoprotein (LDL/"bad cholesterol") levels and increase high-density lipoprotein (HDL/"good cholesterol") levels. However, some studies have reported decreases in total cholesterol and LDL levels with no change in HDL. Due to conflicting data, further studies are necessary.
C
Male infertilityHuman studies report that Pycnogenol® may improve sperm quality and function in sub-fertile men. Further research is needed to confirm these results.
C
Melasma (chloasma)Melasma (or chloasma) is a common disorder of hyperpigmentation of the skin predominately affecting sun-exposed areas in women. Formations of tan or brown patches/spots may occur. Pycnogenol® has been reported to decrease the darkened area and the pigment intensity of melasma and improve symptoms of fatigue, constipation, body pains, and anxiety. Further research is needed before a clear recommendation can be made.
C
Menopausal symptomsEarly research suggests that Pycnogenol® may help reduce menopausal symptoms without causing side effects. Additional research is needed to determine if this treatment is safe and effective.
C
MigraineA combination of pine bark extract containing vitamin C and vitamin E may help reduce the frequency and severity of migraines. However, the effects of pine bark extract alone are unknown because other supplements were also used. More research with Pycnogenol® alone is needed.
C
Platelet aggregationOne human study reports reduced platelet aggregation in smokers. Further research is needed before a clear conclusion can be reached.
C
Prevention of blood clots/edema during long airplane fightsPreliminary human study suggests that Pycnogenol® treatment may be effective in decreasing the number of thrombotic events (DVT and SVT) in moderate-to-high risk subjects during long-haul flights. Edema (swelling) may also be reduced. Further research is needed to confirm these results.
C
RetinopathySeveral studies report benefits of Pycnogenol® in the treatment and prevention of retinopathy, including slowing the progression of retinopathy in diabetics. Better-quality research is needed before a firm conclusion can be reached.
C
SunburnPycnogenol®, taken by mouth, may reduce erythema (redness of the skin) caused by solar ultraviolet light. Further study is needed before a recommendation can be made.
C
Systemic lupus erythematosus (SLE)Pycnogenol® may be useful as a second line therapy to reduce inflammatory features of SLE. Further research is needed before a recommendation can be made.
C
Venous leg ulcersPycnogenol® may be useful for reduction of leg ulcers. Further research is needed before a recommendation can be made.
C
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
In general, 25-360 milligrams has been taken by mouth in divided doses daily. For gum health, 5 milligrams Pycnogenol® in chewing gum for 14 days has been used.
Pycnogenol® appears to be absorbed into the bloodstream in about 20 minutes. Once absorbed, therapeutic effects are purported to last for approximately 72 hours, followed by excretion in the urine. Because of its astringent taste and occasional minor stomach discomfort, it may be best to take Pycnogenol® with or after meals
Children (younger than 18 years)
Due to insufficient data, Pycnogenol® is not recommended for use in children.
Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
Individuals should not take Pycnogenol® if allergic to it or any of its components.
Side Effects and Warnings
Pycnogenol® is generally reported as being well tolerated. Low acute and chronic toxicity with mild unwanted effects may occur in a small percentage of patients following oral administration. Because of its astringent taste and occasional minor stomach discomfort, it may be best to take Pycnogenol® with or after meals. To date, no serious adverse effects have been reported in the available scientific literature, although systematic study of safety is not available.
In theory, Pycnogenol® may alter blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary.
In theory, Pycnogenol® may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
Pregnancy & Breastfeeding
Pycnogenol® is not recommended during pregnancy or breastfeeding due to lack of scientific evidence.
Interactions
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Pycnogenol® may interact with other blood pressure lowering medications, specifically angiotensin converting enzyme inhibitors (ACE-I) such as benazepril (Lotensin®), captopril (Capoten®), enalapril (Vasotec®), fosinopril (Monopril®), lisinopril (Prinivil®), moexipril (Univasc®), perindopril (Aceon®), quinapril (Accupril®), ramipril (Altace®), trandolapril (Mavik®), or angiotensin converting enzyme receptor blockers such as losartan (Cozaar®), irbesartan (Avapro®), candesartan, cilexetil (Atacand®), or valsartan (Diovan®).
Pycnogenol® may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth (such as metformin, glyburide, glipizide) or insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.
Pycnogenol® may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
Pycnogenol® may interfere with immunosuppressant or immunostimulant drugs. Pycnogenol® may also prevent fluoride induced kidney damage.
Pycnogenol® may have protective effects against alcohol's effects on brain neurons; further research is needed to confirm these results.
Interactions with Herbs and Dietary Supplements
Although data has yet to confirm this claim, it has been proposed that Pycnogenol® may increase vitamin C levels.
Pycnogenol® may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
Pycnogenol® may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba , and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
Pycnogenol® may interact with herbs and supplements that affect blood pressure. Pycnogenol® may interfere with immunosuppressant or immunostimulant herbs and supplements. Pycnogenol® and other antioxidants may have additive effects.
Methodology
This patient information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): James Ceurvels, PharmD (Northeastern University); Julie Conquer, PhD (RGB Consulting); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Nicole Giese, MS (Natural Standard Research Collaboration); Sooyoun Kang, PharmD (Massachusetts College of Pharmacy); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods, BS (Northeastern University).
Selected references
Belcaro G, Cesarone MR, Rohdewald P, et al. Prevention of venous thrombosis and thrombophlebitis in long-haul flights with pycnogenol. Clin Appl Thromb Hemost 2004 Oct;10(4):373-7.
Belcaro G, Cesarone MR, Errichi BM, et al. Venous ulcers: microcirculatory improvement and faster healing with local use of Pycnogenol Angiology 2005 Nov-Dec;56(6):699-705.
Belcaro G, Cesarone MR, Ricci A, et al. Control of edema in hypertensive subjects treated with calcium antagonist (nifedipine) or angiotensin-converting enzyme inhibitors with Pycnogenol. Clin Appl Thromb Hemost 2006 Oct;12(4):440-4.
Cesarone MR, Belcaro G, Rohdewald P, et al. Rapid relief of signs/symptoms in chronic venous microangiopathy with pycnogenol: a prospective, controlled study. Angiology 2006 Oct-Nov;57(5):569-76.
Cesarone, MR, Belcaro G, Rohdewald P, et al. Prevention of edema in long flights with pycnogenol. Clin Appl Thromb Hemost 2005;11(3):289-294.
Chayasirisobhon S. Use of a pine bark extract and antioxidant vitamin combination product as therapy for migraine in patients refractory to pharmacologic medication. Headache 2006 May;46(5):788-93.
Dvorakova M, Jezova D, Blazícek P, et al. Urinary catecholamines in children with attention deficit hyperactivity disorder (ADHD): modulation by a polyphenolic extract from pine bark (pycnogenol). Nutr Neurosci 2007 Jun-Aug;10(3-4):151-7.
Koch R. Comparative study of Venostasin and Pycnogenol in chronic venous insufficiency. Phytother Res 2002;16 Suppl 1:S1-S5.
Lau BH, Riesen SK, Truong KP, et al. Pycnogenol as an adjunct in the management of childhood asthma. J Asthma 2004;41(8):825-32.
Liu X, Wei J, Tan F, et al. Antidiabetic effect of Pycnogenol French maritime pine bark extract in patients with diabetes type II. Life Sci. 2004 Oct 8;75(21):2505-13.
Nikolova V, Stanislavov R, Vatev I, et al. [Sperm parameters in male idiopathic infertility after treatment with prelox]. Akush Ginekol (Sofiia) 2007;46(5):7-12.
Segger D, Schonlau F. Supplementation with Evelle improves skin smoothness and elasticity in a double-blind, placebo-controlled study with 62 women. J Dermatolog Treat 2004;15(4):222-226.
Stanislavov R, Nikolova V. Treatment of erectile dysfunction with pycnogenol and L-arginine. J Sex Marital Ther 2003;29(3):207-213.
Tenebaum S, Paull JC, Sparrow EP. An experimental comparison of Pycnogenol and methylphenidate in adults with Attention-Deficit/Hyperactivity Disorder (ADHD). J Atten Disord 2002;6(2):49-60.
Yang HM, Liao MF, Zhu SY, et al. A randomised, double-blind, placebo-controlled trial on the effect of Pycnogenol on the climacteric syndrome in peri-menopausal women. Acta Obstet Gynecol Scand 2007;86(8):978-85.
