Pine Bark Extract

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Pine Bark Extract

Common Names

  • French Marine Pine Bark Extract
  • Pine Bark
  • Procyanidin Oligomers
  • PCOs

For Patients & Caregivers

How It Works

Pine bark extract has been used for a variety of chronic conditions that involve inflammation, but larger studies are needed.

Pycnogenol is derived from the bark of the French maritime pine tree. Preliminary studies suggest it may improve inflammatory conditions and skin disorders because of its antioxidant and anti-inflammatory properties, but other studies are mixed on whether it benefits cardiovascular health. Large-scale studies are needed to establish the safety and effectiveness of pycnogenol in the treatment of chronic disorders.

Purported Uses
  • To treat cardiovascular disease
    A few trials suggest pine bark extract may improve chronic venous insufficiency and endothelial function, but meta-analyses found no benefit with pycnogenol on blood pressure and suggest effects are small for cardiometabolic health. Additional studies are needed.
  • Attention deficit hyperactivity disorder (ADHD)
    One study found pycnogenol is not effective in treating ADHD in adults.
  • Inflammation
    Preliminary studies suggest benefit, but more clinical trials are needed.
  • Erectile dysfunction
    Limited studies have been conducted and more trials are needed to establish this use.
Do Not Take If
  • You have hypersensitivity to pine bark
  • You are using anticoagulant or antiplatelet drugs: Pine bark extract may increase bleeding risk when used with these drugs.
Side Effects
  • Irritability
  • Lower energy levels
Special Point

Many pine bark extracts on the market are not standardized and the concentration of active components and bioactivities are hard to determine.

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For Healthcare Professionals

Brand Name
Pycnogenol®
Scientific Name
Pinus maritima
Clinical Summary

Obtained from the bark of the French maritime pine tree, Pinus maritima, pine bark extract consists of proanthocyanidins and is marketed under the tradename Pycnogenol®.

In vitro and animal studies suggest that pine bark extract has antioxidant, anti-inflammatory (6), immunostimulant (1), cardioprotective (20), and neuroprotective (31) effects. It may also have antimicrobial activities (15) (16) (17).

In humans, preliminary data suggest it may reduce menopausal (8), dysmenorrheic (27), and osteoarthritic (9) (10) symptoms. Pine bark extract may also improve hyperpigmentation (11), erythema (12), and symptoms of endometriosis (13) and lupus (14). Other studies suggest improvements in endothelial dysfunction (2) (33) and chronic venous insufficiency (5), but meta-analyses found no benefit with pycnogenol on blood pressure (36), and determined effects were small for cardiometabolic health (37). Another meta-analyses recommended against pycnogenol and various other supplements for musculoskeletal pain (38).

Pycnogenol may enhance memory in elderly participants (7), but studies in adults and children with ADHD yielded mixed results (3) (4). When used in conjunction with L-arginine, pycnogenol improved erectile dysfunction symptoms (18) (29). A systematic review concluded that large-scale studies are needed to establish the value of pycnogenol in the treatment of chronic disorders (34).

Preliminary data suggest pycnogenol may reduce some adverse effects of radiotherapy and chemotherapy (30), but further research is needed.

Purported Uses
  • ADHD
  • Erectile dysfunction
  • Cardiovascular disease
  • Inflammation
Mechanism of Action

The primary constituents of pine bark extracts are procyanidins and phenolic acids (35). Pine bark extract acts as an antioxidant by scavenging reactive oxygen and nitrogen species and suppressing production of peroxides (21). It increases the activities of antioxidant enzymes by increasing the intracellular glutathione levels (22). In addition to increasing NO production which induces vasodilation (2), pine bark extract also blocks the NF-kB activation stimulated by tumor necrosis factor-alpha (TNF-alpha) and inhibits production of adhesion proteins that cause inflammation and atherosclerosis (22).

In vitro, pycnogenol induced apoptosis in human breast cancer cells (23) and reduced neuronal apoptosis, an important feature of Alzheimer’s disease, by decreasing free radical generation (24). In animal studies, cardioprotective effects were also attributed to free radical scavenging (20).

Contraindications
  • Hypersensitivity to pine bark (26)
Adverse Reactions
  • May cause irritability and lower energy levels  (26).
Herb-Drug Interactions
  • Anticoagulant and/or antiplatelet drugs: Pine bark extract can inhibit platelet aggregation and may increase risk of bleeding when used with these drugs (28).
Dosage (OneMSK Only)
References
  1. Liu, F.J. et al. Pycnogenol enhances immune and haemopoietic functions in senescence-accelerated mice. Cell Mol Life Sci. 1998;54(10):1168-72
  2. Nishioka K, Hidaka T, Nakamura S, et al. Pycnogenol, French maritime pine bark extract, augments endothelium-dependent vasodilation in humans. Hypertens Res. Sep 2007;30(9):775-780.
  3. Tenenbaum, S. et al. An experimental comparison of pycnogenol and methylphenidate in adults with Attention-deficit-hyperactivity disorder (ADHD). J Atten Disord 2002;6(2):49-60
  4. Trebaticka J, et al. Treatment of ADHD with French maritime pine bark extract, Pycnogenol. Eur Child Adolesc Psychiatry 2006.
  5. Arcangeli, P. Pycnogenol in chronic venous insufficiency. Fitoterapia 2000;71(3):236-44
  6. Cho, K.J et al.Inhibition mechanisms of bioflavonoids extracted from the bark of Pinus maritima on the expression of proinflammatory cytokines. Ann N Y Acad Sci. 2001;928:141-56
  7. 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. Jul 2008;22(5):553-562.
  8. Yang HM, Liao MF, Zhu SY, Liao MN, Rohdewald P. 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):978-985.
  9. Belcaro G, Cesarone MR, 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. Apr 2008;22(4):518-523.
  10. Cisar P, Jany R, Waczulikova I, et al. Effect of pine bark extract (Pycnogenol) on symptoms of knee osteoarthritis. Phytother Res. Aug 2008;22(8):1087-1092.
  11. Ni, Z. et al. Treatment of melasma with pycnogenol. Phytother Res 2002;16(6):567-71
  12. Saliou, C. et al. Solar ultraviolet-induced erythema in human skin and nuclear factor-kappa-B-dependent gene expression in keratinocytes are modulated by a French maritime pine bark extract. Free Radic Biol Med 2002;30(2):154-60
  13. Kohama T, Herai K, Inoue M. Effect of French maritime pine bark extract on endometriois as compared with leuprorelin acetate. J Reprod Med 2007;52(8):703-8.
  14. Stefanescu, M. et al. Pycnogenol efficacy in the treatment of systemic lupus erythematosus patients. Phytother Res. 2002;15(8):698-704
  15. Feng WY, Tanaka R, Inagaki Y, et al. Pycnogenol, a procyanidin-rich extract from French maritime pine, inhibits intracellular replication of HIV-1 as well as its binding to host cells. Jpn J Infect Dis. Jul 2008;61(4):279-285.
  16. Matsumori A, Higuchi H, Shimada M. French maritime pine bark extract inhibits viral replication and prevents development of viral myocarditis. J Card Fail. Nov 2007;13(9):785-791.
  17. Rohdewald P, Beil W. In vitro inhibition of Helicobacter pylori growth and adherence to gastric mucosal cells by Pycnogenol. Phytother Res. May 2008;22(5):685-688.
  18. Stanislavov, R and Nikolova, V. Treatment of erectile dysfunction with pycnogenol and L-arginine. J Sex Marital Ther. 2003;29(3):207-13
  19. Kimbrough, C. et al. Pycnogenol chewing gum minimizes gingival bleeding and plaque formation. Phytomedicine 2002;9(5):410-13
  20. Feng, W. et al. Effect of Pycnogenol on the toxicity of heart, bone marrow and immune organs as induced by antitumor drugs. Phytomedicine 2002;9(5):414-18
  21. Packer, L et al. Antioxidant activity and biologic properties of a procyanidin-rich extract from pine (Pinus maritima) bark, pycnogenol. Free Radic Biol Med 1999;27:704-24
  22. Peng, Q. et al. Pycnogenol inhibits tumor necrosis factor-alpha-induced nuclear factor kappa B activation and adhesion molecule expression in human vascular endothelial cells. Cell Mol LifeSci. 2000;57(5):834-41
  23. Huynh, H.T. and Teel, R. W. Selective induction of apoptosis in human mammary cancer cells (MCF-7) by pycnogenol. Anticancer Res 2000;20(4):2417-20
  24. Peng, Q. et al. Pycnogenol protects neurons from amyloid-beta peptide induced apoptosis. Brain Res Mol Brain Res 2002;104(1):55-65
  25. Virgili, F et al. Ferulic acid excretion as a marker of consumption of a french maritime pine (Pinus maritima) bark extract. Free Radic Biol Med 2000;28(8):1249-56
  26. MICROMEDEX(R) Healthcare Series. 120. 2004. Thomson MICROMEDEX.
  27. 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 May;53(5):338-46.
  28. Pütter M, Grotemeyer KH, Würthwein G, et al. Inhibition of smoking-induced platelet aggregation by aspirin and pycnogenol. Thromb Res. 1999 Aug 15;95(4):155-61.
  29. Ledda A, Belcaro G, Cesarone MR, Dugall M, Schönlau F. Investigation of a complex plant extract for mild to moderate erectile dysfunction in a randomized, double-blind, placebo-controlled, parallel-arm study. BJU Int. 2010;106(7):1030-3.
  30. Belcaro G, Cesarone MR, Genovesi D, et al. Pycnogenol may alleviate adverse effects in oncologic treatment. Panminerva Med. 2008 Sep;50(3):227-34.
  31. Ansari MA, Keller JN, Scheff SW. Protective effect of Pycnogenol in human neuroblastoma SH-SY5Y cells following acrolein-induced cytotoxicity. Free Radic Biol Med. 2008 Dec 1;45(11):1510-9.
  32. Wu DC, Li S, Yang DQ, Cui YY. Effects of Pinus massoniana bark extract on the adhesion and migration capabilities of HeLa cells. Fitoterapia. 2011 Dec;82(8):1202-5.
  33. Enseleit F, Sudano I, Périat D, Winnik S, et al. Effects of Pycnogenol on endothelial function in patients with stable coronary artery disease: a double-blind, randomized, placebo-controlled, cross-over study. Eur Heart J. 2012 Jul;33(13):1589-97.
  34. Schoonees A, Visser J, Musekiwa A, Volmink J. Pycnogenol (extract of French maritime pine bark) for the treatment of chronic disorders. Cochrane Database Syst Rev. 2012 Apr 18;4:CD008294.
  35. Rohdewald P. A review of the French maritime pine bark extract (Pycnogenol), a herbal medication with a diverse clinical pharmacology. Int J Clin Pharmacol Ther. 2002 Apr;40(4):158-68.
  36. Fogacci F, Tocci G, Sahebkar A, et al. Effect of Pycnogenol on Blood Pressure: Findings From a PRISMA Compliant Systematic Review and Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled, Clinical Studies. Angiology. Mar 2020;71(3):217-225.
  37. Malekahmadi M, Moradi Moghaddam O, Firouzi S, et al. Effects of pycnogenol on cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. Dec 2019;150:104472.
  38. Crawford C, Boyd C, Paat CF, et al. Dietary Ingredients as an Alternative Approach for Mitigating Chronic Musculoskeletal Pain: Evidence-Based Recommendations for Practice and Research in the Military. Pain Med. Jun 1 2019;20(6):1236-1247.
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