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Research · Supplements

Pycnogenol

A 2020 Cochrane review of 27 trials across 10 chronic conditions found the trials too small and poorly reported for firm conclusions. Two flight trials from one research group reported less ankle swelling and fewer clots. Two blood pressure meta-analyses disagree. Trials pairing pine bark with L-arginine reported higher erectile function scores. Serious adverse events were rarely reported.

Add to Bio HackChecked 2026-11-09
Status
Dietary supplement in the US. Not FDA-approved for any condition.
Also called
French maritime pine bark extract, Pinus pinaster, pine bark extract, maritime pine bark, procyanidins, Flavangenol, Oligopin
Taken for
chronic venous insufficiency, leg swelling, swelling, edema, swelling on long flights, blood clots on flights, blood pressure, skin, skin hydration, erectile dysfunction, knee osteoarthritis, ADHD

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help5

Reported risks1

What people take it for, and what was found

Shown to help5

Limited

Swelling on long flights

Small trials from one group found less ankle swelling on long-haul flights with Pycnogenol, with very high variation between studies.

The numbers and sources
Effect
Of 211 travelers on long-haul flights, 169 completed a controlled trial (81 on Pycnogenol, 88 controls). The edema score rose by 17.9% on Pycnogenol and 58.3% in controls, ankle circumference by 6% against 11%, and the rate of ankle swelling by 36% against 91% (p < 0.05 for each) [1]. A meta-analysis of air travel products found lower edema scores on Pycnogenol in 3 studies (SMD -4.09, 95% CI -6.44 to -1.74, I² 98%) [2].
Population
Travelers without symptoms on long-haul flights [1]. Healthy adults in air travel trials [2].
Sources
[1], [2]
Caveats
Heterogeneity in the pooled result was 98% [2]. The flight trials came from one research group and name the product's maker in their abstracts [1].
Limited

Blood clots on long flights

One trial found 5 clotting events on placebo and none on Pycnogenol in travelers at moderate to high risk on long flights.

The numbers and sources
Effect
In 211 travelers at moderate to high risk of clots on flights averaging 8 hours 15 minutes, the placebo group had 5 clotting events (1 deep vein thrombosis and 4 superficial vein thromboses) and the Pycnogenol group had none (p < 0.025) [3].
Population
211 travelers at moderate to high clot risk, 198 completing [3].
Sources
[3]
Caveats
One trial with few events, from the same group as the flight edema trial [1][3].
Limited

Chronic venous insufficiency

Small trials found less pain and leg swelling in chronic venous insufficiency, at very low certainty.

The numbers and sources
Effect
In one trial of 40 people with chronic venous insufficiency, pine bark extract lowered pain scores (MD -0.59, 95% CI -1.02 to -0.16) and raised physician-judged treatment efficacy (RR 4.75, 95% CI 1.97 to 11.48), at very low certainty [4]. In an open comparison of 40 patients over 4 weeks, 360 mg of Pycnogenol a day reduced lower leg circumference and symptoms significantly, while 600 mg of horse chestnut seed extract a day did not significantly reduce circumference [5].
Population
Two Cochrane-included trials with 60 participants [4]. 40 patients in an open trial [5].
Sources
[4], [5]
Caveats
The Cochrane authors rated this evidence very low certainty [4]. The comparison with horse chestnut was not blinded [5].
Limited

Skin hydration and elasticity

One trial found Pycnogenol prevented the seasonal drop in skin hydration and improved elasticity in outdoor workers over 12 weeks.

The numbers and sources
Effect
In a crossover trial of 76 adults working outdoors in Beijing, 50 mg twice a day for 12 weeks prevented the drop in skin hydration, the rise in water loss through the skin and the skin darkening seen in the dry autumn season, and improved skin elasticity. These changes were not seen on placebo [9].
Population
76 Han Chinese outdoor workers [9].
Sources
[9]
Caveats
One trial. The abstract gives no effect sizes.
Limited

Knee osteoarthritis

One small trial found lower knee osteoarthritis pain, stiffness and function scores and less anti-inflammatory drug use, at very low certainty.

The numbers and sources
Effect
In one trial of 37 adults with knee osteoarthritis, pine bark extract lowered a composite pain, stiffness and function score (MD -730.00, 95% CI -1,011.95 to -448.05) and anti-inflammatory drug use (MD -18.30, 35 adults), at very low certainty [4].
Population
Adults with knee osteoarthritis [4].
Sources
[4]
Caveats
One small trial, rated very low certainty [4].

Mixed results2

Limited

Blood pressure

Small trials found mixed results: one review found blood pressure about 3 mmHg lower, while double-blind placebo trials alone found no significant change.

The numbers and sources
Effect
A meta-analysis of 12 trials (922 people) found systolic pressure 3.22 mmHg lower (95% CI -5.52 to -0.92) and diastolic pressure 1.91 mmHg lower (95% CI -3.64 to -0.18) [6]. A meta-analysis limited to 7 double-blind, placebo-controlled trials (626 people) found no significant change in systolic (WMD -0.028, 95% CI -0.182 to 0.127) or diastolic pressure (WMD -0.144, 95% CI -0.299 to 0.010) [7]. In one trial of 61 people with cardiovascular risk, diastolic pressure was 3.00 mmHg lower, at very low certainty [4].
Population
Adults in blood pressure trials [6][7]. People with cardiovascular disease or risk factors [4].
Sources
[6], [7], [4]
Caveats
The reviews disagree. In the first, the systolic effect was larger when Pycnogenol was given with other treatments [6].
LimitedStudied in men

Erectile dysfunction

Small trials of Pycnogenol with L-arginine found better erectile function scores, so the share due to pine bark is not known.

The numbers and sources
Effect
In 3 studies (184 men), Pycnogenol combined with L-arginine raised erectile function, intercourse satisfaction, orgasmic function, overall satisfaction and sexual desire scores against control. Testosterone did not change [8]. The Cochrane review could not pool two trials of 147 men and rated the evidence very low certainty [4].
Population
Men with mild to moderate erectile dysfunction [8][4].
Sources
[8], [4]
Caveats
The pooled trials tested a combination with L-arginine, so the share of any effect due to pine bark is not known [8]. The abstract gives no effect sizes [8].

Not shown to help1

LimitedStudied in children

ADHD in children

One trial could not show whether attention or hyperactivity changed in children with ADHD, with only a coordination score rising.

The numbers and sources
Effect
In one trial of 57 children with ADHD, the review could not tell whether pine bark extract changed inattention and hyperactivity ratings. A visual and motor coordination score rose (MD 3.37, 95% CI 2.41 to 4.33), at very low certainty [4].
Population
57 children with ADHD [4].
Sources
[4]
Caveats
One trial, rated very low certainty [4].

Doses studied

The venous comparison used 360 mg a day for 4 weeks [5]. The skin trial used 50 mg twice a day for 12 weeks [9]. The flight clot trial gave two 100 mg capsules 2 to 3 hours before the flight, two more 6 hours later and one the next day [3].

Risks

Mixed results1

Limited

Adverse events in trials

Limited evidence: flight trials reported no unwanted effects, but adverse event reporting was too sparse to estimate rates.

The numbers and sources
Effect
For most comparisons, the trials in the Cochrane review did not report serious adverse events or hospital admissions [4]. The flight trials reported no unwanted effects [1][3]. In the open venous trial, Pycnogenol and horse chestnut were tolerated equally [5].
Population
Adults and children in RCTs [4]. Travelers [1][3]. Adults with chronic venous insufficiency [5].
Sources
[4], [1], [3], [5]
Caveats
Adverse event reporting was sparse, so rates cannot be estimated [4].

Sources

  1. Cesarone MR, Belcaro G, Rohdewald P, et al. Prevention of edema in long flights with Pycnogenol. Clinical and Applied Thrombosis/Hemostasis. 2005. https://doi.org/10.1177/107602960501100307
  2. Chan V, Wang L, Allman-Farinelli M. Efficacy of Functional Foods, Beverages, and Supplements Claiming to Alleviate Air Travel Symptoms: Systematic Review and Meta-Analysis. Nutrients. 2021. https://doi.org/10.3390/nu13030961
  3. Belcaro G, Cesarone MR, Rohdewald P, et al. Prevention of venous thrombosis and thrombophlebitis in long-haul flights with pycnogenol. Clinical and Applied Thrombosis/Hemostasis. 2004. https://doi.org/10.1177/107602960401000410
  4. Robertson NU, Schoonees A, Brand A, Visser J. Pine bark (Pinus spp.) extract for treating chronic disorders. Cochrane Database of Systematic Reviews. 2020. https://doi.org/10.1002/14651858.CD008294.pub5
  5. Koch R. Comparative study of Venostasin and Pycnogenol in chronic venous insufficiency. Phytotherapy Research. 2002. https://doi.org/10.1002/ptr.1010
  6. Pourmasoumi M, Hadi A, Mohammadi H, Rouhani MH. Effect of pycnogenol supplementation on blood pressure: A systematic review and meta-analysis of clinical trials. Phytotherapy Research. 2020. https://doi.org/10.1002/ptr.6515
  7. Fogacci F, Tocci G, Sahebkar A, et al. Effect of Pycnogenol on Blood Pressure: Findings From a PRISMA Compliant Systematic Review and Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled, Clinical Studies. Angiology. 2020. https://doi.org/10.1177/0003319719889428
  8. Tian Y, Zhou Q, Li W, et al. Efficacy of L-arginine and Pycnogenol® in the treatment of male erectile dysfunction: a systematic review and meta-analysis. Frontiers in Endocrinology. 2023. https://doi.org/10.3389/fendo.2023.1211720
  9. Zhao H, Wu J, Wang N, et al. Oral Pycnogenol® Intake Benefits the Skin in Urban Chinese Outdoor Workers: A Randomized, Placebo-Controlled, Double-Blind, and Crossover Intervention Study. Skin Pharmacology and Physiology. 2021. https://doi.org/10.1159/000514323

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