About Herbs, Botanicals & Other Products

Scientific Name
Vaccinium macrocarpon
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Common Name

Mossberry, Sassamanash, bounceberry

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Clinical Summary

Cranberry is the fruit of a shrub and has been used in the form of juice to treat urinary tract infections (UTIs). Clinical evidence supports the claim that cranberry juice can prevent UTIs in adults (3) (27)and in children (28). This effect has been shown to be due to tannins in cranberries known as proanthocyanidins that inhibit the adherence of E. coli fimbriae to uroepithelial cells (4) (5). However, regular consumption of cranberry juice for six months did not confer protection against UTIs (30). In another study, patients who took cranberry were more likely to have a recurrent UTI, but did not develop antibiotic resistant bacteria, compared to those who used trimethoprim-sulfamethoxazole (32).

Cranberry extracts demonstrated anti-proliferative effects against prostate (10) (11), liver (12), breast (13), colon (11) (14), and oral (11) cancer cell lines in vitro.
Cranberry juice also inhibited the adhesion of H. pylori to human gastric mucosa (7). A trial done in China suggests that regular consumption of cranberry juice can suppress H. pylori infection, a major factor in peptic ulcer disease and gastric cancer (6).

Cranberry juice has also been shown to prevent plaque formation and the development of gum disease due to its anti-colonizing and anti-adhesion properties (8) (9).

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Purported Uses
  • Urinary Tract Infections
  • Cancer Treatment
  • Antiaging
  • Ulcers
  • Atherosclerosis
  • Gum disease
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Mechanism of Action

Proanthocyanidins found in cranberries inhibit P-fimbriated E. coli from adhering to the uroepithelial cells, thus preventing the development of an infection (4) (5) (16) (17). Research suggests that the high number of A-type linkage proanthocyanidins found in cranberries may enhance the in vitro and urinary bacterial anti-adhesion activities that prevent UTIs (18). A constituent of cranberry juice has been shown to inhibit adhesion of H. pylori to immobilized human mucus, human erythrocytes, and cultured gastric epithelial cells, suggesting that cranberry juice may also prevent stomach ulcers caused H. pylori by preventing the adhesion of the bacteria to the stomach lining (7) (19). Cranberry juice was also shown to decrease adherence of oral streptococci strains to saliva-coated hydroxyapatite (8) (20), glucan-coated hydroxyapatite (20), and impaired biofilm formation (9) (20) suggesting that cranberry juice may slow the development of dental plaque and offer protection from plaque-related diseases.

The total polyphenol fraction of cranberry extract was the most active against oral, colon, and prostate cell lines (11). The specific molecular mechanisms of the anticancer properties of cranberry extracts remain unknown.

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Pharmacokinetics

Urinary pH has been shown to decrease from drinking cranberry juice (21) (22).

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Contraindications

Warfarin: Data are conflicting on cranberry's ability to enhance the potential of warfarin (24) (29).

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Adverse Reactions

Case Reports
Several cases of increased INR (33) (34) and/or bleeding due to suspected interactions involving warfarin and cranberry juice (15) have been reported.
Two patients suffered internal hemorrhage following concurrent use of warfarin and cranberry juice that resulted in their deaths (23) (35).

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Herb-Drug Interactions
  • Warfarin: Cranberry juice may potentiate warfarin-induced anticoagulation, but data are conflicting (24) (29).
  • Cyclosporin: A randomized controlled trial has shown that 240 mL of cranberry juice had no clinically significant effect on the disposition of a 200 mg dose of cyclosporin (25).
  • UGT (Uridine 5'-diphospho-glucuronosyltransferase) substrates: Cranberry modulates UGT enzymes in vitro and can increase risk of side effects of drugs metabolized by them (31).
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Literature Summary and Critique

Beerepoot MAJ, Riet GT, Nys S, et al. Cranberries vs Antibiotics to Prevent Urinary Tract Infections. A Randomized Double-blind Noninferiority Trial in Premenopausal Women. Arch Intern Med. 2011;171(14):1270-1278.
In this study, 221 premenopausal women with recurrent urinary tract infections (UTIs) were randomized to recieve trimethoprim-sulfamethoxazole (TMP-SMX), 480 mg once daily, or cranberry capsules, 500mg twice daily for one year. The primary end points were the mean number of symptomatic UTIs, the proportion of patients with atleast 1 symptomatic UTI, the median time to first UTI, and development of antibiotic resistance in indigenous Escherichia coli. Researchers observed the mean number and proportion of patients with at least 1 symptomatic UTI to be higher in the cranberry group. The median time to first symptomatic UTI was 4 and 8 months for the cranberry and TMP-SMX groups respectively. However, increased resistance was observed for TMP-SMX, trimethoprim, amoxicillin, and ciproflaxin in the E.coli isolates in the TMP-SMX group. No such increases were seen in women who took cranberry.
TMP-SMX is more effective than cranberry capsules in preventing recurrent UTIs but antibiotic resistance is a major concern.

Barbosa-Cesnik C, Brown MB, Buxton M, et al. Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clin Infect Dis. 2011 Jan;52(1):23-30.
In this double-blind, placebo-controlled trial 319 college-aged women with acute urinary tract infection (UTI) were randomized to receive 8 ounces of 27% cranberry juice twice daily or placebo for six months. The subjects were followed up for 6 months or until the occurrence of a second UTI. Researchers failed to find any significant differences in urinary symptoms between the treatment and placebo groups at follow-up. Although small studies have reported the benefits of cranberry juice for prevention of UTIs, large randomized studies are lacking. Further research is needed to determine the usefulness of cranberry juice.

Zhang L, Ma J, Pan K, Go VL, Chen J, You WC. Efficacy of cranberry juice on Helicobacter pylori infection: a double-blind, randomized placebo-controlled trial. Helicobacter 2005;10(2):139-45.
This randomized, double-blind, placebo-controlled trial was conducted to test the effectiveness of cranberry juice in the suppression of H. pylori in an endemically infected population. One hundred and eighty seven adults with H. pylori infection were randomly assigned to receive cranberry juice or a placebo for 90 days. The extent of H. pylori infection was determined using the 13C-urea breath test. The study concluded that significantly more subjects in the cranberry juice group (14.43%) than the placebo group (5.44%) yielded negative test results, suggesting that regular consumption of cranberry juice can suppress H. pylori infection in endemically infected populations.

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References
  1. Avorn J, Monane M, Gurwitz JH, Glynn RJ, Choodnovskiy I, Lipsitz LA. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA 1994;271(10):751-4.
  2. Kontiokari T, Salo J, Eerola E, Uhari M. Cranberry juice and bacterial colonization in children—a placebo-controlled randomized trial. Clin Nutr 2005;24(6):1065-72.
  3. Stothers L. A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol 2002;9(3):1558-62.
  4. Howell AB, Foxman B. Cranberry juice and adhesion of antibiotic-resistant uropathogens. JAMA 2002;287(23):3082-3.
  5. Howell AB, Vorsa N, Der Marderosian A, Foo LY. Inhibition of the adherence of P-fimbriated Escherichia coli to uroepithelial-cell surfaces by proanthocyanidin extracts from cranberries. N Engl J Med 1998;339(15):1085-6.
  6. Zhang L, Ma J, Pan K, Go VL, Chen J, You WC. Efficacy of cranberry juice on Helicobacter pylori infection: a double-blind, randomized placebo-controlled trial. Helicobacter 2005;10(2):139-45.
  7. Burger O, Ofek I, Tabak M, Weiss EI, Sharon N, Neeman I. A high molecular mass constituent of cranberry juice inhibits helicobacter pylori adhesion to human gastric mucus. FEMS Immunol Med Microbiol 2000;29(4):295-301.
  8. Yamanaka A, Kimizuka R, Kato T, Okuda K. Inhibitory effects of cranberry juice on attachment of oral streptococci and biofilm formation. Oral Microbiol Immunol 2004;19(3):150-4.
  9. Weiss EI, Lev-Dor R, Kashamn Y, Goldhar J, Sharon N, Ofek I. Inhibiting interspecies coaggregation of plaque bacteria with a cranberry juice constituent [published erratam appear in J Am Dent Assoc 1999 Jan;130(1):36 and 1999 Mar;130(3):332]. J Am Dent Assoc 1998;129(12):1719-23.
  10. Ferguson PJ, Kurowska E, Freeman DJ, Chambers AF, Koropatnick DJ. A flavonoid fraction from cranberry extract inhibits proliferation of human tumor cell lines. J Nutr 2004;134(6):1529-35.
  11. Seeram NP, Adams LS, Hardy ML, Heber D. Total cranberry extract versus its phytochemical constituents: antiproliferative and synergistic effects against human tumor cell lines. J Agric Food Chem 2004;52(9):2512-7.
  12. Sun J, Chu YF, Wu X, Liu RH. Antioxidant and antiproliferative activities of common fruits. J Agric Food Chem 2002;50(25):7449-54.
  13. Sun J, Hai Liu R. Cranberry phytochemical extracts induce cell cycle arrest and apoptosis in human MCF-7 breast cancer cells. Cancer Lett 2005.
  14. Parry J, Su L, Moore J, Cheng Z, Luther M, Rao JN, et al. Chemical compositions, antioxidant capacities, and antiproliferative activities of selected fruit seed flours. J Agric Food Chem 2006;54(11):3773-8.
  15. MHRA/CSM. Current Problems in Pharmacovigilance, 2004.
  16. Foo LY, Lu Y, Howell AB, Vorsa N. A-Type proanthocyanidin trimers from cranberry that inhibit adherence of uropathogenic P-fimbriated Escherichia coli. J Nat Prod 2000;63(9):1225-8.
  17. Foo LY, Lu Y, Howell AB, Vorsa N. The structure of cranberry proanthocyanidins which inhibit adherence of uropathogenic P-fimbriated Escherichia coli in vitro. Phytochemistry 2000;54(2):173-81.
  18. Howell AB, Reed JD, Krueger CG, Winterbottom R, Cunningham DG, Leahy M. A-type cranberry proanthocyanidins and uropathogenic bacterial anti-adhesion activity. Phytochemistry 2005;66(18):2281-91.
  19. Burger O, Weiss E, Sharon N, Tabak M, Neeman I, Ofek I. Inhibition of Helicobacter pylori adhesion to human gastric mucus by a high-molecular-weight constituent of cranberry juice. Crit Rev Food Sci Nutr 2002;42(3 Suppl):279-84.
  20. Koo H, Nino de Guzman P, Schobel BD, Vacca Smith AV, Bowen WH. Influence of cranberry juice on glucan-mediated processes involved in Streptococcus mutans biofilm development. Caries Res 2006;40(1):20-7.
  21. Gettman MT, Ogan K, Brinkley LJ, Adams-Huet B, Pak CY, Pearle MS. Effect of cranberry juice consumption on urinary stone risk factors. J Urol 2005;174(2):590-4.
  22. Kessler T, Jansen B, Hesse A.Effect of blackcurrant-, cranberry- and plum juice consumption on risk factors associated with kidney stone formation. Eur J Clin Nutr 2002;56(10):1020-3.
  23. Suvarna R, Pirmohamed M, Henderson L. Possible interaction between warfarin and cranberry juice. BMJ 2003;327(7429):1454.
  24. Greenblatt DJ, von Moltke LL, Perloff ES, Luo Y, Harmatz JS, Zinny MA. Interaction of flurbiprofen with cranberry juice, grape juice, tea, and fluconazole: in vitro and clinical studies. Clin Pharmacol Ther 2006;79(1):125-33.
  25. Grenier J, Fradette C, Morelli G, Merritt GJ, Vranderick M, Ducharme MP. Pomelo juice, but not cranberry juice, affects the pharmacokinetics of cyclosporine in humans. Clin Pharmacol Ther 2006;79(3):255-62.
  26. Jepson RG, Mihaljevic L, Craig J. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 2004(2):CD001321.
  27. Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ 2001;322(7302):1571.
  28. Ferrara P, Romaniello L, Vitelli O, et al. Cranberry juice for the prevention of recurrent urinary tract infections: a randomized controlled trial in children. Scand J Urol Nephrol. 2009;43(5):369-72.
  29. Mohammed Abdul MI, Jiang X, Williams KM, et al. Pharmacodynamic interaction of warfarin with cranberry but not with garlic in healthy subjects. Br J Pharmacol. 2008 Aug;154(8):1691-700.
  30. Barbosa-Cesnik C, Brown MB, Buxton M, et al. Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clin Infect Dis. 2011 Jan;52(1):23-30.
  31. Mohamed ME, Frye RF. Effects of herbal supplements on drug glucuronidation. Review of clinical, animal, and in vitro studies. Planta Med. 2011 Mar;77(4):311-21.
  32. 32. Beerepoot MAJ, Riet GT, Nys S, et al. Cranberries vs Antibiotics to Prevent Urinary Tract Infections. A Randomized Double-blind Noninferiority Trial in Premenopausal Women. Arch Intern Med. 2011;171(14):1270-1278.
  33. Hamann GL, Campbell JD, George CM. Warfarin-cranberry juice interaction. Ann Pharmacother. 2011 Mar;45(3):e17. Epub 2011 Mar 1.
  34. Roberts D, Flanagan P. Case report: Cranberry juice and warfarin. Home Healthc Nurse. 2011 Feb;29(2):92-7.
  35. Griffiths AP, Beddall A, Pegler S. Fatal haemopericardium and gastrointestinal haemorrhage due to possible interaction of cranberry juice with warfarin. J R Soc Promot Health. 2008 Nov;128(6):324-6.
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How It Works

Bottom Line: Cranberry juice has not been shown to treat or cure cancer.

Cranberries contain compounds known as proanthocyanidins that have been shown to inhibit E. coli from adhering to the bladder wall, thus preventing the development of an infection. Cranberry juice has also been shown to inhibit the adherence of oral bacteria in the laboratory setting, suggesting that it may slow the development of dental plaque and offer some protection from plaque-related diseases.

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Purported Uses
  • Prevention and treatment of urinary tract infections (UTIs)
    The evidence for this claim is mixed.
  • Anticancer effects
    Lab studies have shown that cranberry juice extract has anti-proliferative effects on cancer cells such as prostate, liver, breast, colon, and oral. But such effects have not been confirmed by clinical trials.
  • Anti aging
    There is no scientific evidence to support this use.
  • Prevention of stomach ulcers
    A study done in China has shown cranberry juice to be effective for the prevention of H. pylori infection.
  • Prevention of Atherosclerosis
    This use is not backed by clinical data.
  • Prevention of Gum Disease/Cavities
    Laboratory studies have shown that cranberry juice prevents bacteria from attaching to one another thereby slowing down plaque formation.
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Research Evidence

Prevention of UTIs:
In this study, 221 premenopausal women with recurrent urinary tract infections (UTIs) were randomized to recieve trimethoprim-sulfamethoxazole (TMP-SMX), 480 mg once daily, or cranberry capsules, 500mg twice daily for one year. The primary end points were the mean number of symptomatic UTIs, the proportion of patients with atleast 1 symptomatic UTI, the median time to first UTI, and development of antibiotic resistance in indigenous Escherichia coli. Researchers observed the mean number and proportion of patients with at least 1 symptomatic UTI to be higher in the cranberry group. The median time to first symptomatic UTI was 4 and 8 months for the cranberry and TMP-SMX groups respectively. However, increased resistance was observed for TMP-SMX, trimethoprim, amoxicillin, and ciproflaxin in the E.coli isolates in the TMP-SMX group. No such increases were seen in women who took cranberry.
TMP-SMX is more effective than cranberry capsules in preventing recurrent UTIs but antibiotic resistance is a major concern.

In a double-blind, placebo-controlled trial 319 college-aged women with acute urinary tract infection (UTI) received 8 ounces of 27% cranberry juice twice daily or placebo for six months. The subjects were followed up for 6 months or until the occurrence of a second UTI. Researchers failed to find any significant differences in urinary symptoms between the treatment and placebo groups at follow-up. Although small studies have reported the benefits of cranberry juice for prevention of UTIs, large randomized studies are lacking. Further research is needed to determine the usefulness of cranberry juice.

A study of 150 women with UTIs caused by E. coli were given 50ml of cranberry-lingonberry juice concentrate a day for six months, an intervention of 100ml of lactobacillus drink five days a week for one year, or no intervention. The study showed that the cranberry group had a 20% risk reduction of UTI recurrence, suggesting that regular drinking of cranberry juice may reduce the recurrence of UTIs. A study of 150 patients showed that cranberry juice and cranberry tablets both decreased the number of patients experiencing at least one UTI per year when compared to placebo. Tablets were taken twice a day and 250ml of juice was taken three times a day for the one year trial. The study also concluded that tablets provided a more cost effective prevention of UTI compared to cranberry juice.

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Patient Warnings

This product is regulated by the FDA as a dietary supplement. Unlike approved drugs, supplements are not required to be manufactured under specific standardized conditions. This product may not contain the labeled amount or may be contaminated. In addition, it may not have been tested for safety or effectiveness.

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Do Not Take If
  • You are taking warfarin (cranberry juice may cause increased bleeding).
  • You are taking drugs that are substrates of UGT (Uridine 5'-diphospho-glucuronosyltransferase) enzymes (cranberry may increase the risk of side effects of these drugs).
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Side Effects
  • Several cases of increased INR and/or bleeding due to suspected interactions involving warfarin and cranberry juice have been reported.
  • Two patients suffered internal hemorrhage following concurrent use of warfarin and cranberry juice that resulted in their deaths.
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Dosage (Inside MSKCC Only)
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Last updated: July 26, 2011
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