Pycnogenol

Last Updated: March 13, 2024

Pycnogenol is a standardized extract of bark from the French maritime pine Pinus pinaster that provides a concentrated source of polyphenols, predominantly procyanidins. Pycnogenol may reduce symptoms of chronic venous insufficiency and osteoarthritis thanks to its antioxidant, anti-inflammatory, and vasoactive properties; however, the evidence is relatively weak.

Pycnogenol is most often used for

What is pycnogenol?

Pycnogenol is a standardized pine bark extract derived specifically from French maritime pine trees (Pinus pinaster) found on the coast of France. It provides a concentrated source of flavonoids and phenolic acids, including procyanidin oligomers (65–75% by weight), catechin, epicatechin, taxifolin, caffeic acid, and ferulic acid. While other French maritime pine bark extracts exist (oligopin and flavangenol), their composition varies slightly due to different extraction techniques. Pycnogenol has been used in the vast majority of clinical trials to date, and will be the focus of this page unless otherwise mentioned.

What are pycnogenol’s main benefits?

Pycnogenol possesses anti-inflammatory, antioxidant, and vasoactive properties that may beneficially impact various health conditions. Despite some promising results, most health outcomes are supported by just a handful of small trials, and many of the existing trials have a high risk of bias.

Pycnogenol may reduce the signs and symptoms of chronic venous insufficiency (e.g., leg pain, heaviness, and edema; venous ulcers; microangiopathy)[4][5][6][7] and reduce leg edema and blood clot risk during long-duration air travel (although the latter has only been observed in a single trial).[8][9]

Short-term (≤3 months) trials have found that pycnogenol may reduce pain, improve physical functioning, and reduce the use of non-steroidal anti-inflammatory drugs (NSAIDs) in people with osteoarthritis.[10][11][12][13] Interestingly, research suggests that some compounds in pycnogenol can enter the synovial fluid in joints, where they may act locally to reduce inflammation and inhibit the breakdown of collagen.[14][15][16]

What are pycnogenol’s main drawbacks?

Pycnogenol is generally considered safe and well tolerated. Side effects occur rarely and may include headache, dizziness, drowsiness, skin irritation, and gastrointestinal upset (e.g., nausea), the latter of which may improve if pycnogenol is taken with food.[1]

Most of the research on pycnogenol has been at least partially funded by the manufacturer of pycnogenol. While this doesn’t invalidate the research, it does make it more prone to bias in favor of pycnogenol.

How does pycnogenol work?

The biological activity of pycnogenol is due to its diverse and rich content of polyphenols.[17] Following ingestion, some of these compounds are metabolized by bacteria in the colon into other bioactive compounds that can be absorbed. For example, bacteria can convert the procyanidins in pycnogenol into the compound M1 (δ-(3,4-dihydroxy-phenyl)-γ-valerolactone), which is thought to strongly contribute to its overall biological effects.[18][19]

Pycnogenol seems to decrease pain and inflammation by reducing the activity of certain pathways in the body that lead to the production of pro-inflammatory compounds, including nuclear factor kappa B (NF-κB) and cyclooxygenase (COX)-1 and COX-2 enzymes.[15][20] As an antioxidant, in vitro and animal research suggests that pycnogenol may directly scavenge free radicals, regenerate other antioxidants in the body (e.g., vitamin C, vitamin E, and glutathione), and increase the activity of antioxidant enzymes.[21][22][23] The above effects, as well as pycnogenol's ability to enhance nitric oxide synthesis and increase capillary integrity, may contribute to reduced capillary permeability and increased blood flow.[24][7]

What else is Pycnogenol known as?
Note that Pycnogenol is also known as:
  • Pine Bark Extract
  • French maritime pine bark extract
  • Pinus pinaster bark extract
  • Oligopin (a different standardized extract)
  • Flavangenol (a different standardized extract)
Pycnogenol should not be confused with:
  • Enzogenol (standardized extract of Pinus radiata)
  • Pinus massoniana bark extract
Dosage information

Most research on French maritime pine extract has used pycnogenol, as opposed to the other standardized extracts, oligopin and flavangenol. These extracts have slightly different chemical compositions, due to different extraction techniques, and there currently isn’t enough evidence to know whether oligopin and flavangenol work the same as pycnogenol.

Pycnogenol is available as capsules or loose powder and is usually given at a dosage of 100 to 200 mg daily, split into two or three doses (e.g., 100 mg twice daily, 50 mg three times daily). Taking pycnogenol with food may reduce gastrointestinal side effects.[1]

Pycnogenol is also available in topical formulations. For healing ulcers associated with chronic vascular insufficiency or diabetes, combining oral and topical pycnogenol appears to be more effective than oral pycnogenol alone.[2][3]

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References
  1. ^Rohdewald PUPDATE ON THE CLINICAL PHARMACOLOGY OF PYCNOGENOL®Medical Research Archives.(2015 Jul)
  2. ^Belcaro G, Cesarone MR, Errichi BM, Ledda A, Di Renzo A, Stuard S, Dugall M, Pellegrini L, Rohdewald P, Ippolito E, Ricci A, Cacchio M, Ruffini I, Fano F, Hosoi MVenous ulcers: microcirculatory improvement and faster healing with local use of PycnogenolAngiology.(2005 Nov-Dec)
  3. ^Belcaro G, Cesarone MR, Errichi BM, Ledda A, Di Renzo A, Stuard S, Dugall M, Pellegrini L, Gizzi G, Rohdewald P, Ippolito E, Ricci A, Cacchio M, Cipollone G, Ruffini I, Fano F, Hosoi MDiabetic ulcers: microcirculatory improvement and faster healing with pycnogenol.Clin Appl Thromb Hemost.(2006-Jul)
  4. ^Cesarone MR, Belcaro G, Agus GB, Ippolito E, Dugall M, Hosoi M, Corsi M, Cotellese R, Feragalli B, Scipione C, Scipione V, Maione CChronic venous insufficiency and venous microangiopathy: management with compression and Pycnogenol®.Minerva Cardioangiol.(2019-Aug)
  5. ^Cesarone MR, Belcaro G, Rohdewald P, Pellegrini L, Ledda A, Vinciguerra G, Ricci A, Gizzi G, Ippolito E, Fano F, Dugall M, Acerbi G, Cacchio M, Di Renzo A, Hosoi M, Stuard S, Corsi MRapid relief of signs/symptoms in chronic venous microangiopathy with pycnogenol: a prospective, controlled study.Angiology.(2006)
  6. ^Cesarone MR, Belcaro G, Rohdewald P, Pellegrini L, Ledda A, Vinciguerra G, Ricci A, Gizzi G, Ippolito E, Fano F, Dugall M, Acerbi G, Cacchio M, Di Renzo A, Hosoi M, Stuard S, Corsi MComparison of Pycnogenol and Daflon in treating chronic venous insufficiency: a prospective, controlled studyClin Appl Thromb Hemost.(2006 Apr)
  7. ^Gulati OPPycnogenol® in chronic venous insufficiency and related venous disorders.Phytother Res.(2014-Mar)
  8. ^Chan V, Wang L, Allman-Farinelli MEfficacy of Functional Foods, Beverages, and Supplements Claiming to Alleviate Air Travel Symptoms: Systematic Review and Meta-Analysis.Nutrients.(2021-Mar-16)
  9. ^Belcaro G, Cesarone MR, Rohdewald P, Ricci A, Ippolito E, Dugall M, Griffin M, Ruffini I, Acerbi G, Vinciguerra MG, Bavera P, Di Renzo A, Errichi BM, Cerritelli FPrevention of venous thrombosis and thrombophlebitis in long-haul flights with pycnogenol.Clin Appl Thromb Hemost.(2004-Oct)
  10. ^Xiaoqian Liu, Gustavo C Machado, Jillian P Eyles, Varshini Ravi, David J HunterDietary supplements for treating osteoarthritis: a systematic review and meta-analysisBr J Sports Med.(2018 Feb)
  11. ^Belcaro G, Cesarone MR, Errichi S, Zulli C, Errichi BM, Vinciguerra G, Ledda A, Di Renzo A, Stuard S, Dugall M, Pellegrini L, Errichi S, Gizzi G, Ippolito E, Ricci A, Cacchio M, Cipollone G, Ruffini I, Fano F, Hosoi M, Rohdewald PTreatment of osteoarthritis with Pycnogenol. The SVOS (San Valentino Osteo-arthrosis Study). Evaluation of signs, symptoms, physical performance and vascular aspectsPhytother Res.(2008 Apr)
  12. ^Cisár P, Jány R, Waczulíková I, Sumegová K, Muchová J, Vojtassák J, Duraćková Z, Lisý M, Rohdewald PEffect of pine bark extract (Pycnogenol) on symptoms of knee osteoarthritisPhytother Res.(2008 Aug)
  13. ^Farid R, Mirfeizi Z, Mirheidari M, Rezaieyazdi Z, Mansouri H, Esmaelli H, Zibadi S, Rohdewald P, Watson RPycnogenol supplementation reduces pain and stiffness and improves physical function in adults with knee osteoarthritisNutr Res.(2007 Nov)
  14. ^Mülek M, Seefried L, Genest F, Högger PDistribution of Constituents and Metabolites of Maritime Pine Bark Extract (Pycnogenol) into Serum, Blood Cells, and Synovial Fluid of Patients with Severe Osteoarthritis: A Randomized Controlled Trial.Nutrients.(2017-Apr-28)
  15. ^Grimm T, Chovanová Z, Muchová J, Sumegová K, Liptáková A, Duracková Z, Högger PInhibition of NF-kappaB activation and MMP-9 secretion by plasma of human volunteers after ingestion of maritime pine bark extract (Pycnogenol).J Inflamm (Lond).(2006-Jan-27)
  16. ^Jessberger S, Högger P, Genest F, Salter DM, Seefried LCellular pharmacodynamic effects of Pycnogenol® in patients with severe osteoarthritis: a randomized controlled pilot study.BMC Complement Altern Med.(2017-Dec-16)
  17. ^Hadi A, Pourmasoumi M, Mohammadi H, Javaheri A, Rouhani MHThe impact of pycnogenol supplementation on plasma lipids in humans: A systematic review and meta-analysis of clinical trials.Phytother Res.(2019-Feb)
  18. ^Grimm T, Skrabala R, Chovanová Z, Muchová J, Sumegová K, Liptáková A, Duracková Z, Högger PSingle and multiple dose pharmacokinetics of maritime pine bark extract (pycnogenol) after oral administration to healthy volunteersBMC Clin Pharmacol.(2006 Aug 3)
  19. ^Rohdewald PJReview on Sustained Relief of Osteoarthritis Symptoms with a Proprietary Extract from Pine Bark, PycnogenolJ Med Food.(2018 Jan)
  20. ^Schäfer A, Chovanová Z, Muchová J, Sumegová K, Liptáková A, Duracková Z, Högger PInhibition of COX-1 and COX-2 activity by plasma of human volunteers after ingestion of French maritime pine bark extract (Pycnogenol).Biomed Pharmacother.(2006-Jan)
  21. ^Packer L, Rimbach G, Virgili FAntioxidant activity and biologic properties of a procyanidin-rich extract from pine (Pinus maritima) bark, pycnogenol.Free Radic Biol Med.(1999-Sep)
  22. ^Wei ZH, Peng QL, Lau BHPycnogenol enhances endothelial cell antioxidant defenses.Redox Rep.(1997-Aug)
  23. ^Maritim A, Dene BA, Sanders RA, Watkins JBEffects of pycnogenol treatment on oxidative stress in streptozotocin-induced diabetic rats.J Biochem Mol Toxicol.(2003)
  24. ^Fitzpatrick DF, Bing B, Rohdewald PEndothelium-dependent vascular effects of Pycnogenol.J Cardiovasc Pharmacol.(1998-Oct)
  25. ^Malekahmadi M, Moradi Moghaddam O, Firouzi S, Daryabeygi-Khotbehsara R, Shariful Islam SM, Norouzy A, Soltani SEffects of pycnogenol on cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials.Pharmacol Res.(2019-Dec)
  26. ^Mármol I, Quero J, Jiménez-Moreno N, Rodríguez-Yoldi M, Ancín-Azpilicueta CA systematic review of the potential uses of pine bark in food industry and health careTrends Food Sci Technol.(2019 Jun)
  27. ^Pourmasoumi M, Hadi A, Mohammadi H, Rouhani MHEffect of pycnogenol supplementation on blood pressure: A systematic review and meta-analysis of clinical trials.Phytother Res.(2020-Jan)
  28. ^Federica Fogacci, Giuliano Tocci, Amirhossein Sahebkar, Vivianne Presta, Maciej Banach, Arrigo Francesco Giuseppe CiceroEffect of Pycnogenol on Blood Pressure: Findings From a PRISMA Compliant Systematic Review and Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled, Clinical StudiesAngiology.(2020 Mar)
  29. ^Zhang Z, Tong X, Wei YL, Zhao L, Xu JY, Qin LQEffect of Pycnogenol Supplementation on Blood Pressure: A Systematic Review and Meta-analysis.Iran J Public Health.(2018-Jun)
  30. ^Liu X, Wei J, Tan F, Zhou S, Würthwein G, Rohdewald PPycnogenol, French maritime pine bark extract, improves endothelial function of hypertensive patientsLife Sci.(2004 Jan 2)
  31. ^Zibadi S, Rohdewald PJ, Park D, Watson RRReduction of cardiovascular risk factors in subjects with type 2 diabetes by Pycnogenol supplementationNutr Res.(2008 May)
  32. ^Hsu CD, Hsieh LH, Chen YL, Lin IC, Chen YR, Chen CC, Shirakawa H, Yang SCComplementary effects of pine bark extract supplementation on inattention, impulsivity, and antioxidative status in children with attention-deficit hyperactivity disorder: A double-blinded randomized placebo-controlled cross-over study.Phytother Res.(2021-Jun)
  33. ^Trebatická J, Kopasová S, Hradecná Z, Cinovský K, Skodácek I, Suba J, Muchová J, Zitnanová I, Waczulíková I, Rohdewald P, Duracková ZTreatment of ADHD with French maritime pine bark extract, Pycnogenol.Eur Child Adolesc Psychiatry.(2006-Sep)
  34. ^Dutta T, Anand U, Mitra SS, Ghorai M, Jha NK, Shaikh NK, Shekhawat MS, Pandey DK, Proćków J, Dey APhytotherapy for Attention Deficit Hyperactivity Disorder (ADHD): A Systematic Review and Meta-analysis.Front Pharmacol.(2022)
  35. ^Dvoráková M, Jezová D, Blazícek P, Trebatická J, Skodácek I, Suba J, Iveta W, Rohdewald P, Duracková ZUrinary catecholamines in children with attention deficit hyperactivity disorder (ADHD): modulation by a polyphenolic extract from pine bark (pycnogenol).Nutr Neurosci.(2007)
  36. ^Dvoráková M, Sivonová M, Trebatická J, Skodácek I, Waczuliková I, Muchová J, Duracková ZThe effect of polyphenolic extract from pine bark, Pycnogenol on the level of glutathione in children suffering from attention deficit hyperactivity disorder (ADHD).Redox Rep.(2006)
  37. ^Luzzi R, Belcaro G, Zulli C, Cesarone MR, Cornelli U, Dugall M, Hosoi M, Feragalli BPycnogenol® supplementation improves cognitive function, attention and mental performance in studentsPanminerva Med.(2011 Sep)
  38. ^Hosoi M, Belcaro G, Saggino A, Luzzi R, Dugall M, Feragalli BPycnogenol® supplementation in minimal cognitive dysfunction.J Neurosurg Sci.(2018-Jun)
  39. ^Belcaro G, Luzzi R, Dugall M, Ippolito E, Saggino APycnogenol® improves cognitive function, attention, mental performance and specific professional skills in healthy professionals aged 35-55.J Neurosurg Sci.(2014-Dec)
  40. ^Belcaro G, Dugall M, Ippolito E, Hu S, Saggino A, Feragalli BThe COFU3 Study. Improvement in cognitive function, attention, mental performance with Pycnogenol® in healthy subjects (55-70) with high oxidative stress.J Neurosurg Sci.(2015-Dec)
  41. ^Ryan J, Croft K, Mori T, Wesnes K, Spong J, Downey L, Kure C, Lloyd J, Stough CAn 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-Jul)
  42. ^Ni Z, Mu Y, Gulati OTreatment of melasma with Pycnogenol.Phytother Res.(2002-Sep)
  43. ^Lima PB, Dias JAF, Esposito ACC, Miot LDB, Miot HAFrench maritime pine bark extract (pycnogenol) in association with triple combination cream for the treatment of facial melasma in women: a double-blind, randomized, placebo-controlled trial.J Eur Acad Dermatol Venereol.(2021-Feb)
  44. ^Pinto C, Delfes M, Montanheiro dos Reis L, Garbers L, Passos P, Skusa de Torre DThe use of pycnogenol in the treatment of melasmaSurg Cosmet Dermatol.(2015 Sep)
  45. ^Kim YJ, Kang KS, Yokozawa TThe anti-melanogenic effect of pycnogenol by its anti-oxidative actions.Food Chem Toxicol.(2008-Jul)
  46. ^Furumura M, Sato N, Kusaba N, Takagaki K, Nakayama JOral administration of French maritime pine bark extract (Flavangenol(®)) improves clinical symptoms in photoaged facial skin.Clin Interv Aging.(2012)
  47. ^Saliou C, Rimbach G, Moini H, McLaughlin L, Hosseini S, Lee J, Watson RR, Packer LSolar 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.(2001-Jan-15)
  48. ^Marini A, Grether-Beck S, Jaenicke T, Weber M, Burki C, Formann P, Brenden H, Schönlau F, Krutmann JPycnogenol® effects on skin elasticity and hydration coincide with increased gene expressions of collagen type I and hyaluronic acid synthase in womenSkin Pharmacol Physiol.(2012)
  49. ^Hua Zhao, Jinhao Wu, Nan Wang, Susanne Grether-Beck, Jean Krutmann, Liu WeiOral Pycnogenol® Intake Benefits the Skin in Urban Chinese Outdoor Workers: A Randomized, Placebo-Controlled, Double-Blind, and Crossover Intervention StudySkin Pharmacol Physiol.(2021)
  50. ^Tian Y, Zhou Q, Li W, Liu M, Li Q, Chen QEfficacy of L-arginine and Pycnogenol ® in the treatment of male erectile dysfunction: a systematic review and meta-analysis.Front Endocrinol (Lausanne).(2023)
  51. ^Trebaticky B, Muchova J, Ziaran S, Bujdak P, Breza J, Durackova ZNatural polyphenols improve erectile function and lipid profile in patients suffering from erectile dysfunction.Bratisl Lek Listy.(2019)
  52. ^Lau BH, Riesen SK, Truong KP, Lau EW, Rohdewald P, Barreta RAPycnogenol as an adjunct in the management of childhood asthma.J Asthma.(2004)
  53. ^Hosseini S, Pishnamazi S, Sadrzadeh SM, Farid F, Farid R, Watson RRPycnogenol((R)) in the Management of AsthmaJ Med Food.(2001 Winter)
  54. ^G Belcaro, R Luzzi, P Cesinaro Di Rocco, M R Cesarone, M Dugall, B Feragalli, B M Errichi, E Ippolito, M G Grossi, M Hosoi, S Errichi, U Cornelli, A Ledda, G GizziPycnogenol® improvements in asthma managementPanminerva Med.(2011 Sep)
  55. ^Choi YH, Yan GHPycnogenol inhibits immunoglobulin E-mediated allergic response in mast cells.Phytother Res.(2009-Dec)
Examine Database References
  1. Skin Quality - Marini A, Grether-Beck S, Jaenicke T, Weber M, Burki C, Formann P, Brenden H, Schönlau F, Krutmann JPycnogenol® effects on skin elasticity and hydration coincide with increased gene expressions of collagen type I and hyaluronic acid synthase in womenSkin Pharmacol Physiol.(2012)
  2. Low-density lipoprotein (LDL) - Zibadi S, Rohdewald PJ, Park D, Watson RRReduction of cardiovascular risk factors in subjects with type 2 diabetes by Pycnogenol supplementationNutr Res.(2008 May)
  3. Endothelin-1 - Ximing Liu, Ha-Jun Zhou, Peter RohdewaldFrench maritime pine bark extract Pycnogenol dose-dependently lowers glucose in type 2 diabetic patientsDiabetes Care.(2004 Mar)
  4. Asthma Symptoms - Hosseini S, Pishnamazi S, Sadrzadeh SM, Farid F, Farid R, Watson RRPycnogenol((R)) in the Management of AsthmaJ Med Food.(2001 Winter)
  5. Asthma Symptoms - G Belcaro, R Luzzi, P Cesinaro Di Rocco, M R Cesarone, M Dugall, B Feragalli, B M Errichi, E Ippolito, M G Grossi, M Hosoi, S Errichi, U Cornelli, A Ledda, G GizziPycnogenol® improvements in asthma managementPanminerva Med.(2011 Sep)
  6. Blood Flow - Nishioka K, Hidaka T, Nakamura S, Umemura T, Jitsuiki D, Soga J, Goto C, Chayama K, Yoshizumi M, Higashi YPycnogenol, French maritime pine bark extract, augments endothelium-dependent vasodilation in humansHypertens Res.(2007 Sep)
  7. High-density lipoprotein (HDL) - Devaraj S, Vega-López S, Kaul N, Schönlau F, Rohdewald P, Jialal ISupplementation with a pine bark extract rich in polyphenols increases plasma antioxidant capacity and alters the plasma lipoprotein profileLipids.(2002 Oct)
  8. High-density lipoprotein (HDL) - Hadi A, Pourmasoumi M, Mohammadi H, Javaheri A, Rouhani MHThe impact of pycnogenol supplementation on plasma lipids in humans: A systematic review and meta-analysis of clinical trials.Phytother Res.(2019-Feb)
  9. Blood glucose - Malekahmadi M, Moradi Moghaddam O, Firouzi S, Daryabeygi-Khotbehsara R, Shariful Islam SM, Norouzy A, Soltani SEffects of pycnogenol on cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials.Pharmacol Res.(2019-Dec)
  10. C-Reactive Protein (CRP) - Omid Nikpayam, Mohammad Hossein Rouhani, Makan Pourmasoumi, Neda Roshanravan, Ehsan Ghaedi, Hamed MohammadiThe Effect of Pycnogenol Supplementation on Plasma C-Reactive Protein Concentration: a Systematic Review and Meta-AnalysisClin Nutr Res.(2018 Apr)
  11. Blood Pressure - Federica Fogacci, Giuliano Tocci, Amirhossein Sahebkar, Vivianne Presta, Maciej Banach, Arrigo Francesco Giuseppe CiceroEffect of Pycnogenol on Blood Pressure: Findings From a PRISMA Compliant Systematic Review and Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled, Clinical StudiesAngiology.(2020 Mar)
  12. Heart Rate - Enseleit F, Sudano I, Périat D, Winnik S, Wolfrum M, Flammer AJ, Fröhlich GM, Kaiser P, Hirt A, Haile SR, Krasniqi N, Matter CM, Uhlenhut K, Högger P, Neidhart M, Lüscher TF, Ruschitzka F, Noll GEffects of Pycnogenol on endothelial function in patients with stable coronary artery disease: a double-blind, randomized, placebo-controlled, cross-over studyEur Heart J.(2012 Jul)
  13. Pain - Reza Farid, Zahra Mirfeizi, Mahyar Mirheidari, Zahra Rezaieyazdi, Hassan Mansouri, Habib Esmaelli, Sherma Zibadi, Peter Rohdewald, Ronald Ross WatsonPycnogenol supplementation reduces pain and stiffness and improves physical function in adults with knee osteoarthritisNutrition Research.()
  14. Osteoarthritis Symptoms - Belcaro G, Cesarone MR, Errichi S, Zulli C, Errichi BM, Vinciguerra G, Ledda A, Di Renzo A, Stuard S, Dugall M, Pellegrini L, Errichi S, Gizzi G, Ippolito E, Ricci A, Cacchio M, Cipollone G, Ruffini I, Fano F, Hosoi M, Rohdewald PTreatment of osteoarthritis with Pycnogenol. The SVOS (San Valentino Osteo-arthrosis Study). Evaluation of signs, symptoms, physical performance and vascular aspectsPhytother Res.(2008 Apr)
  15. Chronic Venous Insufficiency Signs - Cesarone MR, Belcaro G, Rohdewald P, Pellegrini L, Ledda A, Vinciguerra G, Ricci A, Gizzi G, Ippolito E, Fano F, Dugall M, Acerbi G, Cacchio M, Di Renzo A, Hosoi M, Stuard S, Corsi MComparison of Pycnogenol and Daflon in treating chronic venous insufficiency: a prospective, controlled studyClin Appl Thromb Hemost.(2006 Apr)
  16. Chronic Venous Insufficiency Signs - Rainer KochComparative study of Venostasin and Pycnogenol in chronic venous insufficiencyPhytother Res.(2002 Mar)
  17. Leg Edema - Chan V, Wang L, Allman-Farinelli MEfficacy of Functional Foods, Beverages, and Supplements Claiming to Alleviate Air Travel Symptoms: Systematic Review and Meta-Analysis.Nutrients.(2021-Mar-16)
  18. Cognition - Luzzi R, Belcaro G, Zulli C, Cesarone MR, Cornelli U, Dugall M, Hosoi M, Feragalli BPycnogenol® supplementation improves cognitive function, attention and mental performance in studentsPanminerva Med.(2011 Sep)
  19. Erections - R Stanislavov, V NikolovaTreatment of erectile dysfunction with pycnogenol and L-arginineJ Sex Marital Ther.(May-Jun 2003)
  20. Blood Pressure - Liu X, Wei J, Tan F, Zhou S, Würthwein G, Rohdewald PPycnogenol, French maritime pine bark extract, improves endothelial function of hypertensive patientsLife Sci.(2004 Jan 2)
  21. Blood Pressure - Saeed Hosseini, Jeongmin Lee, Ramon T. Sepulveda, Peter Rohdewald, Ronald R. WatsonA randomized, double-blind, placebo-controlled, prospective, 16 week crossover study to determine the role of Pycnogenol in modifying blood pressure in mildly hypertensive patientsNutrition Research.()
  22. Menopausal Symptoms - Errichi S, Bottari A, Belcaro G, Cesarone MR, Hosoi M, Cornelli U, Dugall M, Ledda A, Feragalli BSupplementation with Pycnogenol® improves signs and symptoms of menopausal transitionPanminerva Med.(2011 Sep)
  23. NF-kB Activity - Tanja Grimm, Zuzana Chovanová, Jana Muchová, Katarína Sumegová, Anna Liptáková, Zdeňka Ďuračková and Petra HöggerInhibition of NF-κB activation and MMP-9 secretion by plasma of human volunteers after ingestion of maritime pine bark extract (Pycnogenol)Journal of Inflammation.()
  24. Irritable Bowel Syndrome Symptoms - Belcaro G, Gizzi G, Pellegrini L, Feragalli B, Cotellese R, Cacchio M, Corsi MPycnogenol® supplementation improves the control of irritable bowel syndrome symptomsPanminerva Med.(2018 Jun)