What is Pycnogenol, does it work, and is it the same as other pine bark extracts?

Answer:

Pycnogenol (Horphag Research), a branded extract from the bark of French maritime pine (Pinus pinaster, formerly Pinus maritima Poir.), is promoted for various uses due to its antioxidant and anti-inflammatory properties. Although clinical research has suggested that Pycnogenol may be beneficial for some of these conditions, many of the studies to date have been funded by the makers of Pycnogenol and some were small in size, which limits the impact of the results.

Other French maritime pine bark extracts, such as Flavangenol and Oligopin, have also been evaluated for certain conditions in clinical research, although these brands are much less studied that Pycnogenol. These products also differ slightly from Pycnogenol in how they are extracted: Pycnogenol is obtained by extracting with water and alcohol, while Flavangenol and Oligopin are obtained by extracting with only water (Marmol, Trends Food Sci Technol 2019; Segal, Toxicol Rep 2018), affecting the range of compounds in the extracts.

In addition to French maritime pine bark extract, some supplements contain bark extract from Pinus massoniana, a different pine species that is sometimes called Chinese red pine. This form of pine bark extract has been studied in only limited clinical research without apparent evidence of benefit.

Read below for details about clinical studies evaluating the effectiveness and safety of Pycnogenol and other pine bark extracts for conditions such as asthma, allergies, attention-deficit/hyperactivity disorder (ADHD), benign prostatic hypertrophy (BPH), blood clots during travel, chronic venous insufficient (CVI), arterial plaques and coronary artery calcifications, diabetic retinopathy, fibromyalgia, glaucoma, hair loss, high blood pressure, knee osteoarthritis, menopausal symptoms, Raynaud's phenomenon, sun protection, tinnitus, and varicose veins. Also, find out what to look for when selecting a pine bark extract supplement, and learn why ConsumerLab has not yet tested and reviewed Pycnogenol and other pine bark extract supplements.

Possible benefits of pine bark extracts

As summarized in the table below and discussed in more detail in the subsequent paragraphs, pine bark extract has been evaluated for numerous conditions, with some studies suggesting possible benefits. Most studies assessed the specific branded ingredient Pycnogenol. However, many of the studies were small and, among the Pycnogenol studies, most were manufacturer-funded. Some experts have concluded that there is insufficient evidence to recommend for or against pine bark extracts for any use Robertson, Cochrane Database Syst Rev 2020; Schoonees, Cochrane Database Syst Rev 2012).

Pycnogenol

Chronic venous insufficiency and blood clots

A daily dose of between 150 and 300 mg of Pycnogenol may reduce leg swelling and pain in people with chronic venous insufficiency (CVI), a condition which causes blood to pool in the legs. One clinical study of people with CVI found that 100 mg of Pycnogenol taken three times per day for one month significantly reduced swelling, heaviness and pain in the legs compared to placebo (Arcangeli, Fitoterapia 2000). After two months of treatment, almost 60% of the people taking Pycnogenol had no leg swelling or pain; however, there was no change in venous blood flow.

Pycnogenol may also reduce the risk of blood clots during long flights. One study found people with a moderate-to-high risk of deep venous thrombosis (DVT), or blood clots, who took two 100-mg capsules of Pycnogenol 2-3 hours before a long flight (average flight time 8 hours and 15 minutes), two more capsules six hours later, and one capsule the following day, had a significantly reduced the risk of developing a clot compared to those who took a placebo (Belcaro, Clin Appl Thromb Hemost 2004).

A small study in adults with varicose veins and chronic venous insufficiency found that daily supplementation with 150 mg of Pycnogenol for at least 3 months prior to surgery to remove varicose veins significantly reduced the stretching and dilation of the veins when they were tested after removal, compared to veins from adults who did not take the supplement (Belcaro, Int J Angiol 2014). A dose of 100 mg of Pycnogenol per day for 6 months was also reported to reduce the number of varicose veins caused by pregnancy compared to treatment with compression stockings; however, this study was not blinded (the women chose which treatment they wanted to receive) and did not include a placebo — making these results less reliable (Belcaro, Int J Angiol 2017).

Coronary artery calcifications

A 12-month study among 90 people in Italy with asymptomatic atherosclerosis showed that taking 150 mg/day of Pycnogenol with standard management did not significantly affect the number of calcifications in arteries of hearts, but the average number after 12 months was still significantly lower than that of the standard management group (4.11 vs. 5.8) (Hu, Minerva Cardioangiol 2020).

High blood pressure

An analysis of data from 7 clinical studies among 626 people, some of whom had elevated or high blood pressure at baseline, showed that taking 90 to 200 mg of Pycnogenol daily for 2 weeks to 6 months did not significantly improve systolic or diastolic blood pressure compared to placebo (Fogacci, Angiology 2020).

Fibromyalgia

A study in Italy among 50 women (average age 46) with moderate idiopathic fibromyalgia (widespread muscle stiffness, pain, tenderness and fatigue of unknown cause) found that a significantly lower percentage of participants who took 150 mg of Pycnogenol daily for one month in addition to standard treatment (daily stretching, exercise, application of heat, etc.), reported having symptoms such as stiffness and pain (46% vs. 83%) and widespread pain (42% vs. 63%) compared to a control group who received standard treatment alone. A lower percentage of those who took Pycnogenol also reported needing to use anti-inflammatory medications (NSAID or corticosteroids) (42% vs. 63%). However, because the study was not blinded, placebo-controlled, or randomized (participants chose which group they wanted to be in), it's not possible to determine if Pycnogenol actually improved symptoms (Belcaro, Panminerva Med 2021).

Raynaud's phenomenon

A study in Italy investigated the effects of Pycnogenol in 67 women with Raynaud's phenomenon, a condition in which blood vessels of the hand and fingers spasm in response to cold temperatures and/or emotional stress, causing pain and discoloration (i.e., finger often turn white, blue or blotchy red). The study found that adding 50 mg of Pycnogenol twice daily (in the morning and evening) for one month to standard management (exercise and wearing thermal gloves, avoidance of cold temperatures and smoking) resulted in greater reductions in symptoms such as cold hands/fingers, burning pain, prickling sensations, and color changes. In addition, low-temperature areas and temperature discrepancies across the hand decreased, and the lowest finger temperature increased. However, the study was not blinded (the participants and the researchers knew who was taking Pycnogenol), making the results subject to bias (Hu, Minerva Cardioangiol 2019).

Knee osteoarthritis

Pain from osteoarthritis of the knee may be reduced with Pycnogenol, which has been shown to reduce markers of inflammation in the body (Schafer, Biomed Pharmacother 2006). In one clinical study, people with mild-to-moderate knee osteoarthritis who took 50 mg of Pycnogenol with meals (a total daily dose of 150 mg) daily for 3 months had a significant reduction in pain compared to placebo (Cisar, Phytother Res 2008). Another study in patients with knee osteoarthritis found the same dose significantly reduced pain and improved physical function compared to placebo (Farid, Nutr Res 2007).

Menopause symptoms

A study in Japan among 156 perimenopausal women (average age 47) showed that taking 30 mg of Pycnogenol (by Horphag Research) twice daily for 3 months caused modest but statistically significant improvements, compared to placebo, in self-reported vasomotor symptoms such as hot flashes and night sweats (35.1% vs 28.6% improvement in symptom severity compared to baseline), sleeping problems (27.8% vs 21.0% improvement in symptom severity), and tiredness (48.7% vs 39.6% improvement in symptom severity). However, there were no significant between-group differences in nervousness, anxiety, dizziness, arthritic or muscular pain, headache, palpitations, memory and concentration, menstrual problems, sexual problems or impaired sense of attractiveness compared to placebo. Pycnogenol did not affect blood levels of hormones including estradiol, follicle-stimulating hormone, or dehydroepiandrosterone (DHEA) sulfate (Kohama, J Reprod Med 2013).

Memory and cognition

There is some evidence that Pycnogenol may improve cognitive function in older adults. One double-blind, placebo-controlled study found that taking 150 mg of the extract daily for three months significantly improved measures of working memory in people age 60 to 85 compared to placebo (Ryan, J Psychopharmacol 2008). Preliminary evidence suggests that Pycnogenol may improve cognitive performance in young adults as well, although more research is needed to draw conclusions about this (Luzzi,Panminvera Med 2011).

Attention-deficit/hyperactivity disorder (ADHD)

A study in Slovakia among 57 children (average age 9) with ADHD showed that taking 1 mg/kg body weight of Pycnogenol daily for one month slightly improved inattention based on teacher rating scales compared to placebo. However, there was no improvement in inattention based on a parent rating scale. Furthermore, there was no improvement in hyperactivity based on a parent rating scale and teacher ratings showed mixed results. More research is needed to confirm a benefit, if any, of Pycnogenol for ADHD (Trebaticka, Eur Child Adolesc Psychiatry 2006).

Benign prostatic hypertrophy (BPH)

A two-month study in Italy among 75 men (average age 66) with preclinical or borderline BPH found that adding Pycnogenol supplementation (50 mg three times per day) to standard BPH management (i.e., regular hydration, exercise, frequent voiding, and avoidance of long periods of sitting and of drugs that restrict urine flow) was more effective than standard management, or medication (dutasteride and/or finasteride -- 5 mg per day). Pycnogenol significantly improved symptoms such as emptying, frequency, intermittency, urgency, weak flow, straining and waking at night to urinate. Prostatic volume and PSA levels remained relatively stable in all three groups (Ledda, Minerva Med 2018).

Vision

Among people with damage to the retina due to diabetes (diabetic retinopathy), hardening of the arteries or other conditions, those who took 50 mg of Pycnogenol three times per day (a total daily dose of 150 mg) for two months had improved vision and no deterioration in retinal function compared to those who took a placebo (Spadea, Phytother Res 2001).

Asthma and allergies

There is some evidence that Pycnogenol may improve symptoms of asthma in children and adults. In people with asthmatic allergies to dust mites, those taking 100 mg of Pycnogenol (50 mg taken once in the morning and again in the evening) along with their regular asthma medications (inhaled corticosteroids) had a significant decrease in days with asthma and symptoms such as cough and wheezing, and a reduced need for medication compared to those who only took their asthma medication (Belcaro, Panminerva Med 2011). Another clinical study found that 50 mg of Pycnogenol taken twice daily significantly decreased eye and nasal symptoms of birch allergies compared to placebo, but only if taken at least five weeks before the start of the allergy season -- taking it 3 weeks before allergy season did not significantly decrease symptoms (Wilson, Phytother Res 2010).

Skin and sun protection

In one clinical study, taking between 68 and 112 mg of Pycnogenol daily for 8 weeks significantly increased the amount of simulated UV-radiation required to cause redness and skin damage in healthy people compared to before they took the supplement (Saliou, Free Radic Biol Med 2001).

Hair loss

A small, manufacturer-funded study in China among 63 healthy, postmenopausal women (average age 54) showed that taking 50 mg of Pycnogenol (by Horphag Research) three times daily with meals (total daily dose 150 mg) for 6 months caused a statistically significant increase in hair density of 23% (from 225.8 to 278.6 hairs/cm²) compared to baseline, which was attributed to improved scalp microcirculation, while the placebo group showed a non-significant increase of only 9% (from 226.6 to 247.7 hairs/cm²) compared to baseline. However, it was not reported if the improvement in hair density between the Pycnogenol and placebo groups was statistically significant. Taking Pycnogenol did not significantly improve scalp skin hydration or reduce evaporation of water from the scalp surface. No side effects were observed during the study (Cai, Health Sci Rep 2023). The participants in this study were not reported to have female-pattern hair loss, so it is unclear if Pycnogenol would be beneficial among people with androgenetic alopecia.

Tinnitus

Based on preliminary studies, Pycnogenol may be helpful for people with tinnitus, a high- or low-pitched ringing in the ear which is sometimes associated with poor blood flow to the ear, or other inner ear conditions such as Meniere's disease. One clinical study found that in people with tinnitus who did not have vertigo or hearing loss, a dose between 100 and 150 mg of Pycnogenol taken daily for one month significantly improved blood flow to the inner ear compared to those who did not receive any treatment (Grossi, Panmanerva Med, 2010). In people with tinnitus associated with Meniere's disease, 150 mg of Pycnogenol taken daily for 6 months significantly improved blood flow to the inner ear and symptoms of tinnitus compared to those who received standard treatments (Luzzi, Minerva Med 2014). A weakness of both of studies is that they lacked placebo controls.

A list of published clinical studies for other uses of Pycnogenol can be found on the product's website, here.

Pycnogenol + bilberry

Glaucoma

Two studies, described below, suggest that taking a combination of Pycnogenol and bilberry fruit extract may reduce eye pressure. However, neither study involved a placebo control, as needed to prove a benefit, nor reported improvements in vision.

A study in Japan among 18 people (average age 58) with a common form of glaucoma (primary open-angle) showed that taking one tablet (Sante Glagenox by Santen Pharmaceutical Co.) containing 40 mg of Pycnogenol and 90 mg of bilberry fruit extract (Mirtoselect by Idena) once daily for 4 weeks reduced pressure within the eye by 8.7% compared to baseline. The patients in this study were already taking at least one medication (mainly prostaglandin or a beta-blocker) to control eye pressure. Changes in best-corrected visual acuity were not reported (Manabe, J Clin Biochem Nutr 2021).The lack of a control group limits the impact of these results.

A study among 38 adults (average age 45) without glaucoma but with elevated pressure within the eye, which can cause glaucoma, showed that taking one tablet (Mirtogenol) containing 40 mg of Pycnogenol and 80 mg of bilberry extract (Mirtoselect) twice daily (in the morning and evening) for 6 months reduced pressure within the eye by 3.2 mmHg (from 25.2 to 22.0) compared to no significant decline in the control group that received no treatment. Those in the treatment group also showed improved blood flow in the arteries in the eyes, while those in the control group showed no improvement. These between-group differences were statistically significant, although those treated with Mirtogenol still had elevated eye pressure after 6 months (normal range is 11 to 21 mmgHg). Both groups had normal visual acuity at the start and end of the study (Steigerwalt, Mol Vis. 2008). Mirtogenol is included in the product Eye Pressure Support with Mirtogenol by Life Extension, but ConsumerLab has not tested this product.

Pycnogenol + gotu kola

Coronary artery calcification

Two studies, described below, suggest that taking a combination of Pycnogenol and gotu kola extract may help control calcifications in arteries of the heart, but the results are very preliminary and neither study involved a placebo control, as needed to prove a benefit.

A 12-month study suggested that taking a combination of pine bark extract (Pycnogenol) and gotu kola (Centellicum) might help control the calcifications in arteries of hearts of people with asymptomatic atherosclerosis The 12-month study, among 90 people in Italy, showed that taking 150 mg of Pycnogenol plus 450 mg of Centellicum daily, along with standard management (diet, exercise and lifestyle counseling plus 100 mg/day of aspirin), slightly decreased the average number of calcifications larger than 1 mm (as measured by CT scans) by about 10% (from 4.22 to 3.82), and this reduction was significant compared to a 35% increase (from 4.3 to 5.8) for those receiving standard management only (Hu, Minerva Cardioangiol 2020). However, this study did not include a placebo group, which is needed to prove a benefit.

A 6-month study among 79 asymptomatic people with high cholesterol, high blood pressure (managed with an ACE inhibitor), and narrowing of the carotid or femoral artery due to atherosclerotic plaque showed that taking 150 mg/day of Pycnogenol and 450 mg/day of gotu kola extract, along with standard management, did not significantly reduce cholesterol or triglyceride levels or improve blood pressure or arterial flow compared to standard management alone. However, plaque stability index increased by 11.18%, and "hardness" (i.e., echogenicity) of the plaque increased from 16.7 to 34.2, while there were no significant changes in these outcomes for those receiving standard management alone. More stable, "hard" plaques have been linked with increased arterial stiffness but a lower risk of adverse cardiovascular events, although cardiovascular outcomes were not assessed in this study (Belcaro, Int J Angiol 2017).

Flavangenol

High blood pressure

A clinical study among 121 overweight individuals with elevated or high blood pressure showed that taking 200 mg of Flavangenol once daily in the morning for 12 weeks did not significantly reduce systolic or diastolic blood pressure compared to placebo, regardless of systolic blood pressure readings at baseline. There were also no significant improvements in other risk factors for cardiovascular disease, including blood sugar control, cholesterol levels, or markers of inflammation, and body mass index actually slightly increased in the Flavangenol group compared to placebo (Drieling, JAMA Intern Med 2010).

Skin and sun protection

A clinical study of the branded pine bark extract, Flavangenol (Toyo Shinyaku Inc.), found 100 mg taken daily for 3 months significantly reduced measures of skin damage caused by UV exposure as well as a decrease in color of age spots in healthy young women (Furumura, Clin Interv Aging 2012).

Oligopin

High blood pressure

Taking 150 mg of Oligopin (another brand of French maritime pine bark extract) daily for 5 week did not lower systolic or diastolic blood pressure compared to placebo among 24 people with stage 1 high blood pressure (Valls, Phytomedicine 2016).

Pinus massoniana

High blood pressure

A study in Australia among 60 healthy adults (average age 65), about two-thirds of whom had high blood pressure at baseline, found that consuming 50 mL of a drink (RecoveR8 by Tismor Health & Wellness, which funded the study) containing 1,322 mg of Pinus massoniana extract standardized to 432 mg of total polyphenols daily for 12 weeks did not reduce systolic or diastolic blood pressure compared to placebo, even among those with high systolic blood pressure (>120 mmHg) at baseline (Ferguson, Complement Ther Med 2022).

Safety of Pycnogenol and other pine bark extracts

Pycnogenol

Pycnogenol appears to be safe and is generally well-tolerated, although a low incidence of adverse effects, including gastrointestinal symptoms, dizziness and vertigo and have been reported (American Botanical Council Monograph). In clinical trials, a total daily dose of 100 mg of Pycnogenol has been taken for up to one year and been well-tolerated (Errichi, Panminerva Med 2011). The American Botanical Council has stated that while there are no long-term safety studies, "...there is no evidence from actual product use over several decades by millions of people that might warrant a limitation, and based on the published chemistry and pharmacology of Pycnogenol, there are no data suggesting a limitation on duration of use..." (American Botanical Council Monograph). However, other experts have stated, "None of the studies considered safety as an important concern and the duration of most of the included studies was insufficient to adequately detect adverse events that may occur from taking the supplement chronically" (Robertson, Cochrane Database Syst Rev 2020).

While Pycnogenol is self-affirmed GRAS (Generally Recognized As Safe), it is important to note that self-affirmed GRAS status is only a declaration by the manufacturer; it is not granted by the FDA and does not mean that the agency has reviewed the safety data or recognized this ingredient as safe.

Pycnogenol could potentially lower blood sugar and affect platelet aggregation and increase the risk of bleeding in some people (Liu, Life Sci 2004; Araghi-Niknam, Integr Med 2000). Therefore, it should be used with caution in people with diabetes who are taking medications to lower blood sugar, including insulin, and in people taking blood-thinning drugs such as aspirin, clopidogrel (Plavix) and warfarin (Coumadin).

Although just a single report, it should be noted that a healthy 35-year-old man who had been taking large amounts of Pycnogenol (product brand, dose, and duration of use not specified) experienced rhabdomyolysis (muscle tissue breakdown) — with symptoms including muscle pain, soreness, and dark urine — two days after moving furniture. He was admitted to a hospital with an extremely high creatinine kinase level (a marker of muscle damage) of 154,000 U/L (normal range: about 20 to 200 U/L). After stopping the supplement and receiving intravenous fluids, he was discharged after 6 days. It was speculated that the supplement might have made his muscles more prone to injury (Kermanshah, Cureus 2025).

Pinus massoniana

There is limited clinical evidence about the safety of Pinus massoniana bark extract, but two short-term studies (both of which were funded by the manufacturer) reported no adverse effects when a drink containing 1,322 mg of Pinus massoniana extract was taken daily for 12 weeks (Ferguson, Complement Ther Med 2022; Ferguson, Antioxidants (Basel) 2022).

How to take

Since gastrointestinal discomfort appears to be the most common side effect of Pycnogenol, it may be best to take this supplement with, or after, meals. There does not appear to be any evidence that food increases or decreases Pycnogenol absorption. Although side effects do not appear to be dose related, it is probably best to start with the lowest daily dosage shown to be effective for a particular condition until you know how you react to the supplement (American Botanical Council Monograph).

What to consider when purchasing a supplement

Look for extracts derived from Pinus pinaster
In general, supplements derived from Pinus massoniana tend to cost less — for example, Pine Bark Extract from Vitacost, which is obtained from Pinus massoniana, costs 6 cents per 100 mg of pine bark extract compared to 68 cents per 100 mg of pine bark extract in Pycnogenol Pine Bark Extract by Root² or Pycnogenol French Maritime Pine Bark Extract by Life Extension. However, there is no convincing clinical evidence that Pinus massoniana is beneficial for any condition. Therefore, despite the higher cost, it seems best to look for a pine bark extract product derived from Pinus pinaster.

Choose standardized extracts
Among products containing bark extract from Pinus pinaster, look on the label or check with the manufacturer to confirm that the extract is standardized to 65% to 75% procyanidins or oligomeric proanthocyanidin complexes (OPCs), as specified by the United States Pharmacopeia (USP) for pine bark extract. The branded ingredients Pycnogenol and Oligopin are both standardized to 65% to 75% OPCs. However, while some products containing Oligopin cost less than Pycnogenol-containing products (e.g., French Maritime Pine Bark Extract by California Gold Nutrition, which contains Oligopin, cost only 46 cents per 100 mg), Oligopin has been significantly less clinically studied than Pycnogenol, so it is unclear if it has similar benefits. Therefore, it seems prudent to consider opting for Pycnogenol-containing products over other brands, at least until more research confirms similar benefits of other branded extracts.

Be wary of very low-cost products
Be aware that there are many other pine bark extracts derived from Pinus pinaster that do not contain branded ingredients such as Pycnogenol. These products tend to cost much less — for example, Extra Strength French Maritime Pine Bark Extract by Purely Holistic or Zazzee cost about 3 to 4 cents per 100 mg. However, these products are standardized to 95% proanthocyanidins, a broader class of compounds of which procyanidins are only one type. It is unclear what portion of the proanthocyanidins in these less expensive pine bark extracts is procyanidins. It is possible that the lower cost of these products may result from adulteration with other proanthocyanidin containing extracts such as peanut skin extract. Like pine bark extract, peanut skin extract does contain proanthocyanidins but costs significantly less (for example, in 2015 the price of peanut skin extract was $10-13/kg compared to $20-$22/kg for pine bark extract) (Kupina, Botanical Adulterants Bulletin 2016). The composition and structure of proanthocyanidins in peanut skin extract differ from pine bark extract (Justia Patent #10,802,006).

Check names carefully
Also, be aware that some brands of pine bark extract appear to come from companies with names that sound like the company that makes Pycnogenol, Horphag, but are different (we found one product on Amazon.com, for example, made by "Horbaach").

Will ConsumerLab test Pycnogenol and similar extracts?

Pine bark extract contains flavonoid compounds called oligomeric proanthocyanidin complexes, which are thought to be responsible for some of its effects. Unfortunately, the current method of testing for these compounds can be easily fooled by the addition of peanut skin extract which also contain proanthocyanidins (Justia Patent #10,802,006). Until a reliable, method is developed and validated by an authoritative institution such as USP (United States Pharmacopeia) and AOAC (Association of Analytical Communities) International, ConsumerLab.com is unable to test and review these products.