Skip to Content

Cranberry

Medically reviewed by Drugs.com. Last updated on Dec 20, 2018.

Scientific Name(s): Vaccinium macrocarpon Aiton
Common Name(s): American cranberry, Arandano Americano, Arandano rtepador, Cranberry, Grosse moosbeere, Kranbeere, Tsuru-kokemomo, Vaccinium

Clinical Overview

Use

Some evidence exists for the use of cranberry in preventing, but not treating, urinary tract infections (UTIs). Other possible uses for cranberry, with limited evidence, include reduction of the risk of cardiovascular disease.

Dosing

Cranberry juice, juice concentrate, and dried extract have been studied in UTIs; however, consistency in dosage regimens is lacking. Doses of juice cocktail (25% pure cranberry juice) have ranged from 120 to 1,000 mL/day in divided doses. Concentrated cranberry extract in the form of tablets and capsules is available and 600 mg to more than 1,200 mg/day in divided doses have been used in studies in UTIs. For the prevention of UTIs following catheterization during elective gynecologic surgery, cranberry extract 360 mg (proanthocyanidins 36 mg) has been used twice daily for 6 weeks.

Contraindications

Predisposition to or history of nephrolithiasis (kidney stones); known allergy to cranberry products.

Pregnancy/Lactation

Information is limited; however, when ingested at normal food consumption amounts, cranberry is considered relatively safe in pregnancy. Safety during lactation is unknown.

Interactions

See Drug Interactions section.

Adverse Reactions

The berries and juice have few adverse reactions associated with their consumption. Large daily doses may produce GI symptoms, such as diarrhea. Concentrated cranberry tablets may predispose patients to nephrolithiasis. Cranberry juice should not be used to clear enteral feeding tubes.

Toxicology

Information is lacking.

Scientific Family

  • Ericaceae (Heath family)

Botany

The cranberry plant is native to eastern North America. Some research on the plant can be found under its former name, Oxycoccus macrocarpus (Aiton) Pursh. A number of related cranberry species can be found in areas ranging from damp bogs to mountain forests. The plants grow from Alaska to Tennessee as small, trailing, evergreen shrubs. Their flowers vary from pink to purple and bloom from May to August depending on the species. Small, red berries start forming between June and July and are harvested in September to October.

The genus Vaccinium also includes the blueberry (Vaccinium angustifolium Ait.), deerberry (Vaccinium stamineum L.), bilberry (Vaccinium myrtillus), Caucasian whortleberry (Vaccinium arctostaphylos) and cowberry (Vaccinium vitis-idaea L.). The cranberry plant should not be confused with another plant sometimes known as highbush cranberry, Viburnum opulus L., which is in a different family known as Caprifoliaceae).1, 2, 3

History

The cranberry was primarily used as a traditional medicine for the treatment of bladder and kidney ailments among American Indians. The berries were also used as a fabric and food dye, and as a poultice to treat wounds and blood poisoning. Sailors used the berries to prevent scurvy. Despite a general lack of scientific evidence for their use as effective urinary acidifiers, interest in the medicinal use of cranberries persists among the public. Cranberries are used in Eastern European cultures because of their folkloric role in the treatment of cancers and reduction of fever.4

Chemistry

Cranberries contain about 88% water and are a rich source of phytochemicals, such as organic acids (including benzoic, cinnamic, sinapic, caffeic, ferulic and other acids) and flavonoids (including quercetin, myericetin, cyanidin, catechin, and epicatechin). Cranberries also contain iridoid glycosides and anthocyanins, triterpenoids, and other alkaloids and constituents. They also contain small amounts of protein, fiber, sodium, potassium, selenium, and vitamins A, C, and E (2 to 10 mg). Cranberries are also a dietary source of resveratrol.66 Dried berries contain little sodium or fat. Extensive reviews of the chemical composition of cranberries have been published.3, 4, 5

Uses and Pharmacology

Antibacterial

Trials investigating the efficacy of cranberry in Helicobacter pylori eradication have been of varying methodological quality.26, 27 In vitro studies evaluated the effect of cranberry on GI bacteria as well as on nasopharyngeal bacteria.28, 29

Cancer

Cranberry phytochemicals, especially proanthocyanins, quercetin, and ellagic and ursolic acids, have been investigated for a role in cancer treatment. Induction of apoptosis and inhibition of tumor proliferation via inhibition of cell invasion and migration have been suggested as mechanisms. In vitro studies have shown cranberry extracts to inhibit growth of human cancer cell lines, including oral, colon, prostate, breast, liver, lung, and leukemia.2, 5, 6

Animal data

Limited animal studies have been conducted. Reductions in the incidence of induced tumors and decreased tumor size have been demonstrated.6

Clinical data

There are no clinical data regarding the use of cranberry for cancer treatment. The effect of cranberries on markers for cancer has been investigated in healthy adults.7

Cardiovascular

Reviews suggest that the high polyphenolic content of cranberry may contribute to a reduction in the risk of cardiovascular disease. Suggested mechanisms, based mainly on animal studies, include increased resistance of low-density lipoprotein to oxidation, inhibition of platelet aggregation, and reduced blood pressure.7, 30, 31 However, clinical trials have failed to consistently demonstrate clinically relevant effects of cranberry on blood pressure, lipid profile, or glycemic response, even at high daily intake of anthocyanins.32, 33, 34, 35 A small, 60-day study in patients with metabolic syndrome found that cranberry juice significantly increased adiponectin and folic acid levels, and reduced homocysteine and measures of oxidation. There was no significant change in pro-inflammatory cytokines.36 Variations in cranberry preparations used in the studies as well as interpersonal variations may have contributed to the equivocal findings in these studies.37

Urinary tract infections

A review of the suggested mechanisms by which cranberry may act against pathogens of the urinary tract has been published. Studies included in the review were largely conducted in vitro; however, a limited number of clinical studies were included.3 Cranberry does not appear to exert any direct bacteriostatic or bactericidal effects, nor does it change urine pH; however, it does inhibit the adherence of bacteria (primarily P-fimbriated Escherichia coli) to surfaces, including the inhibition of bacterial biofilm formation. Cranberry may also decrease UTI symptoms by suppressing inflammatory processes in response to bacteria.3, 8, 9

The Scottish Intercollegiate Guidelines Network Management of suspected bacterial urinary tract infection in adults (2012) recommended that women with recurrent UTI consider using cranberry products to reduce the frequency of recurrence based on placebo-controlled data. There are no trials about the effectiveness of antibiotics or cranberry products for preventing recurrent UTI in men. In addition, the guidelines recommend that cranberry products be avoided in patients taking warfarin.10 The Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines on recurrent UTI (2010) strongly recommend cranberry products as effective in reducing recurrent UTIs based on controlled data.11 The American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin (2008) for the treatment of UTIs in nonpregnant women notes that there is some data to suggest that the use of cranberry products may decrease recurrent UTIs; there are insufficient data to determine the length of therapy and the concentration required to prevent recurrence long term. No recommendation regarding the use of cranberry juice is provided.12 The Infectious Diseases Society of America guidelines regarding catheter-associated UTI in adults (2010) recommend that cranberry products not be used routinely to reduce catheter-associated bacteriuria or catheter-associated UTIs in patients with neurogenic bladders managed with intermittent or indwelling catheterization. The guidelines further state that data are insufficient to make a recommendation on the use of cranberry products to reduce catheter-associated bacteriuria or catheter-associated UTI in other groups of catheterized patients.13

Clinical data (prevention)

The most recent Cochrane Systematic Review of cranberry for UTI prevention pooled data from 24 studies (n = 3412) and concluded that cranberry products did not significantly reduce the incidence of symptomatic UTI compared with placebo, water, or no treatment (relative risk [RR] 0.74; 95% confidence interval [CI], 0.42 to 1.31). Cranberry also failed to demonstrate significant benefit for UTI prevention in specific populations including the elderly (RR 0.75; 95% CI, 0.39 to 1.44); pregnant women (RR 1.04; 95% CI, 0.97 to 1.17); pediatric recurrent UTI (RR 0.48; 95% CI, 0.19 to 1.22); oncology (RR 1.15; 95% CI, 0.75 to 1.77); or neurogenic bladder/spinal cord injury (RR 0.95; 95% CI, 0.75 to 1.20). Cranberry was not significantly better than antibiotics in females with UTI (RR 1.31; 95% CI, 0.85 to 2.02), or children (RR 0.69; 95% CI, 0.32 to 1.51).14 A 24-week, placebo–controlled trial published after the Cochrane review found no overall benefit of cranberry juice compared with placebo for prevention of UTI recurrence in women with a history of frequent UTIs, but women older than 50 (n = 118) had a significantly lower incidence with cranberry.15 However, a double-blind, randomized, placebo-controlled trial reported a statistically significant reduction in the occurrence of UTIs in 160 catheterized women (23 to 88 years of age) who took cranberry capsules subsequent to elective gynecological surgery. The treatment group received 2 cranberry capsules (cranberry extract 360 mg; proanthocyanidins [PACs] 36 mg) twice daily for 6 weeks after surgery. Incidence of UTI was reduced by 50% with cranberry versus placebo (19% vs 38%, P = 0.008); culture confirmed incidence was also significantly reduced (15% vs 29%, P = 0.037) and the median time to UTI was longer (18 days vs 8.5 days, P = 0.0005).60 Similar results were found in a small controlled pilot study in 36 adolescents with recurrent UTIs in which a standardized extract (120 mg cranberry with 36 mg PACs/day × 60 days) added to standard treatment produced significantly fewer UTIs compared to baseline (P=0.0001) and standard treatment alone (P=0.0001). The number of patients experiencing zero symptoms during the 60 days was also significantly lower with cranberry versus control (63.1% vs 23.5%, respectively, P<0.05).64 However, a 1-year double-blind, randomized, placebo-controlled trial in 185 elderly women residing in nursing homes found no significant difference in bacteriuria plus pyuria between oral cranberry supplementation compared to control. Cranberry 72 mg or control was administered daily for 360 days to women whose mean age was 86.4 years. Surrogate consent had to be obtained for the majority of participants (93.5%). Protocol dictated clean catch urine specimens 6 times over 12 months to assess for bacteriuria plus pyuria; secondary outcomes included symptomatic UTI, antibiotics for suspected UTI, and total antimicrobial prescriptions, all-cause death, and all-cause hospitalization.62 In a randomized, controlled trial (n=67), consumption of 120 mL cranberry juice daily for 6 months was observed to significantly reduce recurrence of UTIs in uncircumcised boys (6 to 18 years of age) compared to placebo in both circumcised and uncircumcised boys.65

Trials comparing cranberry with trimethoprim 100 mg/day (for 6 months) or trimethoprim-sulfamethoxazole (TMP-SMX) 480 mg/day yielded results favoring antibiotic therapy for reducing the risk of UTI recurrence17, 61; however, antibiotic resistance measured in 1 trial was over the 12-month trial period,16 and adverse effects were higher for trimethoprim in the other trial.17 Cost-effectiveness did not favor cranberry (1 g/day) compared with TMP-SMX (480 mg/day) over a 12-month period in premenopausal women with recurrent UTIs.61

Clinical data (treatment)

A systematic review found no well-designed trials assessing evidence for effect in the treatment of UTIs. Methodological issues included study design, measurement of outcomes and dosage, and duration of treatment. A dose-dependent effect on the inhibition of adherence by E. coli was demonstrated in 1 clinical study, and an optimal dose of proanthocyanins 72 mg/day was consequently suggested.8, 16 Another dose study suggests using 500 to 1,000 mg/day of a standardized preparation containing 1.5% proanthocyanidins (≈ 7.5 to 15 mg/day) based on elimination rates of E. coli in study participants.18 The use of cranberries for first-line treatment of UTIs remains unsupported.3, 19, 20, 21

Clinical data (special populations)

In elderly men with lower UTI symptom scores (including elevated prostate-specific antigen and chronic nonbacterial prostatitis) anthocyanins 1.65 mg/day for 6 months lowered irritative and obstructive symptomatic scores and improved measures of urination.22 Similarly, a double-blind, randomized, placebo-controlled trial evaluated 6-months of a commercial cranberry powder product (Flowens) on mild to moderate lower urinary tract symptoms (LUTS) in 124 men. LUTS was evaluated using the international prostate symptom score (IPSS); all participants had an IPSS of 8 or higher and a PSA less than 2.5 ng/mL. IPSS was significantly reduced in both the cranberry powder 250 mg and 500 mg groups (−3.1 and −4.1, respectively), whereas placebo yielded a −1.5 difference. Dose and baseline IPSS were significant covariates (P<0.0001 each). Voiding and storage symptoms were significantly improved at 6 months with 500 mg cranberry powder (P<0.001 and P=0.018, respectively). A significant dose-dependent reduction in post-voiding residual volume was observed.63 A 1-year controlled trial in elderly long-term care residents found significant improvements in the incidence of clinically-defined UTIs with cranberry (1,000 mg/day; 1.8% proanthocyanidins) in those at high-risk (ie, long-term catheterization, diabetes mellitus, previous UTI in last year) compared with placebo.59 A small, 1-year, pediatric study in toilet-trained children with a history of 2 UTIs in the previous year found that cranberry juice fortified with proanthocyanidins significantly reduced the incidence of UTI recurrence compared with placebo.23 A randomized, controlled study in 55 uncircumcised boys 6 to 18 years of age with uncomplicated UTI observed a significant reduction in rates of recurrent episodes in boys who consumed 120 mL cranberry juice (Ocean Spray) daily for 6 months compared to placebo (25% vs 37%, respectively, P<0.05). Additionally, the reduction in recurrence in the cranberry group was also significantly greater than the positive control of 12 circumcised boys who consumed the placebo juice (25% vs 33.3%, respectively, P<0.05).65 A retrospective evaluation of data on renal transplant patients found a lower incidence of UTI recurrence in patients who received cranberry or L-methionine compared with those receiving no prophylaxis.24 Activity against Candida in the urine was shown in a small study.25

Dosing

Uptake of anthocyanins has been shown to be highly variable, which may have implications for interpreting trial data.37 Cranberry juice, juice concentrate, and dried extract have been studied in UTIs; however, consistency in dosage regimens is lacking.3 Doses of juice cocktail (25% pure cranberry juice) have ranged from 120 to 1,000 mL/day in divided doses. Concentrated cranberry extract in the form of tablets and capsules is available and 600 mg to more than 1,200 mg/day in divided doses has been used in studies in UTIs.3 For the prevention of UTIs following catheterization during elective gynecologic surgery, cranberry extract 360 mg (proanthocyanidins 36 mg) has been used twice daily for 6 weeks.60

Pregnancy / Lactation

No direct evidence of safety or harm to the mother or fetus has been found. Indirect evidence suggests minimal risk in pregnancy. There were insufficient data to evaluate risk during lactation. When ingested at normal food consumption amounts, cranberries are considered safe during pregnancy.40

Interactions

Vitamin K Antagonists: Cranberry may enhance the anticoagulant effect of Vitamin K Antagonists. Monitor therapy.41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55

Adverse Reactions

The ingestion of more than 3 to 4 L per day of cranberry juice may result in diarrhea and other GI symptoms; however, clinical trials recorded few adverse reactions beyond this effect.3, 11, 14, 33 Use with caution in individuals with diabetes or glucose intolerance, due to risk of hyperglycemia. Some commercially available cranberry juice products contain large amounts of sugar. Sugar-free cranberry juice products are also available. Controversy exists over cranberry as a risk factor for the formation of calcium oxalate kidney stones, and the use of cranberry products in individuals with a history of nephrolithiasis probably should be avoided. A small study observed that consumption of 1 L/day of cranberry juice significantly increases the relative saturation ratio of calcium oxalate compared to drinking water similarly for subjects with and without a medical history of calcium oxalate stone formation.3, 56, 57, 67 Cranberry juice should not be used to clear enteral feeding tubes because water has been shown to be more effective and, due to the acidity of the juice, proteins in the tube could be denatured and contribute to further clogging.58

Toxicology

Information is lacking. An oral median lethal dose of more than 5g/kg body weight in rats has been suggested.2

Index Terms

  • Oxycoccus macrocarpus

References

1. ö macrocarpon Aiton. USDA, NRCS. 2008. The PLANTS Database [database online]. http://plants.usda.gov. September 9, 2008. National Plant Data Center, Baton Rouge, LA 70874-4490 USA.
2. Neto CC. Cranberry and its phytochemicals: a review of in vitro anticancer studies. J Nutr. 2007;137(suppl 1):186S-193S.17182824
3. Guay DR. Cranberry and urinary tract infections. Drugs. 2009;69(7):775-807.1944186810.2165/00003495-200969070-00002
4. Pappas E, Schaich KM. Phytochemicals of cranberries and cranberry products: characterization, potential health effects, and processing stability. Crit Rev Food Sci Nutr. 2009;49(9):741-781.20443158
5. Côté J, Caillet S, Doyon G, Sylvain JF, Lacroix M. Bioactive compounds in cranberries and their biological properties. Crit Rev Food Sci Nutr. 2010;50(7):666-679.20694928
6. Neto CC. Cranberries: ripe for more cancer research? J Sci Food Agric. 2011;91(13):2303-2307.2191012410.1002/jsfa.4621
7. Duthie SJ, Jenkinson AM, Crozier A, et al. The effects of cranberry juice consumption on antioxidant status and biomarkers relating to heart disease and cancer in healthy human volunteers. Euro J Nutr. 2006;45(2):113-122.16032375
8. Howell AB, Botto H, Combescure C, et al. Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC Infect Dis. 2010;10:94.20398248
9. Vasileiou I, Katsargyris A, Theocharis S, Giaginis C. Current clinical status on the preventive effects of cranberry consumption against urinary tract infections. Nutr Res. 2013;33(8):595-607.2389034810.1016/j.nutres.2013.05.018
10. Scottish Intercollegiate Guidelines Network Management of suspected bacterial urinary tract infection in adults. A national clinical guideline. July 2012. http://www.sign.ac.uk
11. Epp A, Larochelle A, Lovatsis D, et al; Society of Obstetricians and Gynaecologists of Canada. Recurrent urinary tract infection. J Obstet Gynaecol Can. 2010;32(11):1082-1101. Erratum in: J Obstet Gynaecol Can. 2011;33(1):12.21176321
12. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 91: Treatment of urinary tract infections in nonpregnant women. Obstet Gynecol. 2008;111(3):785-794. doi: 10.1097/AOG.0b013e318169f6ef.18310389
13. Hooton TM, Bradley SF, Cardenas DD, et al; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625-663.20175247
14. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10:CD001321.2307689110.1002/14651858.CD001321.pub5
15. Takahashi S, Hamasuna R, Yasuda M, et al. A randomized clinical trial to evaluate the preventive effect of cranberry juice (UR65) for patients with recurrent urinary tract infection. J Infect Chemother. 2013;19(1):112-117.2296109210.1007/s10156-012-0467-7
16. Beerepoot MA, ter Riet G, Nys S, et al. Cranberries vs antibiotics to prevent urinary tract infections: a randomized double-blind noninferiority trial in premenopausal women. Arch Intern Med. 2011;171(14):1270-1278.21788542
17. McMurdo ME, Argo I, Phillips G, Daly F, Davey P. Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women. J Antimicrob Chemother. 2009;63(2):389-395.19042940
18. Sengupta K, Alluri KV, Golakoti T, et al. A randomized, double blind, controlled, dose dependent clinical trial to evaluate the efficacy of a proanthocyanidin standardized whole cranberry (Vaccinium macrocarpon) powder on infections of the urinary tract. Curr Bioact Compd. 2011;7(1):39-46.
19. Raz R, Chazan B, Dan M. Cranberry juice and urinary tract infection. Clin Infect Dis. 2004;38(10):1413-1419.15156480
20. Jepson RG, Mihaljevic L, Craig JC. Cranberries for treating urinary tract infections. Cochrane Database Syst Rev. 2000;(4):CD001322.1079677510.1002/14651858.CD001322
21. Tong H, Heong S, Chang S. Effect of ingesting cranberry juice on bacterial growth in urine. Am J Health Syst Pharm. 2006;63(15):1417-1419.16849705
22. Vidlar A, Vostalova J, Ulrichova J, et al. The effectiveness of dried cranberries (Vaccinium macrocarpon) in men with lower urinary tract symptoms. Br J Nutr. 2010;104(8):1181-1189.20804630
23. Afshar K, Stothers L, Scott H, MacNeily AE. Cranberry juice for the prevention of pediatric urinary tract infection: a randomized controlled trial. J Urol. 2012;188(4 suppl):1584-1587.2291023910.1016/j.juro.2012.02.031
24. Pagonas N, Hörstrup J, Schmidt D, et al. Prophylaxis of recurrent urinary tract infection after renal transplantation by cranberry juice and L-methionine. Transplant Proc. 2012;44(10):3017-3021.23195017
25. Lee YL, Owens J, Thrupp L, et al. The antifungal activity of urine after ingestion of cranberry products. J Altern Complement Med. 2009;15(9):957-958.19757972
26. Shmuely H, Yahav J, Samra Z, et al. Effect of cranberry juice on eradication of Helicobacter pylori in patients treated with antibiotics and a proton pump inhibitor. Mol Nutr Food Res. 2007;51(6):746-751.17487928
27. Zhang L, Ma J, Pan K, Go VL, Chen J, You WC. Efficacy of cranberry juice on Helicobacter pylori infection: a double-blind, randomized placebo-controlled trial. Helicobacter. 2005;10(2):139-145.15810945
28. Puupponen-Pimiä R, Nohynek L, Alakomi HL, Oksman-Caldentey KM. The action of berry phenolics against human intestinal pathogens. Bio Factors. 2005;23(4):243-251.16498212
29. Kontiokari T, Salo J, Eerola E, Uhari M. Cranberry juice and bacterial colonization in children—a placebo-controlled randomized trial. Clin Nutr. 2005;24(6):1065-1072.16194582
30. McKay DL, Blumberg J. Cranberries (Vaccinium macrocarpon) and cardiovascular disease risk factors. Nutr Rev. 2007;65(11):490-502.18038941
31. Neto CC. Cranberry and blueberry: evidence for protective effects against cancer and vascular diseases. Mol Nutr Food Res. 2007;51(6):652-664.17533651
32. Basu A, Betts NM, Ortiz J, Simmons B, Wu M, Lyons TJ. Low-energy cranberry juice decreases lipid oxidation and increases plasma antioxidant capacity in women with metabolic syndrome. Nutr Res. 2011;31(3):190-196.21481712
33. Dohadwala MM, Holbrook M, Hamburg NM, et al. Effects of cranberry juice consumption on vascular function in patients with coronary artery disease. Am J Clin Nutr. 2011;93(5):934-940.21411615
34. Chambers BK, Camire ME. Can cranberry supplementation benefit adults with type 2 diabetes? Diabetes Care. 2003;26(9):2695-2696.12941742
35. Wilson T, Luebke JL, Morcomb EF, et al. Glycemic responses to sweetened dried and raw cranberries in humans with type 2 diabetes. J Food Sci. 2010;75(8):H218-223.2153549810.1111/j.1750-3841.2010.01800.x
36. Simão TN, Lozovoy MA, Simão AN, et al. Reduced-energy cranberry juice increases folic acid and adiponectin and reduces homocysteine and oxidative stress in patients with the metabolic syndrome. Br J Nutr. 2013;110(10):1885-1894.23750500
37. Milbury PE, Vita JA, Blumberg JB. Anthocyanins are bioavailable in humans following an acute dose of cranberry juice. J Nutr. 2010;140(6):1099-1104.20375263
38. Ferrara P, Romaniello L, Vitelli O, Gatto A, Serva M, Cataldi L. Cranberry juice for the prevention of recurrent urinary tract infections: a randomized controlled trial in children. Scand J Urol Nephrol. 2009;43(5):369-372.19921981
39. Salo J, Uhari M, Helminen M, et al. Cranberry juice for the prevention of recurrences of urinary tract infections in children: a randomized placebo-controlled trial. Clin Infect Dis. 2012;54(3):340-346.22100577
40. Dugoua JJ, Seely D, Perri D, Millis E, Koren G. Safety and efficacy of cranberry (vaccinium macrocarpon) during pregnancy and lactation. Can Clin Pharmacol. 2008;15(1):e80-e86.18204103
41. Hamann GL, Campbell JD, George CM. Warfarin-cranberry juice interaction. Ann Pharmacother. 2011:45(3);e17.21364039
42. Grant P. Warfarin and cranberry juice: an interaction? J Heart Valve Dis. 2004;13(1):25-26.14765835
43. Suvarna R, Pirmohamed M, and Henderson L. Possible interaction between warfarin and cranberry juice. BMJ. 2003;327(7429):1454.14684645
44. Paeng CH, Sprague M, Jackevicius CA. Interaction between warfarin and cranberry juice. Clin Ther. 2007;29(8):1730-1735.17919554
45. Rindone JP, Murphy TW. Warfarin-cranberry juice interaction resulting in profound hypoprothrombinemia and bleeding. Am J Ther. 2006;13(3):283-284.16772772
46. Griffiths AP, Beddall A, Pegler S. Fatal haemopericardium and gastrointestinal haemorrhage due to possible interaction of cranberry juice with warfarin. J R Soc Promot Health. 2008;128(6):324-326.19058474
47. Mergenhagen KA, Sherman O. Elevated international normalized ratio after concurrent ingestion of cranberry sauce and warfarin. Am J Health Syst Pharm. 2008;65(22):2113-2116.18997138
48. Mohammed Abdul MI, Jiang X, Williams KM, et al. Pharmacodynamic interaction of warfarin with cranberry but not with garlic in healthy subjects. Br J Pharmacol. 2008;154(8):1691-1700.18516070
49. Lilja JJ, Backman JT, Neuvonen PJ. Effects of daily ingestion of cranberry juice on the pharmacokinetics of warfarin, tizanidine, and midazolam--probes of CYP2C9, CYP1A2, and CYP3A4. Clin Pharmacol Ther. 2007;81(6):833-839.17392729
50. Li Z, Seeram NP, Carpenter CL, et al. Cranberry does not affect prothrombin time in male subjects on warfarin. J Am Diet Assoc. 2006;106(12):2057-2061.17126638
51. Ansell J, McDonough M, Zhao Y, et al. The absence of an interaction between warfarin and cranberry juice: a randomized, double-blind trial. J Clin Pharmacol. 2009;49(7):824-830.19553405
52. Zikria J, Goldman R, Ansell J. Cranberry juice and warfarin: when bad publicity trumps science. Am J Med. 2010;123(5):384-392.20399311
53. Hodek P, Trefil P, and Stiborova M. Flavonoids-potent and versatile biologically active compounds interacting with cytochromes P450. Chem Biol Interact. 2002;22;139(1):1-21.11803026
54. Greenblatt DJ, von Moltke LL, Perloff ES, et al. Interaction of flurbiprofen with cranberry juice, grape juice, tea, and fluconazole: in vitro and clinical studies. Clin Pharmacol Ther. 2006;79(1):125-133.16413247
55. Thijssen HH, Flinois JP, Beaune PH. Cytochrome P4502C9 is the principal catalyst of racemic acenocoumarol hydroxylation reactions in human liver microsomes. Drug Metab Dispos. 2000;28(11):1284-1290.11038154
56. Terris MK, Issa MM, Tacker JR. Dietary supplementation with cranberry concentrate tablets may increase the risk of nephrolithiasis. Urology. 2001;57(1):26-29.11164137
57. McHarg T, Rodgers A, Charlton K. Influence of cranberry juice on the urinary risk factors for calcium oxalate kidney stone formation. BJU Int. 2003;92(7):765-768.14616463
58. Dandeles LM, Lodolce AE. Efficacy of agents to prevent and treat enteral feeding tube clogs. Ann Pharmacother. 2011;45(5):676-680.21521858
59. Calijouw MA, van den Hout WB, Putter H, Achterberg WP, Cools HJ, Gussekloo J. Effeciveness of cranberry capsules to prevent urinary tract infections in vulnerable older persons: a double-blind randomized placebo-controlled trial inn long-term care facilities. J Am Geriatr Soc. 2014;62:103-110.25180378
60. Foxman B, Cronenwett AE, Spino C, Berger M, Morgan DM. Cranberry juice capsules and urinary tract infection after surgery: results of a randomized trial. Am J Obstet Gynecol. 2015;212: Apr 13. pii: S0002-9378(15)00355-5. [epub ahead of print]25882919
61. Bosmans JE, Beerepoot MA, Prins JM, ter Riet G, Geerlings SE. Cost-effectiveness of cranberry vs antibiotics to prevent urinary tract infections in premenopausal women: a randomized clinical trial. PLoS ONE. 2014;9(4):e91939.24705418
62. Juthani-Mehta M, Van Ness PH, Bianco L, et al. Effect of cranberry capsules on bacteriuria plus pyuria among older women in nursing homes: A randomized clnical trial. JAMA. 2016:316(18):1879-1887.
63. Vidlar A, Student Jr V, Vostalova J, et al. Cranberry fruit powder (Flowens™) improves lower urinary tract symptoms in men: a double-blind, randomized, placebo-controlled study. World J Urol. 2016;34:419-424.26049866
64. Ledda A, Belcaro G, Dugall M, et al. Highly standardized cranberry extract supplementation (Anthocran) as prophylaxis in young healthy subjects with recurrent urinary tract infections. Eur Rev Med Pharmacol Sci. 2017;21:389-393.28165546
65. Wan KS, Liu CK, Lee WK, Ko MC, Huang CS. Cranberries for preventing recurrent urinary tract infections in uncircumcised boys. Altern Ther Health Med. 2016;22(6):20-23.27866177
66. Neves AR, Lucio M, Lima JL, Reis S. Resveratrol in medicinal chemistry: a critical review of its pharmacokinetics, drug-delivery, and membrane interactions. Curr Med Chem. 2012;19(11):1663-1681.22257059
67. Gettman MT, Ogan K, Brinkley LJ, Adams-Huet B, Pak CY, Pearle MS. Effect of cranberry juice consumption on urinary stone risk factors. J Urol. 2005;174(2):590-594.16006907

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Hide