Pycnogenol Ingredients & Drug Interactions
by Bronson Laboratories
What is this page for?
First and foremost: checking Pycnogenol against your medications. The heart of this page is the interaction checker and the full interaction report — how this product’s ingredients may interact with prescription and over-the-counter medicines you may be taking.
Around that, we add a pharmacist’s high-level view of the product as a whole — what’s inside, the evidence for its stated use, how transparent the label is, and what safety data exists — so you can see the full picture in one place. It’s educational information from our licensed clinical databases and the clinical staff at HelloPharmacist — not medical advice — and we don’t sell or endorse products. Our editorial policy
Pycnogenol is a dietary supplement by Bronson Laboratories with 2 active ingredients. Its ingredients are commonly taken for bone health and osteoporosis prevention, dietary calcium deficiency, heartburn relief (calcium carbonate antacids).Based on those ingredients, 489 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Pycnogenol(R), Calcium. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Pycnogenol by Bronson Laboratories
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HelloPharmacist Scorecard of Pycnogenol by Bronson Laboratories
Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.
What’s inside
Full disclosure
This product contains 2 active ingredients: calcium and Pycnogenol, a standardized extract from maritime pine bark. Calcium is a mineral essential for bone strength, heart and muscle function, and other vital processes.
Maritime pine bark extract is a plant compound studied for potential effects on blood circulation, joint health, and inflammation. The tablet also contains several inactive ingredients — cellulose, stearic acid, sodium croscarmellose, magnesium stearate, and silicon dioxide — which serve as binders, flow agents, and other structural components to hold the tablet together.
Does it work?
Couldn't assess
Calcium is established as effective for kidney disease, indigestion, low blood calcium (hypocalcemia), high potassium levels (hyperkalemia), and likely effective for osteoporosis prevention and treatment. Pycnogenol shows possibly effective evidence for osteoarthritis and chronic venous insufficiency (a condition affecting blood flow in the veins).
Its effectiveness for asthma is rated possibly effective; for high cholesterol (hyperlipidemia), the evidence currently suggests it is possibly ineffective. The data we hold does not establish its effectiveness for other conditions it may be marketed for.
How safe is it?
Well-documented data
Calcium is generally well tolerated at recommended doses. The most common side effects from taking it by mouth are belching, constipation, diarrhea, gas, and stomach upset.
Rare but serious concerns include kidney stones and a condition called calciphylaxis. Very high intakes (over 1500–2000 mg daily) have been associated in some studies with increased risk of prostate cancer and heart disease, though the evidence remains debated.
Maritime pine bark extract is generally well tolerated in clinical studies, but long-term safety data are limited. Common side effects include gastrointestinal complaints, dizziness, and vertigo.
A few rare case reports mention headache and chest pain, though causation was unclear. During pregnancy, there is not enough safety data — the product should be avoided.
During breastfeeding, safety data are also insufficient — it should be avoided as well.
Meds to double-check
Major interaction found
Before starting Pycnogenol, double-check with your doctor or pharmacist if you take HIV integrase inhibitors (dolutegravir, elvitegravir, or raltegravir), the antibiotic ceftriaxone, levothyroxine for thyroid disease, sotalol for heart rhythm, diltiazem for blood pressure, calcipotriene cream for psoriasis, blood thinners or antiplatelet drugs, immunosuppressants, or diabetes medications. Timing changes or monitoring may be needed.
The bottom line
Scorecard at a glanceFully disclosed formula with no assessable stated purpose. Major medication interactions have been identified, and safety information is well characterized.
This product may help with bone health (through calcium) or joint and circulation concerns (through maritime pine bark), but its interactions with HIV drugs, thyroid medication, blood thinners, and diabetes drugs make it essential to check with your own doctor or pharmacist before taking it, especially if you're on any prescription medications. If you're pregnant or breastfeeding, talk with your healthcare provider first, since safety data for the pine bark ingredient are incomplete.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 2 of 2 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Jun 1, 2012.
This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed
General information
Key facts about Pycnogenol, straight from the product label.
| Brand | Bronson Laboratories |
|---|---|
| Barcode (UPC) | 716563192013 |
| Net contents | 60 Tablet(s) |
| Market status | On market |
| Date entered into DSLD | Jun 1, 2012 |
| DSLD ID | 8875 |
| Product type | Botanical With Nutrients |
| Supplement form | Tablet Or Pill |
| Dietary claims / uses | All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years) |
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.
Supplement Facts
The label details for Pycnogenol by Bronson Laboratories, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Calcium | 54 mg | 5% |
| Pycnogenol(R) | 25 mg | -- |
Other ingredients: Cellulose, Stearic Acid, Sodium Croscarmellose, Magnesium Stearate, Silicon Dioxide
Tap any ingredient to jump to its full detail below.
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
Suggested/Recommended/Usage/Directions
DIRECTIONS: As a dietary supplement for adults, 1 tablet one to two times daily, with meals and a glass of water, or as directed by a health professional.
Storage
Store at room temperature. Protect from light.
Precautions
Keep out of reach of children.
FDA Disclaimer Statement
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
General Statements
EST. 1960
PROMOTES ANTIOXIDANT PROTECTION
Made in USA
FDA Statement of Identity
Dietary Supplement
Seals/Symbols
Pycnogenol(R) French maritime pine bark extract
Brand IP Statement(s)
Pycnogenol(R) is a registered trademark of Horphag Research, Ltd. Pycnogenol(R) French maritime pine bark extract is produced by U.S. Patent Nos. 4,698,360 and 5,720,956.
General
No. 192
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Pycnogenol by Bronson Laboratories label
The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.
Label images are published by the NIH Dietary Supplement Label Database for the version of this product on file. Always read your actual product label.
View the full label (PDF)The Ingredients in Pycnogenol by Bronson Laboratories
These are the 2 active ingredients this product is made of. Select any to open its full monograph.
Serving size1 Tablet(s) Dosage formTablet Or Pill Amounts shown are per serving.
Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.
Calcium
Interacts with168 drugs
Calcium is an essential mineral your body needs for strong bones, nerve signaling, and muscle function, and supplements can help fill gaps when diet f...
Calcium monograph & interactionsPycnogenol(R)
Interacts with327 drugs
Maritime pine bark extract (often sold as Pycnogenol) is a plant-based antioxidant most studied for circulation, vein, and skin health. Some research...
Pycnogenol(R) monograph & interactionsOther (inactive) ingredients: Cellulose, Stearic Acid, Sodium Croscarmellose, Magnesium Stearate, Silicon Dioxide. These complete the product’s ingredient list but are not active constituents.
Pycnogenol by Bronson Laboratories Drug Interactions
HelloPharmacist Interaction Report
Pycnogenol by Bronson Laboratories contains calcium and maritime pine bark extract, both of which interact with medications.
The most serious concern is calcium's Major-severity interaction with HIV integrase inhibitors (dolutegravir and elvitegravir) and the antibiotic ceftriaxone — calcium can significantly reduce blood levels of these HIV drugs or cause dangerous precipitation if given intravenously with ceftriaxone, potentially compromising treatment.
Read the full breakdown — every affected drug type, severity by severity
Calcium also has Moderate interactions with the thyroid medication levothyroxine, the heart rhythm drug sotalol, the blood pressure medication diltiazem, the psoriasis cream calcipotriene, and the HIV drug raltegravir. Each requires separation in timing or monitoring to maintain effectiveness.
Maritime pine bark extract carries Moderate-level concerns with blood thinners and antiplatelet drugs (raising bleeding risk), immunosuppressant therapy (possibly weakening its effect), and diabetes medications (potentially lowering blood sugar too far).
Altogether, these interactions span 489 individual medications. Check your exact prescriptions with the search tool on this page before starting.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Pycnogenol?
Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.
Go to the checkerIngredients driving the most interactions
Individual Drug Interactions
The ingredients in Pycnogenol interact with 489 drugs. Click any drug to see the details.
2 of the 2 ingredients in Pycnogenol interact with drugs. Each result below shows which ingredient is responsible. Pycnogenol(R) Calcium
CeftriaxoneRocephin
How Ceftriaxone interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
CalciumCeftriaxone (rocephin) Major
Interaction Summary
Co-administration of intravenous calcium and ceftriaxone can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys.
Read the full Calcium + Ceftriaxone interactionCobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide FumarateGenvoya
How Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
CalciumElvitegravir (vitekta), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionDolutegravirTivicay
How Dolutegravir interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
CalciumDolutegravir (tivicay) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium + Dolutegravir interactionDolutegravir, Emtricitabine, Tenofovir AlafenamideDolutegravir, Emtricitabine, Tenofovir Alafenamide
How Dolutegravir, Emtricitabine, Tenofovir Alafenamide interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
CalciumDolutegravir (tivicay), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionDolutegravir, RilpivirineJuluca
How Dolutegravir, Rilpivirine interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
CalciumDolutegravir (tivicay) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium + Dolutegravir, Rilpivirine interactionElvitegravirVitekta
How Elvitegravir interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
CalciumElvitegravir (vitekta) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium + Elvitegravir interactionElvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil FumarateStribild
How Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
CalciumElvitegravir (vitekta), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interaction6-mercaptopurinePurinethol
How 6-mercaptopurine interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Immunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol(r) + 6-mercaptopurine interactionAbciximabReoPro
How Abciximab interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol(r) + Abciximab interactionAbrocitinibCibinqo
How Abrocitinib interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Anticoagulant/antiplatelet Drugs, Immunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol(r) + Abrocitinib interactionAcarboseGlucobay, Prandase, Precose
How Acarbose interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Antidiabetes Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of hypoglycemia when used with antidiabetes drugs.
Read the full Pycnogenol(r) + Acarbose interactionAcenocoumarolSintrom
How Acenocoumarol interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol(r) + Acenocoumarol interactionAcetaminophen, AspirinGemnisyn
How Acetaminophen, Aspirin interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol(r) + Acetaminophen, Aspirin interactionAcetaminophen, Aspirin, CaffeineExcedrin, Excedrin Extra Strength, Excedrin Migraine
How Acetaminophen, Aspirin, Caffeine interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol(r) + Acetaminophen, Aspirin, Caffeine interactionAcetaminophen, IbuprofenCombogesic
How Acetaminophen, Ibuprofen interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol(r) + Acetaminophen, Ibuprofen interactionAcetohexamideDymelor
How Acetohexamide interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Antidiabetes Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of hypoglycemia when used with antidiabetes drugs.
Read the full Pycnogenol(r) + Acetohexamide interactionAcetylsalicylic AcidEntrophen
How Acetylsalicylic Acid interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol(r) + Acetylsalicylic Acid interactionAdalimumabHumira
How Adalimumab interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Immunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol(r) + Adalimumab interactionAdalimumab-adazHyrimoz
How Adalimumab-adaz interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Immunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol(r) + Adalimumab-adaz interactionAdalimumab-adbmCyltezo
How Adalimumab-adbm interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Immunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol(r) + Adalimumab-adbm interactionAdalimumab-afzbAbrilada
How Adalimumab-afzb interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Immunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol(r) + Adalimumab-afzb interactionAdalimumab-attoAmjevita
How Adalimumab-atto interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Immunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol(r) + Adalimumab-atto interactionAdalimumab-bwwdHadlima
How Adalimumab-bwwd interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Immunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol(r) + Adalimumab-bwwd interactionAdalimumab-fkjpHulio
How Adalimumab-fkjp interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Immunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol(r) + Adalimumab-fkjp interactionAlbiglutideTanzeum
How Albiglutide interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Antidiabetes Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of hypoglycemia when used with antidiabetes drugs.
Read the full Pycnogenol(r) + Albiglutide interactionAlefaceptAmevive
How Alefacept interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Immunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol(r) + Alefacept interactionAlemtuzumabCampath
How Alemtuzumab interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
Pycnogenol(r)Immunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol(r) + Alemtuzumab interactionAlendronateBinosto, Fosamax
How Alendronate interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
CalciumBisphosphonates Moderate
Interaction Summary
Calcium reduces the absorption of bisphosphonates.
Read the full Calcium + Alendronate interactionAlendronate Sodium
How Alendronate Sodium interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
CalciumBisphosphonates Moderate
Interaction Summary
Calcium reduces the absorption of bisphosphonates.
Read the full Calcium + Alendronate Sodium interactionAlendronate Sodium, CholecalciferolFosamax Plus D
How Alendronate Sodium, Cholecalciferol interacts with Pycnogenol — through 1 ingredient. Tap an ingredient for the detail:
CalciumBisphosphonates Moderate
Interaction Summary
Calcium reduces the absorption of bisphosphonates.
Read the full Calcium + Alendronate Sodium, Cholecalciferol interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Pycnogenol with known interactions, here are the types of medications they can affect. Open any type for the detail — or search your exact drug in the checker above.
Pycnogenol(R)
Anticoagulant/Antiplatelet Drugs
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Clinical research suggests that maritime pine bark extract inhibits platelet aggregation. However, the clinical significance of this effect is unclear.
Antidiabetes Drugs
Theoretically, maritime pine bark extract might increase the risk of hypoglycemia when used with antidiabetes drugs.
One clinical study shows that maritime pine bark extract decreases blood sugar in patients with diabetes being treated with antidiabetes agents. Monitor blood glucose levels closely. Dose adjustments might be necessary.
Immunosuppressants
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
In vitro and animal research suggests that maritime pine bark extract has immunostimulant activity. This effect has not been reported in humans.
Calcium
Ceftriaxone (Rocephin)
Co-administration of intravenous calcium and ceftriaxone can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys.
Avoid administering intravenous calcium in any form, such as parenteral nutrition or Lactated Ringers, within 48 hours of intravenous ceftriaxone. Case reports in neonates show that administering intravenous ceftriaxone and calcium can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys. In several cases, neonates have died as a result of this interaction. So far there are no reports in adults; however, there is still concern that this interaction might occur in adults.
Dolutegravir (Tivicay)
Calcium seems to reduce levels of dolutegravir.
Advise patients to take dolutegravir either 2 hours before or 6 hours after taking calcium supplements. Pharmacokinetic research suggests that taking calcium carbonate 1200 mg concomitantly with dolutegravir 50 mg reduces plasma levels of dolutegravir by almost 40%. Calcium appears to decrease levels of dolutegravir through chelation.
Elvitegravir (Vitekta)
Calcium seems to reduce levels of elvitegravir.
Advise patients to take elvitegravir either 2 hours before or 2 hours after taking calcium supplements. Pharmacokinetic research suggests that taking calcium along with elvitegravir can reduce blood levels of elvitegravir through chelation.
Aluminum
Calcium citrate might increase aluminum absorption and toxicity. Other types of calcium do not increase aluminum absorption.
Calcium citrate can increase the absorption of aluminum when taken with aluminum hydroxide. The increase in aluminum levels may become toxic, particularly in individuals with kidney disease. However, the effect of calcium citrate on aluminum absorption is due to the citrate anion rather than calcium cation. Calcium acetate does not appear to increase aluminum absorption.
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)
Calcium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption when taken in a fasting state.
Advise patients that bictegravir/emtricitabine/tenofovir alafenamide and calcium can be taken together if taken with food. However, if taken on an empty stomach, bictegravir/emtricitabine/tenofovir alafenamide should not be taken with, or 2 hours after, calcium containing products.
Bisphosphonates
Calcium reduces the absorption of bisphosphonates.
Advise patients to take bisphosphonates at least 30 minutes before calcium, but preferably at a different time of day. Calcium supplements decrease absorption of bisphosphonates.
Calcipotriene (Dovonex)
Taking calcipotriene with calcium might increase the risk for hypercalcemia.
Calcipotriene is a vitamin D analog used topically for psoriasis. It can be absorbed in sufficient amounts to cause systemic effects, including hypercalcemia. Theoretically, combining calcipotriene with calcium supplements might increase the risk of hypercalcemia.
Digoxin (Lanoxin)
Using intravenous calcium with digoxin might increase the risk of fatal cardiac arrhythmias.
Hypercalcemia increases the risk of fatal cardiac arrhythmias with digoxin. However, one retrospective analysis of clinical data suggests that intravenous calcium does not increase the risk of dysrhythmias or mortality in patients receiving digoxin.
Diltiazem (Cardizem, Others)
Theoretically, calcium may reduce the therapeutic effects of diltiazem.
Hypercalcemia can reduce the effectiveness of verapamil in atrial fibrillation. Theoretically, calcium might increase this risk of hypercalcemia and reduce the effectiveness of diltiazem.
Levothyroxine (Synthroid, Others)
Calcium seems to reduce the absorption and effectiveness of levothyroxine.
Advise patients to take levothyroxine and calcium supplements at least 4 hours apart. Calcium reduces levothyroxine absorption, probably by forming insoluble complexes. Calcium carbonate supplements reduce effectiveness of levothyroxine in patients with hypothyroidism.
Lithium
Theoretically, concomitant use of calcium and lithium may increase this risk of hypercalcemia.
Clinical research suggests that long-term use of lithium may cause hypercalcemia in 10% to 60% of patients. Theoretically, concomitant use of lithium and calcium supplements may further increase this risk.
Quinolone Antibiotics
Calcium seems to reduce the absorption of quinolone antibiotics.
Advise patients to take oral quinolones at least 2 hours before or 4-6 hours after calcium supplements or calcium-fortified foods. Taking calcium at the same time as oral quinolones can reduce quinolone absorption. Calcium binds to quinolones in the gut.
Raltegravir (Isentress)
Calcium may reduce levels of raltegravir.
Pharmacokinetic research shows that taking a single dose of calcium carbonate 3000 mg along with raltegravir 400 mg twice daily modestly decreases the mean area under the curve of raltegravir, but the decrease does not necessitate a dose adjustment of raltegravir. However, a case of elevated HIV-1 RNA levels and documented resistance to raltegravir has been reported for a patient taking calcium carbonate 1 gram three times daily plus vitamin D3 (cholecalciferol) 400 IU three times daily in combination with raltegravir 400 mg twice daily for 11 months. It is thought that calcium reduced raltegravir levels by chelation, leading to treatment failure.
Sotalol (Betapace)
Calcium seems to reduce the absorption of sotalol.
Advise patients to separate doses by at least 2 hours before or 4-6 hours after calcium. Calcium appears to reduce the absorption of sotalol, probably by forming insoluble complexes.
Tetracycline Antibiotics
Calcium seems to reduce the absorption of tetracycline antibiotics.
Advise patients to take oral tetracyclines at least 2 hours before, or 4-6 hours after calcium supplements. Taking calcium at the same time as oral tetracyclines can reduce tetracycline absorption. Calcium binds to tetracyclines in the gut.
Thiazide Diuretics
Taking calcium along with thiazides might increase the risk of hypercalcemia and renal failure.
Thiazides reduce calcium excretion by the kidneys. Using thiazides along with moderately large amounts of calcium carbonate increases the risk of milk-alkali syndrome (hypercalcemia, metabolic alkalosis, renal failure). Patients may need to have their serum calcium levels and/or parathyroid function monitored regularly.
Verapamil (Calan, Others)
Theoretically, calcium may reduce the therapeutic effects of verapamil.
Hypercalcemia can reduce the effectiveness of verapamil in atrial fibrillation. Theoretically, use of calcium supplements may increase this risk of hypercalcemia and reduce the effectiveness of verapamil.
Calcium Channel Blockers
Intravenous calcium may decrease the effects of calcium channel blockers; oral calcium is unlikely to have this effect.
Intravenous calcium is used to decrease the effects of calcium channel blockers in the management of overdose. Intravenous calcium gluconate has been used before intravenous verapamil (Isoptin) to prevent or reduce the hypotensive effects without affecting the antiarrhythmic effects. But there is no evidence that dietary or supplemental calcium when taken orally interacts with calcium channel blockers.
Brand information
Manufacturer and brand details for Pycnogenol, from the product label.
Bronson Laboratories
- Name
- Bronson Laboratories
- City
- Lindon
- State
- UT
- ZipCode
- 84042
Pycnogenol by Bronson Laboratories: Common Questions
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Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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Label information is sourced from the NIH Dietary Supplement Label Database and reflects the product version on file; always read your actual product label. This page is for education only and is not a substitute for professional medical advice. Confirm with your pharmacist or doctor before combining supplements and medications.
The Full Monographs Behind Pycnogenol’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Calcium
Interacts with 168 drugsCalcium is an essential mineral your body needs for strong bones, nerve signaling, and muscle function, and supplements can help fill gaps when diet falls short. Most people do best getting...
Read the full Calcium monograph → Herb & supplement monographMaritime Pine
Interacts with 327 drugsMaritime pine bark extract (often sold as Pycnogenol) is a plant-based antioxidant most studied for circulation, vein, and skin health. Some research is promising, but many studies are small...
Read the full Maritime Pine monograph →Sources & How We Checked
Pycnogenol's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.
- NIH Dietary Supplement Label Database (DSLD) — The official product label on file for this supplement.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference behind the ingredient interaction data.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.
The 76 references behind this product’s interaction data
Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.
Calcium 62 references
- Shils M, Olson A, Shike M. Modern Nutrition in Health and Disease. 8th ed. Philadelphia, PA: Lea and Febiger, 1994.
- Hernandez-Avila M, Gonzalez-Cossio T, Hernandez-Avila JE, et al. Dietary calcium supplements to lower blood lead levels in lactating women: a randomized placebo-controlled trial. Epidemiology 2003;14:206-12.. PubMed
- Thys-Jacobs S, Ceccarelli S, Bierman A, et al. Calcium supplementation in premenstrual syndrome: a randomized crossover trial. J Gen Intern Med 1989;4:183-9. PubMed
- Maton PN, Burton ME. Antacids revisited: a review of their clinical pharmacology and recommended therapeutic use. Drugs 1999;57:855-70.
- Clemens JD, Feinstein AR. Calcium carbonate and constipation: a historical review of medical mythopoeia. Gastroenterology 1977;72:957-61. DOI
- Saunders D, Sillery J, Chapman R. Effect of calcium carbonate and aluminum hydroxide on human intestinal function. Dig Dis Sci 1988;33:409-13. PubMed
- Friedman PA, Bushinsky DA. Diuretic effects on calcium metabolism. Semin Nephrol 1999;19:551-6.
- Koo WK, Walters JC, Esterlitz J, et al. Maternal calcium supplementation and fetal bone mineralization. Obstet Gynecol 1999;94:577-82. DOI
- Raman L, Rajalakshmi K, Krishnamachari KAVR, et al. Effect of calcium supplementation to undernourished mothers during pregnancy on the bone density of the neonates. Am J Clin Nutr 1978; 31:466-9. DOI
- Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
- Chan JM, Giovannucci E, Andersson SO, et al. Dairy products, calcium, phosphorous, vitamin D, and risk of prostate cancer. Cancer Causes Control 1998;9:559-66.
- Butner LE, Fulco PP, Feldman G, et al. Calcium carbonate-induced hypothyroidism. Ann Intern Med 2000:132:595. PubMed
- Schneyer CR. Calcium carbonate and reduction of levothyroxine efficacy. JAMA 1998;279:750. PubMed
- Moser LR, Smythe MA, Tisdale JE. The use of calcium salts in the prevention and management of verapamil-induced hypotension. Ann Pharmacother 2000;34:622-9. PubMed
- Singh N, Singh PN, Hershman JM. Effect of calcium carbonate on the absorption of levothyroxine. JAMA 2000;283:2822-5. PubMed
- Kahela P, Anttila M, Tikkanen R, Sundquist H. Effect of food, food constituents and fluid volume on the bioavailability of sotalol. Acta Pharmacol Toxicol (Copenh) 1979;44:7-12.. PubMed
- Pletz MW, Petzold P, Allen A, et al. Effect of calcium carbonate on bioavailability of orally administered gemifloxacin. Antimicrob Agents Chemother 2003;47:2158-60.. PubMed
- Bar-Or D, Yoel G. Calcium and calciferol antagonize effect of verapamil in atrial fibrillation. Br Med J 1981;282:1585-6.
- Decktor DL, Robinson M, Maton PN, et al. Effects of aluminum/magnesium hydroxide and calcium carbonate on esophageal and gastric pH in subjects with heartburn. Am J Ther 1995;2:546-52. PubMed
- Simoneau G. Absence of rebound effect with calcium carbonate. Eur J Drug Metab Pharmacokinet 1996;21:351-7. PubMed
- Peters ML, Leonard M, Licata AA. Role of alendronate and risedronate in preventing and treating osteoporosis. Cleve Clin J Med 2001;68:945-51. PubMed
- Bourke JF, Mumford R, Whittaker P, et al. The effects of topical calcipotriol on systemic calcium homeostasis in patients with chronic plaque psoriasis. J Am Acad Dermatol 1997;37:929-34.
- Gueguen L, Pointillart A. The bioavailability of dietary calcium. J Am Coll Nutr 2000;19:119s-136s. PubMed
- Vella A, Gerber TC, Hayes DL, Reeder GS. Digoxin, hypercalcaemia, and cardiac conduction. Postgrad Med J 1999;75:554-6. PubMed
- Bania TC, Blaufeux B, Hughes S, et al. Calcium and digoxin vs. calcium alone for severe verapamil toxicity. Acad Emerg Med 2000;7:1089-96. PubMed
- Tseng M, Breslow RA, Graubard BI, Ziegler RG. Dairy, calcium, and vitamin D intakes and prostate cancer risk in the National Health and Nutrition Examination Epidemiologic Follow-up Study cohort. Am J Clin Nutr 2005;81:1147-54. PubMed
- Weingarten MA, Zalmanovici A, Yaphe J. Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. Cochrane Database Syst Rev 2004;(1):CD003548. PubMed
- Tavani A, Bertuccio P, Bosetti C, et al. Dietary intake of calcium, vitamin D, phosphorus and the risk of prostate cancer. Eur Urol 2005;48:27-33. PubMed
- Giovannucci E, Liu Y, Stampfer MJ, Willett WC. A prospective study of calcium intake and incident and fatal prostate cancer. Cancer Epidemiol Biomarkers Prev 2006;15:203-10. PubMed
- Rocephin (ceftriaxone) and calcium interaction. Pharmacist's Letter / Prescriber's Letter 2007;23(10):231005.
- Bolland MJ, Barber PA, Doughty RN, et al. Vascular events in healthy older women receiving calcium supplementation: randomised control trial. BMJ 2008;336:262-6.
- Bolland MJ, Avenell A, Baron JA, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010;341:c3691. PubMed
- Calcium supplementation and vascular events. Pharmacist's Letter / Prescriber's Letter 2008;24(3):240306.
- Dietary reference intakes for calcium and vitamin D. Institute of Medicine, November 30, 2010. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Vitamin%20D%20and%20Calcium%202010%20Repo
- Coburn JW, Mischel MG, Goodman WG, et al. Calcium citrate markedly enhances aluminum absorption from aluminum hydroxide. Am J Kidney Dis. 1991;17(6):708-11. PubMed
- Bradley JS, Wassel RT, Lee L, et al. Intravenous ceftriaxone and calcium in the neonate: assessing the risk for cardiopulmonary adverse events. Pediatrics. 2009;123(4):e609-13. PubMed
- Kays MB, Overholser BR, Mueller BA, et al. Effects of sevelamer hydrochloride and calcium acetate on the oral bioavailability of ciprofloxacin. Am J Kidney Dis. 2003;42(6):1253-9. PubMed
- Neuhofel, A. L., Wilton, J. H., Victory, J. M., Hejmanowsk, L. G., and Amsden, G. W. Lack of bioequivalence of ciprofloxacin when administered with calcium-fortified orange juice: a new twist on an old interaction. J Clin Pharmacol. 2002;42(4):461-466. DOI
- Dickinson, H. O., Nicolson, D. J., Cook, J. V., Campbell, F., Beyer, F. R., Ford, G. A., and Mason, J. Calcium supplementation for the management of primary hypertension in adults. Cochrane.Database.Syst.Rev. 2006;(2):CD004639. PubMed
- Jones, B. J. and Twomey, P. J. Requesting patterns for serum calcium concentration in patients on long-term lithium therapy. Int J Clin Pract. 2009;63(1):170-172. PubMed
- Levine, M., Nikkanen, H., and Pallin, D. J. The effects of intravenous calcium in patients with digoxin toxicity. J Emerg.Med. 2011;40(1):41-46. PubMed
- Castelo-Branco, C., Ciria-Recasens, M., Cancelo-Hidalgo, M. J., Palacios, S., Haya-Palazuelos, J., Carbonell-Abello, J., Blanch-Rubio, J., Martinez-Zapata, M. J., Manasanch, J., and Perez-Edo, L. Efficacy of ossein-hydroxyapatite complex compared with ca
- Li K, Kaaks R, Linseisen J, Rohrmann S. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation i
- Chung M, Tang AM, Fu Z. Calcium Intake and Cardiovascular Disease Risk: An Updated Systematic Review and Meta-analysis. Ann Intern Med. 2016 Oct 25. PubMed
- Nolan CR, Califano JR, Butzin CA. Influence of calcium acetate or calcium citrate on intestinal aluminum absorption. Kidney Int. 1990;38(5):937-41. PubMed
- Lewis JR, Radavelli-Bagatini S, Rejnmark L, et al. The effects of calcium supplementation on verified coronary heart disease hospitalization and death in postmenopausal women: a collaborative meta-analysis of randomized controlled trials. J Bone Miner Res PubMed
- Jalloh MA, Gregory PJ, Hein D, et al. Dietary supplement interactions with antiretrovirals: a systematic review. Int J STD AIDS. 2017 Jan;28(1):4-15. PubMed
- Lappe J, Watson P, Travers-Gustafson D, Recker R, Garland C, Gorham E, Baggerly K, McDonnell SL. Effect of Vitamin D and Calcium Supplementation on Cancer Incidence in Older Women: A Randomized Clinical Trial. JAMA. 2017 Mar 28;317(12):1234-1243. PubMed
- Grove ML, Cook D. Calcium and heart attacks. Doesn't apply to most calcium prescriptions. BMJ. 2010;341:c5003. PubMed
- Insentress [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp.; 2014.
- Roberts JL, Kiser JJ, Hindman JT, Meditz AL. Virologic failure with a raltegravir-containing antiretroviral regimen and concomitant calcium administration. Pharmacotherapy 2011;31(10):298e-302e. DOI
- Vitekta [package insert]. Foster City, CA: Gilead Sciences, Inc.; 2014.
- Storan ER, O'Gorman SM, Murphy A, Laing M. Case Report of Calciphylaxis Secondary to Calcium and Vitamin D<sub>3</sub> Supplementation. J Cutan Med Surg. 2017;21(2):162-163. DOI
- Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental vitamins and minerals for CVD prevention and treatment. J Am Coll Cardiol 2018;71(22):2570-84. PubMed
- Borkenhagen JF, Connor EL, Stafstrom CE. Neonatal hypocalcemic seizures due to excessive maternal calcium ingestion. Pediatr Neurol 2013;48(6):469-71. PubMed
- WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016 (http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/ anc-positive-pregnancy-experience/en/).
- Aune D, Navarro Rosenblatt DA, Chan DS, et al. Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. Am J Clin Nutr. 2015;101(1):87-117. PubMed
- Lan T, Park Y, Colditz GA, et al. Adolescent dairy product and calcium intake in relation to later prostate cancer risk and mortality in the NIH-AARP Diet and Health Study. Cancer Causes Control. 2020;31(10):891-904. PubMed
- Zhang Y, Li Y, Liu J, et al. Association of Vitamin D or Calcium Supplementation with Cardiovascular Outcomes and Mortality: A Meta-Analysis with Trial Sequential Analysis. J Nutr Health Aging 2021;25(2):263-270. PubMed
- Myung SK, Kim HB, Lee YJ, Choi YJ, Oh SW. Calcium Supplements and Risk of Cardiovascular Disease: A Meta-Analysis of Clinical Trials. Nutrients 2021;13(2):368. PubMed
- Hetaimish B. Neonatal Calcinosis Cutis After Treatment of Hypocalcemia with Calcium Gluconate: A Report of 2 Cases. Am J Case Rep 2024;25:e943397. PubMed
- US Food and Drug Administration (FDA). Biktarvy Prescribing Information. October 2024. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/210251Orig1s020lbl.pdf. Accessed July 16, 2025.
Maritime Pine 14 references
- Rice-Evans CA, Packer L, eds. Flavonoids in Health and Disease. Manhattan, NY: Marcel Dekker, Inc., 1998.
- Liu FJ, Zhang YX, Lau BH. Pycnogenol enhances immune and haemopoietic functions in senescence-accelerated mice. Cell Mol Life Sci 1998;54:1168-72. PubMed
- Putter M, Grotemeyer KH, Wurthwein G, et al. Inhibition of smoking-induced platelet aggregation by aspirin and pycnogenol. Thromb Res 1999;95:155-61. PubMed
- Kohama T, Inoue M. Pycnogenol alleviates pain associated with pregnancy. Phytother Res 2006;20:232-4.
- Liu X, Zhou HJ, Rohdewald P. French maritime pine bark extract pycnogenol dose-dependently lowers glucose in type 2 diabetic patients (letter). Diabetes Care 2004;27:839. PubMed
- Liu X, Wei J, Tan F, et al. Antidiabetic effect of Pycnogenol French maritime pine bark extract in patients with diabetes type II. Life Sci 2004;75:2505-13. PubMed
- 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.
- 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. PubMed
- 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.Psychi PubMed
- 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
- 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.
- 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
- 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.
- 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.
Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
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