MARITIME PINE: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews

Overview

Maritime pine trees (Pinus pinaster) grow in countries on the Mediterranean Sea. Its bark may be helpful for asthma and improved leg circulation.

Maritime pine contains chemicals that might improve blood flow, stimulate the immune system, reduce swelling, prevent infections, and have antioxidant effects. Maritime pine trees that grow in southwest France are used to make Pycnogenol, the trademarked name for a specific maritime pine bark extract.

Maritime pine bark extract is used for asthma, high cholesterol, decline in memory, ADHD, and many other conditions, but there is no good scientific evidence to support many of these uses.

Uses & Effectiveness

Possibly Effective for

Asthma. Taking a specific maritime pine bark extract (Pycnogenol) by mouth daily, along with asthma medications, seems to decrease asthma symptoms and the need for rescue inhalers in children and adults with asthma. Keep in mind that maritime pine bark extract shouldn't be used in place of asthma medicine.
Poor circulation that can cause the legs to swell (chronic venous insufficiency or CVI). Taking a specific maritime pine bark extract (Pycnogenol) by mouth seems to reduce leg pain and heaviness, as well as swelling, in people with circulation problems.
Osteoarthritis. Taking a specific maritime pine bark extract (Pycnogenol) by mouth might improve some symptoms of knee osteoarthritis. It also might reduce the need for pain medications in some people.

Possibly Ineffective for

High cholesterol. Taking a specific maritime pine bark extract (Pycnogenol) doesn't lower low-density lipoprotein (LDL or "bad") cholesterol in people with high cholesterol.

There is interest in using maritime pine bark for a number of other purposes, but there isn't enough reliable information to say whether it might be helpful.

Side Effects

When taken by mouth: A specific maritime pine bark extract (Pycnogenol) is possibly safe when taken in doses of 50-450 mg daily for up to one year. It might cause dizziness and stomach problems in some people.

When applied to the skin: A specific maritime pine bark extract (Pycnogenol) is possibly safe when used as a cream for up to 7 days or as a powder for up to 6 weeks.

Special Precautions and Warnings

Pregnancy: Taking a specific maritime pine bark extract (Pycnogenol) is possibly safe when used in late pregnancy. But until more is known, it should be used cautiously or avoided during pregnancy.

Breast-feeding: There isn't enough reliable information to know if maritime pine is safe to use when breast-feeding. Stay on the safe side and avoid use.

Children: A specific maritime pine bark extract (Pycnogenol) is possibly safe to take by mouth for up to 3 months in children 6-18 years of age.

"Auto-immune diseases" such as multiple sclerosis (MS), lupus (systemic lupus erythematosus, SLE), rheumatoid arthritis (RA), or other conditions: Maritime pine might cause the immune system to become more active, and this could increase the symptoms of auto-immune diseases. If you have one of these conditions, it's best to avoid using maritime pine.

Bleeding conditions: Taking high doses of maritime pine might increase the risk of bleeding in people with bleeding conditions.

Surgery: Maritime pine might slow blood clotting and reduce blood sugar. There is some concern that it might cause blood sugar to go too low and increase the chance of bleeding during and after surgery. Stop using maritime pine at least 2 weeks before a scheduled surgery.

Interactions

Moderate Interaction

Be cautious with this combination

Medications that decrease the immune system (Immunosuppressants) interacts with MARITIME PINE
Maritime pine can increase the activity of the immune system. Some medications, such as those used after a transplant, decrease the activity of the immune system. Taking maritime pine along with these medications might decrease the effects of these medications.
Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) interacts with MARITIME PINE
Maritime pine might slow blood clotting. Taking maritime pine along with medications that also slow blood clotting might increase the risk of bruising and bleeding.
Medications for diabetes (Antidiabetes drugs) interacts with MARITIME PINE
Maritime pine might lower blood sugar levels. Taking maritime pine along with diabetes medications might cause blood sugar to drop too low. Monitor your blood sugar closely.

Dosing

Maritime pine bark extract has most often been used by adults at a dose of 50 mg, taken 2-3 times daily, for up to one year. It's also used in various products, including creams and topical powders. Speak with a healthcare provider to find out what type of product and dose might be best for a specific condition.

View References

REFERENCES:

Morgan LR, Holdiness MR, Gillen LE. N-acetylcysteine: its bioavailability and interaction with ifosfamide metabolites. Semin Oncol 1983;10:56-61.

Morini M, Cai T, Aluigi MG, et al. The role of the thiol N-acetylcysteine in the prevention of tumor invasion and angiogenesis. Int J Biol Markers 1999;14:268-71. View abstract.

Munshi NC, Loehrer PJ Sr, Williams SD, et al. Comparison of N-acetylcysteine and mesna as uroprotectors with ifosfamide combination chemotherapy in refractory germ cell tumors. Invest New Drugs 1992;10:159-163.. View abstract.

Murch SJ, Simmons CB, Saxena PK. Melatonin in feverfew and other medicinal plants. Lancet 1997;350:1598-9. View abstract.

North DS, Peterson RG, Krenzelok EP. Effect of activated charcoal administration on acetylcysteine serum levels in humans. Am J Hosp Pharm. 1981;38(7):1022-4. View abstract.

Norton EW. A randomized trial of vitamin A and vitamin E supplementation for retinitis pigmentosa. Arch Ophthalmol 1993;111:1460. View abstract.

Oldemeyer JB, Biddle WP, Wurdeman RL, et al. Acetylcysteine in the prevention of contrast-induced nephropathy after coronary angiography. Am Heart J 2003;146:E23. . View abstract.

Oliveira CP, Cotrim HP, Stefano JT, Siqueira ACG, Salgado ALA, Parise ER. N-Acetylcysteine and/or ursodeoxycholic acid associated with metformin in non-alcoholic steatohepatitis: an open-label multicenter randomized controlled trial. Arq Gastroenterol 2019;56(2):184-90. View abstract.

Oner G, Muderris II. Clinical, endocrine and metabolic effects of metformin vs N-acetyl-cysteine in women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2011;159(1):127-31. View abstract.

Pannu, N., Wiebe, N., and Tonelli, M. Prophylaxis strategies for contrast-induced nephropathy. JAMA 2006;295(23):2765-2779. View abstract.

Papi A, Di Stefano AFD, Radicioni M. Pharmacokinetics and safety of single and multiple doses of oral N-acetylcysteine in healthy Chinese and Caucasian volunteers: an open-label, phase I clinical study. Adv Ther. 2021;38(1):468-78. View abstract.

Pasupathy S, Tavella R, Grover S, et al. Early use of N-acetylcysteine with nitrate therapy in patients undergoing primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction reduces myocardial infarct size (the NACIAM Trial [N-acetylcysteine in acute myocardial infarction]). Circulation. 2017 Sept 5;136(10):894-903. View abstract.

Paydary K, Akamaloo A, Ahmadipour A, Pishgar F, Emamzadehfard S, Akhondzadeh S. N-acetylcysteine augmentation therapy for moderate-to-severe obsessive-compulsive disorder: a randomized, double-blind, placebo-controlled trial. J Clin Pharm Ther. 2016 Apr;41(2):214-9. View abstract.

Pela R, Calcagni AM, Subiaco S, et al. N-acetylcysteine reduces the exacerbation rate in patients with moderate to severe COPD. Respiration 1999;66:495-500.. View abstract.

Product information for acetylcysteine inhalant. American Regent, Inc., Shirley, NY. May 2014.

Qi Q, Ailiyaer Y, Liu R, et al. Effect of N-acetylcysteine on exacerbations of bronchiectasis (BENE): a randomized controlled trial. Respir Res 2019;20(1):73. View abstract.

Rafiee B, Bagher Tabei SM. The effect of N-acetyl cysteine consumption on men with abnormal sperm parameters due to positive history of COVID-19 in the last three months. Arch Ital Urol Androl 2021;93(4):465-467. View abstract.

Renzi FP, Donovan JW, Martin TG, Morgan L, Harrison EF. Concomitant use of activated charcoal and N-acetylcysteine. Ann Emerg Med. 1985;14(6):568-72. View abstract.

Rogliani P, Calzetta L, Cavalli F, Matera MG, Cazzola M. Pirfenidone, nintedanib and N-acetylcysteine for the treatment of idiopathic pulmonary fibrosis: A systematic review and meta-analysis. Pulm Pharmacol Ther. 2016;40:95-103. View abstract.

Ruiz FJ, Salom MG, Inglés AC, et al. N-acetyl-L-cysteine potentiates depressor response to captopril and enalaprilat in SHRs. Am J Physiol. 1994;267(3 Pt 2):R767-72. View abstract.

Sacchinelli A, Venturella R, Lico D, et al. The efficacy of inositol and N-acetyl cysteine administration (Ovaric HP) in improving the ovarian function in infertile women with PCOS with or without insulin resistance. Obstet Gynecol Int 2014;2014:141020. View abstract.

Salehpour S, Sene AA, Saharkhiz N, et al. N-Acetylcysteine as an adjuvant to clomiphene citrate for successful induction of ovulation in infertile patients with polycystic ovary syndrome. J Obstet Gynaecol Res 2012;38(9):1182-6. View abstract.

Sarris J, Byrne G, Castle D, et al. N-acetyl cysteine (NAC) augmentation in the treatment of obsessive-compulsive disorder: A phase III, 20-week, double-blind, randomized, placebo-controlled trial. Prog Neuropsychopharmacol Biol Psychiatry 2022;117:110550. View abstract.

Schmidl D, Werkmeister R, Kaya S, et al. A Controlled, Randomized Double-Blind Study to Evaluate the Safety and Efficacy of Chitosan-N-Acetylcysteine for the Treatment of Dry Eye Syndrome. J Ocul Pharmacol Ther. 2017;33(5):375-382. View abstract.

Sekharam M, Trotti A, Cunnick JM, Wu J. Suppression of fibroblast cell cycle progression in G1 phase by N-acetylcysteine. Toxicol Appl Pharmacol 1998;149:210-6. View abstract.

Shahreki E, Kaykhaei MA, Mosallanezhad Z, et al. Effects of selenium and/or N-acetyl-cysteine supplementation on nonthyroidal illness syndrome in hemodialysis patients: a factorial randomized controlled trial. Pharmacology. 2022 Jun 10:1-6. View abstract.

Shyu KG, Cheng JJ, Kuan P. Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure. J Am Coll Cardiol 2002;40:1383-8.. View abstract.

Sio TT, Blanchard MJ, Novotny PJ, et al. N-acetylcysteine rinse for thick secretion and mucositis of head and neck chemoradiotherapy (Alliance MC13C2): A double-blind randomized clinical trial. Mayo Clin Proc. 2019;94(9):1814-1824. View abstract.

Slattery KM, Dascombe B, Wallace LK, et al. Effect of N-acetylcysteine on cycling performance after intensified training. Med Sci Sports Exerc 2014;46(6):1114-23. View abstract.

Spiller HA, Krenzelok EP, Grande GA, et al. A prospective evaluation of the effect of activated charcoal before oral N-acetylcysteine in acetaminophen overdose. Ann Emerg Med 1994;23:519-23. View abstract.

Su X, Xie X, Liu L, et al. Comparative effectiveness of 12 treatment strategies for preventing contrast-induced acute kidney injury: a systematic review and Bayesian network meta-analysis. Am J Kidney Dis. 2017 Jan;69(1):69-77. View abstract.

Taher A, Lashgari M, Sedighi L, et al. A pilot study on intravenous N-Acetylcysteine treatment in patients with mild-to-moderate COVID19-associated acute respiratory distress syndrome. Pharmacol Rep. 2021;1-10. View abstract.

Tam J, Nash EF, Ratjen F, et al. Nebulized and oral thiol derivatives for pulmonary disease in cystic fibrosis. Cochrane Database Syst Rev. 2013;7:CD007168. View abstract.

Tenenbein PK, Sitar DS, Tenenbein M. Interaction between N-acetylcysteine and activated charcoal: implications for the treatment of acetaminophen poisoning. Pharmacotherapy 2001;21:1331-6. View abstract.

Tepel M, van der Giet M, Schwarzfeld C, et al. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000;343:180-4. View abstract.

Tepel M, van der Giet M, Statz M, et al. The antioxidant acetylcysteine reduces cardiovascular events in patients with end-stage renal failure: a randomized, controlled trial. Circulation 2003;107:992-5.. View abstract.

Thakker D, Raval A, Patel I, Walia R. N-acetylcysteine for polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled clinical trials. Obstet Gynecol Int. 2015;2015:817849.

Tomko RL, Baker NL, Hood CO, et al. Depressive symptoms and cannabis use in a placebo-controlled trial of N-Acetylcysteine for adult cannabis use disorder. Psychopharmacology (Berl). 2020;237(2):479-490. View abstract.

Tomko RL, Gilmore AK, Gray KM. The role of depressive symptoms in treatment of adolescent cannabis use disorder with N-Acetylcysteine. Addict Behav. 2018;85:26-30. View abstract.

U.S. Food and Drug Administration. Approved drug products with therapeutic equivalence evaluation, 36th edition. Accessed 27 December 2016. Available at: https://www.fda.gov/ucm/groups/fdagov-public/@fdagov-drugs-gen/documents/document/ucm071436.pdf.

Unverferth DV, Jagadeesh JM, Unverferth Bj, et al. Attempt to prevent doxorubicin-induced acute human myocardial morphologic damage with acetylcysteine. J Natl Cancer Inst 1983;71:917-20. View abstract.

Vadoud-Seyedi J, de Dobbeleer G, Simonart T. Treatment of haemodialysis-associated pseudoporphyria with N-acetylcysteine: report of two cases. Br J Dermatol 2000;142:580-1. View abstract.

van Zandwijk N, Dalesio O, Pastorino U, et al. EUROSCAN, a randomized trial of vitamin A and N-acetylcysteine in patients with head and neck cancer or lung cancer. For the European Organization for Research and Treatment of Cancer Head and Neck and Lung Cancer Cooperative Groups. J Natl Cancer Inst 2000;92:977-86. View abstract.

van Zandwijk N. N-acetylcysteine for lung cancer prevention. Chest 1995;107:1437-41. View abstract.

Wang W, Zhang Y, Liu Y, Xu L, Shi D. Severe chest pain due to N-acetylcysteine-induced esophagitis. Case Rep Med. 2019;2019:8057259. View abstract.

Warning Letter. LES Labs. U.S. Food & Drug Administration. https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/les-labs-593764-07232020. Updated July 29, 2020. Accessed May 1, 2021.

Ahn, J., Grun, I. U., and Mustapha, A. Antimicrobial and antioxidant activities of natural extracts in vitro and in ground beef. J Food Prot. 2004;67(1):148-155. View abstract.

Ahn, J., Grun, I. U., and Mustapha, A. Effects of plant extracts on microbial growth, color change, and lipid oxidation in cooked beef. Food Microbiol. 2007;24(1):7-14. View abstract.

Aoki, H., Nagao, J., Ueda, T., Strong, J. M., Schonlau, F., Yu-Jing, S., Lu, Y., and Horie, S. Clinical assessment of a supplement of Pycnogenol(R) and L-arginine in Japanese patients with mild to moderate erectile dysfunction. Phytother.Res. 2012;26(2):204-207. View abstract.

Araghi-Niknam, M., Hosseini, S., Larson, D., Rohdewald, P., and Watson, R. R. Pine bark extract reduces platelet aggregation. Integr.Med. 3-21-2000;2(2):73-77. View abstract.

Baumann, L. How to prevent photoaging? J Invest Dermatol. 2005;125(4):xii-xiii. View abstract.

Belcaro, G., Cesarone, M. R., Dugall, M., Hosoi, M., Ippolito, E., Bavera, P., and Grossi, M. G. Investigation of Pycnogenol(R) in combination with coenzymeQ10 in heart failure patients (NYHA II/III). Panminerva Med 2010;52(2 Suppl 1):21-25. View abstract.

Belcaro, G., Cesarone, M. R., Errichi, B. M., Ledda, A., Di Renzo, A., Stuard, S., Dugall, M., Pellegrini, L., Rohdewald, P., Ippolito, E., Ricci, A., Cacchio, M., Ruffini, I., Fano, F., and Hosoi, M. Venous ulcers: microcirculatory improvement and faster healing with local use of Pycnogenol. Angiology 2005;56(6):699-705. View abstract.

Belcaro, G., Cesarone, M. R., Errichi, B. M., 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., and Hosoi, M. Diabetic ulcers: microcirculatory improvement and faster healing with pycnogenol. Clin.Appl.Thromb.Hemost. 2006;12(3):318-323. View abstract.

Belcaro, G., Cesarone, M. R., Errichi, B., Di, Renzo A., Grossi, M. G., Ricci, A., Dugall, M., Cornelli, U., Cacchio, M., and Rohdewald, P. Pycnogenol treatment of acute hemorrhoidal episodes. Phytother.Res. 2010;24(3):438-444. View abstract.

Belcaro, G., Cesarone, M. R., Errichi, S., Zulli, C., Errichi, B. M., 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., and Rohdewald, P. 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.

Belcaro, G., Cesarone, M. R., Errichi, S., Zulli, C., Errichi, B. M., Vinciguerra, G., Ledda, A., Di Renzo, A., Stuard, S., Dugall, M., Pellegrini, L., Gizzi, G., Ippolito, E., Ricci, A., Cacchio, M., Cipollone, G., Ruffini, I., Fano, F., Hosoi, M., and Rohdewald, P. Variations in C-reactive protein, plasma free radicals and fibrinogen values in patients with osteoarthritis treated with Pycnogenol. Redox.Rep. 2008;13(6):271-276. View abstract.

Belcaro, G., Cesarone, M. R., Rohdewald, P., Ricci, A., Ippolito, E., Dugall, M., Griffin, M., Ruffini, I., Acerbi, G., Vinciguerra, M. G., Bavera, P., Di Renzo, A., Errichi, B. M., and Cerritelli, F. Prevention of venous thrombosis and thrombophlebitis in long-haul flights with pycnogenol. Clin Appl.Thromb.Hemost. 2004;10(4):373-377. View abstract.

Belcaro, G., Cesarone, M., Silvia, E., Ledda, A., Stuard, S., G V, Dougall, M., Cornelli, U., Hastings, C., and Schonlau, F. 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.

Belcaro, G., Luzzi, R., Cesinaro Di, Rocco P., Cesarone, M. R., Dugall, M., Feragalli, B., Errichi, B. M., Ippolito, E., Grossi, M. G., Hosoi, M., Errichi, S., Cornelli, U., Ledda, A., and Gizzi, G. Pycnogenol(R) improvements in asthma management. Panminerva Med. 2011;53(3 Suppl 1):57-64. View abstract.

Berryman, A. M., Maritim, A. C., Sanders, R. A., and Watkins, J. B., III. Influence of treatment of diabetic rats with combinations of pycnogenol, beta-carotene, and alpha-lipoic acid on parameters of oxidative stress. J Biochem Mol Toxicol 2004;18(6):345-352. View abstract.

Bors, W., Michel, C., and Stettmaier, K. Electron paramagnetic resonance studies of radical species of proanthocyanidins and gallate esters. Arch Biochem Biophys. 2-15-2000;374(2):347-355. View abstract.

Cesarone, M. R., Belcaro, G., Rohdewald, P., Pellegrini, L., Ippolito, E., Scoccianti, M., Ricci, A., Dugall, M., Cacchio, M., Ruffini, I., Fano, F., Acerbi, G., Vinciguerra, M. G., Bavera, P., Di Renzo, A., Errichi, B. M., and Mucci, F. Prevention of edema in long flights with Pycnogenol. Clin Appl.Thromb.Hemost. 2005;11(3):289-294. View abstract.

Cesarone, M. R., 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., and Corsi, M. Comparison of Pycnogenol and Daflon in treating chronic venous insufficiency: a prospective, controlled study. Clin Appl Thromb.Hemost. 2006;12(2):205-212. View abstract.

Cesarone, M. R., 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., and Corsi, M. Rapid relief of signs/symptoms in chronic venous microangiopathy with pycnogenol: a prospective, controlled study. Angiology 2006;57(5):569-576. View abstract.

Cesarone, M. R., Belcaro, G., Rohdewald, P., Pellegrini, L., Ledda, A., Vinciguerra, G., Ricci, A., Ippolito, E., Fano, F., Dugall, M., Cacchio, M., Di, Renzo A., Hosoi, M., Stuard, S., and Corsi, M. Improvement of signs and symptoms of chronic venous insufficiency and microangiopathy with Pycnogenol: a prospective, controlled study. Phytomedicine. 2010;17(11):835-839. View abstract.

Cesarone, M. R., Belcaro, G., Stuard, S., Schonlau, F., Di, Renzo A., Grossi, M. G., Dugall, M., Cornelli, U., Cacchio, M., Gizzi, G., and Pellegrini, L. Kidney flow and function in hypertension: protective effects of pycnogenol in hypertensive participants--a controlled study. J.Cardiovasc.Pharmacol.Ther. 2010;15(1):41-46. View abstract.

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;46(5):788-793. View abstract.

Cho, K. J., Yun, C. H., Packer, L., and Chung, A. S. Inhibition mechanisms of bioflavonoids extracted from the bark of Pinus maritima on the expression of proinflammatory cytokines. Ann N Y Acad Sci 2001;928:141-156. View abstract.

Cho, K. J., Yun, C. H., Yoon, D. Y., Cho, Y. S., Rimbach, G., Packer, L., and Chung, A. S. Effect of bioflavonoids extracted from the bark of Pinus maritima on proinflammatory cytokine interleukin-1 production in lipopolysaccharide-stimulated RAW 264.7. Toxicol Appl.Pharmacol 10-1-2000;168(1):64-71. View abstract.

Chovanova, Z., Muchova, J., Sivonova, M., Dvorakova, M., Zitnanova, I., Waczulikova, I., Trebaticka, J., Skodacek, I., and Durackova, Z. Effect of polyphenolic extract, Pycnogenol, on the level of 8-oxoguanine in children suffering from attention deficit/hyperactivity disorder. Free Radic.Res 2006;40(9):1003-1010. View abstract.

Cisar, P., Jany, R., Waczulikova, I., Sumegova, K., Muchova, J., Vojtassak, J., Durackova, Z., Lisy, M., and Rohdewald, P. Effect of pine bark extract (Pycnogenol) on symptoms of knee osteoarthritis. Phytother.Res. 2008;22(8):1087-1092. View abstract.

Clark, C. E., Arnold, E., Lasserson, T. J., and Wu, T. Herbal interventions for chronic asthma in adults and children: a systematic review and meta-analysis. Prim.Care Respir.J 2010;19(4):307-314. View abstract.

Dene, B. A., Maritim, A. C., Sanders, R. A., and Watkins, J. B., III. Effects of antioxidant treatment on normal and diabetic rat retinal enzyme activities. J Ocul.Pharmacol Ther 2005;21(1):28-35. View abstract.

Devaraj, S., Vega-Lopez, S., Kaul, N., Schonlau, F., Rohdewald, P., and Jialal, I. Supplementation with a pine bark extract rich in polyphenols increases plasma antioxidant capacity and alters the plasma lipoprotein profile. Lipids 2002;37(10):931-934. View abstract.

Drieling, R. L., Gardner, C. D., Ma, J., Ahn, D. K., and Stafford, R. S. No beneficial effects of pine bark extract on cardiovascular disease risk factors. Arch.Intern.Med. 9-27-2010;170(17):1541-1547. View abstract.

Durackova, B. Trebatický V. Novotný I. Žit®anová J. Breza. Lipid metabolism and erectile function improvement by Pycnogenol®, extract from the bark of Pinus pinaster in patients suffering from erectile dysfunction - a pilot study. Nutrition Research 2003;23(9):1189-1198.

Durackova, Z., Trebaticky, B., Novotny, V., Zitnanova, A., and Breza, J. Lipid metabolism and erectile dysfunction improvement by Pycnogenol(R), extract from the bark of Pinus pinaster in patients suffering from erectile dysfunction -- a pilot study. Nutr.Res. 2003;23:1189-1198.

Dvorakova, M., Jezova, D., Blazicek, P., Trebaticka, J., Skodacek, I., Suba, J., Iveta, W., Rohdewald, P., and Durackova, Z. Urinary catecholamines in children with attention deficit hyperactivity disorder (ADHD): modulation by a polyphenolic extract from pine bark (pycnogenol). Nutr.Neurosci. 2007;10(3-4):151-157. View abstract.

Dvorakova, M., Paduchova, Z., Muchova, J., Durackova, Z., and Collins, A. R. How does pycnogenol(R) influence oxidative damage to DNA and its repair ability in elderly people? Prague.Med.Rep. 2010;111(4):263-271. View abstract.

Dvorakova, M., Sivonova, M., Trebaticka, J., Skodacek, I., Waczulikova, I., Muchova, J., and Durackova, Z. The 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;11(4):163-172. View abstract.

Enseleit, F., Sudano, I., Periat, D., Winnik, S., Wolfrum, M., Flammer, A. J., Frohlich, G. M., Kaiser, P., Hirt, A., Haile, S. R., Krasniqi, N., Matter, C. M., Uhlenhut, K., Hogger, P., Neidhart, M., Luscher, T. F., Ruschitzka, F., and Noll, G. 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;33(13):1589-1597. View abstract.

Errichi, B. M., Belcaro, G., Hosoi, M., Cesarone, M. R., Dugall, M., Feragalli, B., Bavera, P., Hosoi, M., Zulli, C., Corsi, M., Ledda, A., Luzzi, R., and Ricci, A. Prevention of post thrombotic syndrome with Pycnogenol(R) in a twelve month study. Panminerva Med. 2011;53(3 Suppl 1):21-27. View abstract.

Errichi, S., Bottari, A., Belcaro, G., Cesarone, M. R., Hosoi, M., Cornelli, U., Dugall, M., Ledda, A., and Feragalli, B. Supplementation with Pycnogenol(R) improves signs and symptoms of menopausal transition. Panminerva Med. 2011;53(3 Suppl 1):65-70. View abstract.

Furumura, M., Sato, N., Kusaba, N., Takagaki, K., and Nakayama, J. Oral administration of French maritime pine bark extract (Flavangenol((R))) improves clinical symptoms in photoaged facial skin. Clin.Interv.Aging 2012;7:275-286. View abstract.

Grimm, T., Chovanova, Z., Muchova, J., Sumegova, K., Liptakova, A., Durackova, Z., and Hogger, P. Inhibition 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;3:1. View abstract.

Grimm, T., Skrabala, R., Chovanova, Z., Muchova, J., Sumegova, K., Liptakova, A., Durackova, Z., and Hogger, P. Single and multiple dose pharmacokinetics of maritime pine bark extract (pycnogenol) after oral administration to healthy volunteers. BMC.Clin Pharmacol 2006;6:4. View abstract.

Grossi, M. G., Belcaro, G., Cesarone, M. R., Dugall, M., Hosoi, M., Cacchio, M., Ippolito, E., and Bavera, P. Improvement in cochlear flow with Pycnogenol(R) in patients with tinnitus: a pilot evaluation. Panminerva Med. 2010;52(2 Suppl 1):63-67. View abstract.

Hasegawa, N. Stimulation of lipolysis by pycnogenol. Phytother Res 1999;13(7):619-620. View abstract.

Henrotin, Y., Lambert, C., Couchourel, D., Ripoll, C., and Chiotelli, E. Nutraceuticals: do they represent a new era in the management of osteoarthritis? - a narrative review from the lessons taken with five products. Osteoarthritis.Cartilage. 2011;19(1):1-21. View abstract.

Hosseini S, Pishnamazi S Sadrzadeh SMH Farid F Farid R Watson RR. Pycnogenol in the management of asthma. J Medicinal Food 2001;4(4):201-209.

Hosseini, S., Lee, J., Sepulveda, R. T., Fagan, T., Rohdewald, P., and Watson, R. R. A randomized, double blind, placebo controlled, prospective 16 week crossover study to determine the role of Pycnogenol(R) in modifying blood pressure in mildly hypertensive patients. Nutr.Res. 2001;21(9):67-76.

Hosseini, S., Pishnamazi, S., Sadrzadeh, S. M., Farid, F., Farid, R., and Watson, R. R. Pycnogenol((R)) in the Management of Asthma. J Med Food 2001;4(4):201-209. View abstract.

Huang, W. W., Yang, J. S., Lin, C. F., Ho, W. J., and Lee, M. R. Pycnogenol induces differentiation and apoptosis in human promyeloid leukemia HL-60 cells. Leuk.Res 2005;29(6):685-692. View abstract.

Huynh, H. T. and Teel, R. W. Effects of intragastrically administered Pycnogenol on NNK metabolism in F344 rats. Anticancer Res 1999;19(3A):2095-2099. View abstract.

Huynh, H. T. and Teel, R. W. Effects of pycnogenol on the microsomal metabolism of the tobacco-specific nitrosamine NNK as a function of age. Cancer Lett 10-23-1998;132(1-2):135-139. View abstract.

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):2417-2420. View abstract.

Kim, H. C. and Healey, J. M. Effects of pine bark extract administered to immunosuppressed adult mice infected with Cryptosporidium parvum. Am J Chin Med 2001;29(3-4):469-475. View abstract.

Kim, Y. G. and Park, H. Y. The effects of Pycnogenol on DNA damage in vitro and expression of superoxide dismutase and HP1 in Escherichia coli SOD and catalase deficient mutant cells. Phytother.Res 2004;18(11):900-905. View abstract.

Kimbrough, C., Chun, M., dela, Roca G., and Lau, B. H. PYCNOGENOL chewing gum minimizes gingival bleeding and plaque formation. Phytomedicine 2002;9(5):410-413. View abstract.

Kobayashi, M. S., Han, D., and Packer, L. Antioxidants and herbal extracts protect HT-4 neuronal cells against glutamate-induced cytotoxicity. Free Radic.Res 2000;32(2):115-124. View abstract.

Kohama T, Negami M. Effect of Low-dose French Maritime Pine Bark Extract on Climacteric Syndrome in 170 Perimenopausal Women: A Randomized, Double-blind, Placebo-controlled Trial. J Reproductive Med 2013;58(1):39-47.

Ledda, A., Belcaro, G., Cesarone, M. R., Dugall, M., and Schonlau, 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):1030-1033. View abstract.

Liu, X., Wei, J., Tan, F., Zhou, S., Wurthwein, G., and Rohdewald, P. Pycnogenol, French maritime pine bark extract, improves endothelial function of hypertensive patients. Life Sci 1-2-2004;74(7):855-862. View abstract.

Luzzi, R., Belcaro, G., Zulli, C., Cesarone, M. R., Cornelli, U., Dugall, M., Hosoi, M., and Feragalli, B. Pycnogenol(R) supplementation improves cognitive function, attention and mental performance in students. Panminerva Med. 2011;53(3 Suppl 1):75-82. View abstract.

Mach, J., Midgley, A. W., Dank, S., Grant, R. S., and Bentley, D. J. The effect of antioxidant supplementation on fatigue during exercise: potential role for NAD+(H). Nutrients. 2010;2(3):319-329. View abstract.

Macrides, T. A., Shihata, A., Kalafatis, N., and Wright, P. F. A comparison of the hydroxyl radical scavenging properties of the shark bile steroid 5 beta-scymnol and plant pycnogenols. Biochem Mol Biol Int 1997;42(6):1249-1260. View abstract.

Marini, A., Grether-Beck, S., Jaenicke, T., Weber, M., Burki, C., Formann, P., Brenden, H., Schonlau, F., and Krutmann, J. Pycnogenol(R) effects on skin elasticity and hydration coincide with increased gene expressions of collagen type I and hyaluronic acid synthase in women. Skin Pharmacol.Physiol 2012;25(2):86-92. View abstract.

Maritim, A., Dene, B. A., Sanders, R. A., and Watkins, J. B., III. Effects of pycnogenol treatment on oxidative stress in streptozotocin-induced diabetic rats. J Biochem Mol Toxicol 2003;17(3):193-199. View abstract.

Mochizuki, M. and Hasegawa, N. Pycnogenol stimulates lipolysis in 3t3-L1 cells via stimulation of beta-receptor mediated activity. Phytother Res 2004;18(12):1029-1030. View abstract.

Mochizuki, M. and Hasegawa, N. Therapeutic efficacy of pycnogenol in experimental inflammatory bowel diseases. Phytother Res 2004;18(12):1027-1028. View abstract.

Moini, H., Arroyo, A., Vaya, J., and Packer, L. Bioflavonoid effects on the mitochondrial respiratory electron transport chain and cytochrome c redox state. Redox.Rep 1999;4(1-2):35-41. View abstract.

Nelson, A. B., Lau, B. H., Ide, N., and Rong, Y. Pycnogenol inhibits macrophage oxidative burst, lipoprotein oxidation, and hydroxyl radical-induced DNA damage. Drug Dev.Ind Pharm 1998;24(2):139-144. View abstract.

Ni, Z., Mu, Y., and Gulati, O. Treatment of melasma with Pycnogenol. Phytother.Res. 2002;16(6):567-571. View abstract.

Nikolova, V., Stanislavov, R., Vatev, I., Nalbanski, B., and Punevska, M. [Sperm parameters in male idiopathic infertility after treatment with prelox]. Akush.Ginekol.(Sofiia) 2007;46(5):7-12. View abstract.

Noda, Y., Anzai, K., Mori, A., Kohno, M., Shinmei, M., and Packer, L. Hydroxyl and superoxide anion radical scavenging activities of natural source antioxidants using the computerized JES-FR30 ESR spectrometer system. Biochem Mol Biol Int 1997;42(1):35-44. View abstract.

Ohkita, M., Kiso, Y., and Matsumura, Y. Pharmacology in health foods: improvement of vascular endothelial function by French maritime pine bark extract (Flavangenol). J.Pharmacol.Sci. 2011;115(4):461-465. View abstract.

Packer, L., Rimbach, G., and Virgili, F. Antioxidant activity and biologic properties of a procyanidin-rich extract from pine (Pinus maritima) bark, pycnogenol. Free Radic.Biol Med 1999;27(5-6):704-724. View abstract.

Pavone, C., Abbadessa, D., Tarantino, M. L., Oxenius, I., Lagana, A., Lupo, A., and Rinella, M. [Associating Serenoa repens, Urtica dioica and Pinus pinaster. Safety and efficacy in the treatment of lower urinary tract symptoms. Prospective study on 320 patients]. Urologia. 2010;77(1):43-51. View abstract.

Peng, Q. L., Buz'Zard, A. R., and Lau, B. H. Pycnogenol protects neurons from amyloid-beta peptide-induced apoptosis. Brain Res Mol Brain Res 7-15-2002;104(1):55-65. View abstract.

Peng, Q., Wei, Z., and Lau, B. H. Pycnogenol inhibits tumor necrosis factor-alpha-induced nuclear factor kappa B activation and adhesion molecule expression in human vascular endothelial cells. Cell Mol Life Sci 2000;57(5):834-841. View abstract.

Perera, N., Liolitsa, D., Iype, S., Croxford, A., Yassin, M., Lang, P., Ukaegbu, O., and van, Issum C. Phlebotonics for haemorrhoids. Cochrane.Database.Syst.Rev. 2012;8:CD004322. View abstract.

Reuter, J., Wolfle, U., Korting, H. C., and Schempp, C. Which plant for which skin disease? Part 2: Dermatophytes, chronic venous insufficiency, photoprotection, actinic keratoses, vitiligo, hair loss, cosmetic indications. J.Dtsch.Dermatol.Ges. 2010;8(11):866-873. View abstract.

Roseff SJ, Gulati R. Improvement of sperm quality by pycnogenol. Eur Bull Drug Res 1999;7:33-36.

Roseff, S. J. Improvement in sperm quality and function with French maritime pine tree bark extract. J Reprod Med 2002;47(10):821-824. View abstract.

Rucklidge, J. J., Johnstone, J., and Kaplan, B. J. Nutrient supplementation approaches in the treatment of ADHD. Expert.Rev.Neurother. 2009;9(4):461-476. View abstract.

Ryan, J., Croft, K., Mori, T., Wesnes, K., Spong, J., Downey, L., Kure, C., Lloyd, J., and Stough, C. 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.

Schafer, A., Chovanova, Z., Muchova, J., Sumegova, K., Liptakova, A., Durackova, Z., and Hogger, P. Inhibition of COX-1 and COX-2 activity by plasma of human volunteers after ingestion of French maritime pine bark extract (Pycnogenol). Biomed.Pharmacother. 2006;60(1):5-9. View abstract.

Schmidtke I, Schoop W. Pycnogenol: stasis oedema and its medical treatment. Schweizerische Zeitschrift fur GanzheitsMedizin 1995;3:114-115.

Schoonees, A., Visser, J., Musekiwa, A., and Volmink, J. Pycnogenol((R)) for the treatment of chronic disorders. Cochrane.Database.Syst.Rev. 2012;2:CD008294. View abstract.

Schoonees, A., Visser, J., Musekiwa, A., and Volmink, J. Pycnogenol(R) (extract of French maritime pine bark) for the treatment of chronic disorders. Cochrane.Database.Syst.Rev. 2012;4:CD008294. View abstract.

Segger, D. and Schonlau, F. Supplementation with Evelle improves skin smoothness and elasticity in a double-blind, placebo-controlled study with 62 women. J Dermatolog.Treat. 2004;15(4):222-226. View abstract.

Sharma, S. C., Sharma, S., and Gulati, O. P. Pycnogenol inhibits the release of histamine from mast cells. Phytother Res 2003;17(1):66-69. View abstract.

Siler-Marsiglio, K. I., Paiva, M., Madorsky, I., Serrano, Y., Neeley, A., and Heaton, M. B. Protective mechanisms of pycnogenol in ethanol-insulted cerebellar granule cells. J Neurobiol. 2004;61(2):267-276. View abstract.

Stanislavov, R., Nikolova, V., and Rohdewald, P. Improvement of seminal parameters with Prelox: a randomized, double-blind, placebo-controlled, cross-over trial. Phytother.Res 2009;23(3):297-302. View abstract.

Stefanescu, M., Matache, C., Onu, A., Tanaseanu, S., Dragomir, C., Constantinescu, I., Schonlau, F., Rohdewald, P., and Szegli, G. Pycnogenol efficacy in the treatment of systemic lupus erythematosus patients. Phytother Res 2001;15(8):698-704. View abstract.

Steigerwalt, R., Belcaro, G., Cesarone, M. R., Di, Renzo A., Grossi, M. G., Ricci, A., Dugall, M., Cacchio, M., and Schonlau, F. Pycnogenol improves microcirculation, retinal edema, and visual acuity in early diabetic retinopathy. J.Ocul.Pharmacol.Ther. 2009;25(6):537-540. View abstract.

Stuard, S., Belcaro, G., Cesarone, M. R., Ricci, A., Dugall, M., Cornelli, U., Gizzi, G., Pellegrini, L., and Rohdewald, P. J. Kidney function in metabolic syndrome may be improved with Pycnogenol(R). Panminerva Med. 2010;52(2 Suppl 1):27-32. View abstract.

Suzuki, N., Uebaba, K., Kohama, T., Moniwa, N., Kanayama, N., and Koike, K. 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.

Thornfeldt, C. Cosmeceuticals containing herbs: fact, fiction, and future. Dermatol.Surg. 2005;31(7 Pt 2):873-880. View abstract.

Torras, M. A., Faura, C. A., Schonlau, F., and Rohdewald, P. Antimicrobial activity of Pycnogenol. Phytother Res 2005;19(7):647-648. View abstract.

Trebaticka, J., Kopasova, S., Hradecna, Z., Cinovsky, K., Skodacek, I., Suba, J., Muchova, J., Zitnanova, I., Waczulikova, I., Rohdewald, P., and Durackova, Z. Treatment of ADHD with French maritime pine bark extract, Pycnogenol. Eur.Child Adolesc.Psychiatry 2006;15(6):329-335. View abstract.

Virgili, F., Kobuchi, H., and Packer, L. Procyanidins extracted from Pinus maritima (Pycnogenol): scavengers of free radical species and modulators of nitrogen monoxide metabolism in activated murine RAW 264.7 macrophages. Free Radic.Biol Med 1998;24(7-8):1120-1129. View abstract.

Voss, P., Horakova, L., Jakstadt, M., Kiekebusch, D., and Grune, T. Ferritin oxidation and proteasomal degradation: protection by antioxidants. Free Radic.Res 2006;40(7):673-683. View abstract.

Wang S, Tan D Zhao Y et al. The effect of pycnogenol on the microcirculation, platelet function and ischemic myocardium in patients with coronary artery diseases. Eur Bull Drug Res 1999;7:19-25.

Wei, Z., Peng, Q., and Lau, B. Pycnogenol enhances endothelial cell antioxidant defenses. Redox Report 1997;3:219-224.

Zhang, D., Tao, Y., Gao, J., Zhang, C., Wan, S., Chen, Y., Huang, X., Sun, X., Duan, S., Schonlau, F., Rohdewald, P., and Zhao, B. Pycnogenol in cigarette filters scavenges free radicals and reduces mutagenicity and toxicity of tobacco smoke in vivo. Toxicol Ind Health 2002;18(5):215-224. View abstract.

Zibadi, S., Rohdewald, P. J., Park, D., and Watson, R. R. Reduction of cardiovascular risk factors in subjects with type 2 diabetes by Pycnogenol supplementation. Nutr.Res. 2008;28(5):315-320. View abstract.

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;12:440-4. View abstract.

Aldret RL, Bellar D. A Double-Blind, Cross-Over Study to Examine the Effects of Maritime Pine Extract on Exercise Performance and Postexercise Inflammation, Oxidative Stress, Muscle Soreness, and Damage. J Diet Suppl. 2020;17(3):309-20. View abstract.

Arcangeli P. Pycnogenol in chronic venous insufficiency. Fitoterapia 2000;71:236-44. View abstract.

Asmat U, Abad K, Ismail K. Diabetes mellitus and oxidative stress-a concise review. Saudi Pharma J 2015. Available at: https://dx.doi.org/10.1016/j.jsps.2015.03.013.

Belcaro G, Cesarone MR, Cornelli U, et al. Xerostomia: prevention with Pycnogenol® supplementation: a pilot study. Minerva Stomatol. 2019;68(6):303-7. View abstract.

Belcaro G, Cesarone MR, Hu S, et al. Pycnogenol® supplementation alleviates symptoms of Parkinson's disease with mild cognitive impairment. J Neurosurg Sci 2022;66(4):371-377. View abstract.

Belcaro G, Cesarone R, Steigerwalt J, et al. Jet-lag: prevention with Pycnogenol. Preliminary report: evaluation in healthy individuals and in hypertensive patients. Minerva Cardioangiol. 2008 Oct;56(5 Suppl):3-9. View abstract.

Belcaro G, Cornelli U, Cesarone MR, et al. Preventive effects of Pycnogenol® on cardiovascular risk factors (including endothelial function) and microcirculation in subjects recovering from coronavirus disease 2019 (COVID-19). Minerva Med 2022;113(2):300-308. View abstract.

Belcaro G, Cornelli U, Dugall, M, Hosoi M, Cotllese R, Feragalli B. Long-haul flights, edema, and thrombotic events: prevention with stockings and Pycnogenol supplementation (LONFLIT Registry Study). Minverva Cardioangiologica. 2018 Apr;66(2):152-9. View abstract.

Belcaro G, Cornelli U, Luzzi R, et al. Pycnogenol supplementation improves health risk factors in subjects with metabolic syndrome. Phytother Res 2013;27(10):1572-8.View abstract.

Belcaro G, Dugall M, Hosol M, et al. Pycnogenol and centella asiatica for asymptomatic atherosclerosis progression. Int Angiol. 2014 Feb;33(1):20-6. View abstract.

Belcaro G, Dugall M, Hu S, et al. Prevention of recurrent venous thrombosis and post-thrombotic syndrome. Minerva Cardioangiol. 2018;66(3):238-245. View abstract.

Belcaro G, Dugall M, Ippolito E, et al. Pycnogenol and centella asiatica to prevent asymptomatic atherosclerosis progression in clinical events. Minerva Cardioangiol. 2017 Feb;65(1):24-31. View abstract.

Belcaro G, Dugall M, Ippolito E, Hus S, Saggino A, Feragalli B. The 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;59(4):437-46.

Belcaro G, Dugall M, Luzzi R, Hosoi M, Corsi M. Improvements of venous tone with pycnogenol in chronic venous insufficiency: an ex vivo study on venous segments. Int J Angiol 2014;23(1):47-52. View abstract.

Belcaro G, Dugall M, Luzzi R, Ippolito E, Cesarone MR. Postpartum varicose veins: supplementation with pycnogenol or elastic compression-A 12-month follow-up. Int J Angiol. 2017 Mar;26(1):12-19. View abstract.

Belcaro G, Dugall M. Preservation of muscular mass and strength in aged subjects with Pycnogenol supplementation. Minerva Ortopedica e Traumatologica 2016 Sept;67(3):124-30.

Belcaro G, Gizzi G, Pellegrini L, et al. Pycnogenol in postpartum symptomatic hemorrhoids. Minerva Ginecol. 2014 Feb;66(1):77-84. View abstract.

Belcaro G, Gizzi G, Pellegrini L, et al. Pycnogenol supplementation improves the control of irritable bowel syndrome symptoms. Panminerva Med. 2018 Jun;60(2):65-89. View abstract.

Belcaro G, Luzzi R, Dugall M, Ippolito E, Saggino A. Pycnogenol improves cognitive function, attention, mental performance and specific professional skills in healthy professionals aged 35-55. J Neurosurg Sci. 2014 Dec;58(4):239-48. View abstract.

Belcaro G, Luzzi R, Hu S, et al. Improvement in signs and symptoms in psoriasis patients with Pycnogenol supplementation. Panminerva Med. 2014 Mar;56(1):41-8. View abstract.

Belcaro G, Rohdewald P, Cesarone MR, et al. Restless legs syndrome: prevention with Pycnogenol® and improvement of the venoarteriolar response. Panminerva Med 2022;64(2):253-258. View abstract.

Belcaro G, Shu H, Luzzi R, et al. Improvement of common cold with Pycnogenol: a winter registry study. Panminerva Med 2014;56(4):301-8. View abstract.

Belcaro G. A clinical comparison of pycnogenol, antistax, and stocking in chronic venous insufficiency. Int J Angiol. 2015 Dec;24(4):268-74. Epub 2015 Jul 15. View abstract.

Bito T, Roy S, Sen CK, Packer L. Pine bark extract pycnogenol downregulates IFN-gamma-induced adhesion of T cells to human keratinocytes by inhibiting inducible ICAM-1 expression. Free Radic Biol Med 2000;28:219-27.. View abstract.

Blazso G, Gabor M, Schonlau F, Rohdewald P. Pycnogenol accelerates wound healing and reduces scar formation. Phytother Res 2004;18:579-81. View abstract.

Bottari A, Belcaro G, Ledda A, et al. Lady Prelox improves sexual function in generally healthy women of reproductive age. Minerva Ginecol 2013;65(4):435-44. View abstract.

Branchey L, Branchey M, Shaw S, Lieber CS. Relationship between changes in plasma amino acids and depression in alcoholic patients. Am J Psychiatry 1984;141:1212-5. View abstract.

Cai C, Zeng B, Lin L, et al. An oral French maritime pine bark extract improves hair density in menopausal women: A randomized, placebo-controlled, double blind intervention study. Health Sci Rep 2023;6(1):e1045. View abstract.

Cesarone MR, Belcaro G, Agus GB, et al. Chronic venous insufficiency and venous microangiopathy: management with compression and Pycnogenol®. Minerva Cardioangiol. 2019;67(4):280-7. View abstract.

Cesarone MR, Belcaro G, Hosoi M, et al. Supplementary management with Pycnogenol® in Parkinson's disease to prevent cognitive impairment. J Neurosurg Sci. 2020;64(3):258-62. View abstract.

Cesarone MR, Belcaro G, Nicolaides AN, et al. Prevention of venous thrombosis in long-haul flights with Flite Tabs: The LONFLIT-FLITE randomized, controlled trial. Angiology 2003;54:531-9. View abstract.

Cesarone MR, Belcaro G, Rohdewald P, et al. Improvement of diabetic microangiopathy with Pycnogenol: A prospective, controlled study. Angiology 2006;57:431-6. View abstract.

Cesarone MR, Belcaro G, Scipione C, et al. Prevention of vaginal dryness in perimenopausal women. Supplementation with Lady Prelox®. Minerva Ginecol. 2019;71(6):434-41. View abstract.

Cesarone MR, Belcaro G, Scipione C, et al. Xerostomia and prevention of dryness with a Pycnogenol® mouth spray: a pilot study. Minerva Gastroenterol (Torino) 2023. View abstract.

Cesarone MR, Hu S, Belcaro G, et al. Pycnogenol®-Centellicum® supplementation improves lung fibrosis and post-COVID-19 lung healing. Minerva Med 2022;113(1):135-140. View abstract.

Cheshier JE, Ardestani-Kaboudanian S, Liang B, et al. Immunomodulation by pycnogenol in retrovirus-induced or ethanol-fed mice. Life Sci 1996;58:87-96. View abstract.

Corrigan JJ Jr. Coagulation problems relating to vitamin E. Am J Pediatr Hematol Oncol 1979;1:169-73. View abstract.

Cotellese R, Hu S, Cesarone MR, et al. Pycnogenol® supplementation prevents inflammation and symptoms in recurrent, non-severe urinary infections. Panminerva Med 2021;63(3):343-348. View abstract.

Dauer A, Metzner P, Schimmer O. Proanthocyanidins from the bark of Hamamelis virginiana exhibit antimutagenic properties against nitroaromatic compounds. Planta Med 1998;64:324-7. View abstract.

Durackova Z, Trebaticky B, Novotny V, et al. Lipid metabolism and erectile function improvement by Pycnogenol, extract from the bark of Pinus pinaster in patients suffering from erectile dysfunction-a pilot study. Nutr Res 2003;23:1189-98..

Ezzikouri S, Nishimura T, Kohara M, et al. Inhibitor effects of Pycnogenol on hepatitis C virus replication. Antiviral Res. 2015 Jan;113:93-102. View abstract.

Farid R, Mirfeizi Z Mirheidari M Z Rezaieyazdi Mansouri H Esmaelli H. Pycnogenol® supplementation reduces pain and stiffness and improves physical function in adults with knee osteoarthritis. Nutrition Research 2007;27(11):692-697.

Feragalli B, Dugall M, Luzzi R, et al. Pycnogenol: supplementary management of symptomatic osteoarthritis with a patch. An observational registry study. Minerva Endocrinol. 2019;44(1):97-101. View abstract.

Fitzpatrick DF, Bing, Rohdewald P. Endothelium-dependent vascular effects of Pycnogenol. J Cardiovasc Pharmacol 1998;32:509-15. View abstract.

Fogacci F, Tocci G, Sahebkar A, Presta V, Banach M, Cicero AFG. 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. 2020;71(3):217-25. View abstract.

Foster S, Tyler VE. Tyler's Honest Herbal, 4th ed., Binghamton, NY: Haworth Herbal Press, 1999.

Grosse Duweler K, Rohdewald P. Urinary metabolites of French maritime pine bark extract in humans. Pharmazie 2000;55:364-8. View abstract.

Gulati OP. Pycnogenol in venous disorders: a review. Eur Bull Drug Res 1999;7:8-13.

Hadi A, Pourmasoumi M, Mohammadi H, Javaheri A, Rouhani MH. The impact of pycnogenol supplementation on plasma lipids in humans: A systematic review and meta-analysis of clinical trials. Phytother Res. 2019;33(2):276-287. View abstract.

Hasegawa N. Inhibition of lipogenesis by pycnogenol. Phytother Res 2000;14:472-3. View abstract.

Heiman SW. Pycnogenol for ADHD? J Am Acad Child Adolesc Psychiatry 1999;38:357-8. View abstract.

Hosoi M, Belcaro G, Saggino A, Luzzi R, Dugall M, Feragalli B. Pycnogenol supplementation in minimal cognitive dysfunction. J Nuerosurg Sci. 2018 Jun;62(3):279-284. View abstract.

Hosseini S, Lee J, Sepulveda RT, et al. A randomized, double-blind, placebo-controlled, prospective, 16 week crossover study to determine the role of pycnogenol in modifying blood pressure in mildly hypertensive patients. Nutr Res 2001;21:1251-60.

Hu S, Belcaro G, Ledda A, et al. Behçet syndrome: effects of Pycnogenol supplementation during regression phases. Minerva Cardioangiol. 2018;66(4):386-390. View abstract.

Hu S, Hosoi M, Belcaro G, et al. Management of mild, primary Raynaud Syndrome: supplementation with Pycnogenol®. Minerva Cardioangiol. 2019;67(5):392-8. View abstract.

Ikuyama S, Fan B, Gu J, Mukae K, Watanabe H. Molecular mechanism of intracellular lipid accumulation: suppressive effect of Pycnogenol in liver cells. Functional Foods in Health & Disease 203;3(9):353-364.

Institute of Medicine. The role of protein and amino acids in sustaining and enhancing performance. Washington, DC: National Academy Press, 1999. Available at: https://books.nap.edu/books/0309063469/html/309.html#pagetop

Jialal I, Devaraj S, Hirany S, et al. The effect of pycnogenol supplementation on markers of inflammation. Alternative Therapies 2001;7:S17.

Khurana H, Pandey RK, Saksena AK, Kumar A. An evaluation of vitamin E and pycnogenol in children suffering from oral mucositis during cancer chemotherapy. Oral Dis 2013;19(5):456-64.View abstract.

Koch R. Comparative study of venostatin and pycnogenol in chronic venous insufficiency. Phytother Res 2002:16:S1-S5. Phytother Res 2002:16:S1-S5. View abstract.

Kohama T, Inoue M. Pycnogenol alleviates pain associated with pregnancy. Phytother Res 2006;20:232-4. View abstract.

Kohama T, Suzuki N, Ohno S, Inoue M. Analgesic efficacy of French maritime pine bark extract in dysmenorrhea: an open clinical trial. J Reprod Med 2004;49:828-32. View abstract.

Kohama T, Suzuki N. The treatment of gynecological disorders with pycnogenol. Eur Bull Drug Res 1999;7:30-2.

Vinciguerra G, Belcaro G, Feragalli B, et al. PycnoRacer®, a fitness drink including Pycnogenol®, improves recovery and training in the Cooper test. Panminerva Med 2019;61(4):457-63. View abstract.

Virgili F, Kim D, Packer L. Procyanidins extracted from pine bark protect alpha-tocopherol in ECV 304 endothelial cells challenged by activated RAW 264.7 macrophages: role of nitric oxide and peroxynitrite. FEBS Letters 1998;431:315-8. View abstract.

Virgili F, Pagana G, Bourne L, et al. Ferulic acid excretion as a marker of consumption of a French maritime pine (Pinus maritima) bark extract. Free Radic Biol Med 2000;28:1249-56.. View abstract.

Wang S, Tan D, Zhao Y, et al. The effect of pycnogenol on the microcirculation, platelet function and ischemic myocardium in patients with coronary artery diseases. Eur Bull Drug Res 1999;7:19-25.

Watson RR. Reduction of cardiovascular disease risk factors by French maritime pine bark extract. CVR&R 1999;June:326-9.

Wilson D, Evans M, Guthrie N et al. A randomized, double-blind, placebo-controlled exploratory study to evaluate the potential of pycnogenol for improving allergic rhinitis symptoms. Phytother Res 2010;24:1115-9. View abstract.

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;86:978-85. View abstract.

Zhao H, Wu J, Wang N, Grether-Beck S, Krutmann J, Wei L. Oral pycnogenol intake benefits the skin in urban Chinese outdoor workers: a randomized, placebo-controlled, double-blind, and crossover intervention study. Skin Pharmacol Physiol 2021;34(3):135-45. View abstract.

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