Pycnogenol® (Pinus pinaster subsp. atlantica Villar)
DRUGS AND SUPPLEMENTS

Pycnogenol® (Pinus pinaster subsp. atlantica Villar)

March 22, 2017

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Pycnogenol® (Pinus pinaster subsp. atlantica Villar)

Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • Arbre d'or (French), bioflavonoid, borovice hvězdicovitá (Czech), caffeic acid, catechin, condensed tannins, epicatechin, French maritime pine bark extract, French Pinus maritime bark, ferulic acid, Maritime pine tree bark, merimänd (Estonian), Pinuspinaster, Pinusmaritima, oligomeric proanthocyanidin complexes, PCOs, phenolic fruit acid, pi marítim (Catalan), pi pinastre (Catalan), pin maritime (French), pin de Corte (French), pin mésogéen (French), pin des Landes (French), pin de Bordeaux (French), Pinaceae (family), pinastro (Italian, Spanish), pinheiro-bravo (Portuguese), pino costiero (Italian), pino gallego (Spanish), pino marítimo (Spanish), pino marittimo (Italian), pino resinero (Spanish), pino rodeno (Spanish), pino rubial (Spanish), proanthocyanidins, procyandiol oligomers, PYC, pygenol, Strandfyr (Danish), Strandkiefer (German), taxifolin, Terpentintall (Swedish).

  • Select combination products: Evelle® (vitamin C, vitamin E, carotenoids, selenium, zinc, amino acids, glycosaminoglycans, blueberry extract), GlucAffectTM (Pycnogenol®, Madeglucyl™, Silbinol®, Glucohelp, salacia, fish oil), Mirtogenol® (Mirtoselect® and Pycnogenol®), PycnoQ10® (Pycnogenol® and coenzyme Q10), Zinopin® (Pycnogenol® and standardized ginger root extract).

  • Note: Pinus pinaster is sometimes confused with Pinus halepensis or Pinus brutia Ten.

Background

  • Pycnogenol® is the registered trade name for a patented 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), as one of the generic terms for chemical constituents ("pycnogenols") is the same as the patented trade name (Pycnogenol®). Some GSE products have been 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 French maritime pine bark extract. Scientific literature regarding this product should not be referenced as a basis for the safety or effectiveness of GSE.

Scientific Evidence

Uses

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.

Grade*

Asthma

Pycnogenol® 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 insufficiency

Chronic 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

ADHD (Attention Deficient Hyperactivity Disorder)

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

Antioxidant

Due to conflicting study results, it is unclear if Pycnogenol® has significant antioxidant effects in humans. Further research is necessary.

C

Cognitive function

Initial clinical evidence suggests that Pycnogenol® may improve cognitive function in healthy, elderly individuals. Additional research is necessary to further evaluate this effect.

C

Diabetes

Supplementation of Pycnogenol® with conventional diabetes treatment may lower glucose levels and improve endothelial function. Further research is needed to confirm these results.

C

Diabetic microangiopathy

Supplementation 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

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 dysfunction

Pycnogenol®, 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 / plaque

Chewing 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

Glaucoma

Initial clinical evidence suggests that Pycnogenol® may decrease intraocular pressure. Additional research is necessary to further evaluate this effect.

C

High blood pressure

Use 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 cholesterol

Pycnogenol® 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 infertility

Human 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 symptoms

Early 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

Migraine

A 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

Muscle cramps

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

Osteoarthritis

Initial clinical evidence suggests that Pycnogenol® may reduce pain and inflammation in patients with osteoarthritis. Additional research is necessary to further evaluate this effect.

C

Pelvic pain in pregnancy

Initial clinical evidence suggests that Pycnogenol® may improve pain in pregnancy. Additional research is necessary to further evaluate this effect.

C

Platelet aggregation

One 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 fights

Preliminary 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

Retinopathy

Several 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

Sunburn

Pycnogenol®, 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 ulcers

Pycnogenol® 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 (it may not work); F: Strong scientific evidence against this use (it likely does not work).

Tradition/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 health care professional.

  • Allergies, Alzheimer's disease, antimicrobial, anti-parasitic, atherosclerosis, autoimmune disorders, bone marrow production, bruising, cancer prevention, cancer treatment, cardiovascular disease, cerebral ischemia, chemotherapy side effects, doxorubicin cardiotoxicity, endometriosis, exercise capacity, fat burning, G6PD deficiency, gout prevention (xanthine oxidase and dehydrogenase inhibitor), hemorrhoids, hormonal effects, immunomodulation, inflammation, inflammatory bowel disease, jet lag, joint disorders, joint hypermobility, kidney protection, leukemia, lung cancer, macular degeneration, metabolic syndrome, mitral valve prolapse, motion sickness, myalgia, myocardial ischemia/reperfusion injury, myopathy, neurodegenerative diseases, night vision, osteoporosis, pelvic cramps, psoriasis, radioprotection, rheumatoid arthritis, scar prevention, scoliosis, scurvy, sickle cell anemia, skin disorders, skin rejuvenation, varicose veins, vasorelaxant, wound healing.

Dosing

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.

  • Diabetes complications in the small blood vessels: 100mg of Pycnogenol® has been applied to the skin daily with or without systemic Pycnogenol® (150mg daily).

  • Leg ulcers: 50mg Pycnogenol® by mouth three times daily plus powder applied to the skin has been used for six weeks.

Children (younger than 18 years)

  • Attention deficit hyperactivity disorder (ADHD): 1mg/kg Pycnogenol® daily for four weeks has been taken by mouth.

  • Due to insufficient data, Pycnogenol® is not recommended for use in young 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, its components, or members of the Pinaceae family.

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. Reported side effects include gastrointestinal upset and dizziness. 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®).

  • Based on clinical trial, use of Pycnogenol® may reduce the need for nifedipine (Procardia®, Procardia XL®) in patients with mild high blood pressure,

  • 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.

  • Based on clinical study, Pycnogenol® may have positive effects on fertility, and may have antilipemic effects.

  • Based on preclinical study, Pycnogenol® may have anticancer, antifungal, antimicrobial, anti-allergy, inotropic, and skin protective effects. Theoretically, there may be additive effects with other drugs that treat these conditions. However, additional clinical research is needed to verify these interactions.

Interactions with Herbs and Dietary Supplements

  • Pycnogenol® may interact with herbs and supplements that affect blood pressure.

  • Although data has yet to confirm this claim, it has been proposed that Pycnogenol® may increase vitamin C levels and may have additive effects with vitamin E.

  • 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 interfere with immunosuppressant or immunostimulant herbs and supplements.

  • Pycnogenol® and other antioxidants may have additive effects.

  • Based on clinical study, Pycnogenol® may have positive effects on fertility, may have antilipemic effects, and may interact with L-arginine, L-lysine, pinokinase, or rutin.

  • Based on preclinical study, Pycnogenol® may have anticancer, antifungal, antimicrobial, anti-allergy, inotropic, and skin protective effects. Theoretically, there may be additive effects with other agents that treat these conditions. Pycnogenol® may also interact with alpha-lipoic acid, beta-carotene, and S-allyl cysteine. However, additional clinical research is needed to verify these interactions.

Author Information

  • This 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).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Belcaro, G., Cesarone, M., Silvia, E., et al. Daily consumption of Reliv Glucaffect for 8 weeks significantly lowered blood glucose and body weight in 50 subjects. Phytother.Res. 4-29-2009. View Abstract

  2. Belcaro, G., Cesarone, M. R., Errichi, S., et al. Treatment of osteoarthritis with Pycnogenol. The SVOS (San Valentino Osteo-arthrosis Study). Evaluation of signs, symptoms, physical performance and vascular aspects. Phytother.Res. 2008;22(4):518-523. View Abstract

  3. 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. View Abstract

  4. 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. View Abstract

  5. 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. View Abstract

  6. 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. View Abstract

  7. 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. View Abstract

  8. 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. View Abstract

  9. Koch R. Comparative study of Venostasin and Pycnogenol in chronic venous insufficiency. Phytother Res 2002;16 Suppl 1:S1-S5. View Abstract

  10. 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. View Abstract

  11. Ryan, J., Croft, K., Mori, T., et al. An examination of the effects of the antioxidant Pycnogenol on cognitive performance, serum lipid profile, endocrinological and oxidative stress biomarkers in an elderly population. J Psychopharmacol. 2008;22(5):553-562. View Abstract

  12. Stanislavov R, Nikolova V. Treatment of erectile dysfunction with pycnogenol and L-arginine. J Sex Marital Ther 2003;29(3):207-213. View Abstract

  13. Suzuki, N., Uebaba, K., Kohama, T., et al. French maritime pine bark extract significantly lowers the requirement for analgesic medication in dysmenorrhea: a multicenter, randomized, double-blind, placebo-controlled study. J Reprod.Med. 2008;53(5):338-346. View Abstract

  14. 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.

  15. 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. View Abstract

Copyright © 2013 Natural Standard (www.naturalstandard.com)

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

Updated:  

March 22, 2017