Punicalagins (Pomegranate Ellagitannins)
Also called punicalagin, punicalagin A/B, pomegranate ellagitannins, Pomanox, pomegranate polyphenols.
Best grade C across 10 graded outcomes Botanical Last checked
The short answer
From 17 sourcesPunicalagins are pomegranate tannins, and some pomegranate extracts state how much they contain. Extract trials are small and mixed: they lowered rheumatoid arthritis activity, inflammatory markers and blood pressure in older adults, and liver fat alongside a diet, while prostate and blood-sugar tests were null and pooled trials showed no effect on insulin resistance.
Every graded outcome on this page
10 rows · line = participants- CGrade CInsulin resistance (HOMA-IR) and insulin sensitivityBlood sugarn 673
- CGrade CInflammatory markers and blood pressure in older adultsHeart markersn 76
- CGrade CLiver fat and metabolic risk factors in NAFLDLivern 76
- CGrade CProstate tissue oxidative stress before surgeryProstaten 70
- CGrade CRheumatoid arthritis disease activity (DAS28)Jointsn 55
- DGrade DPSA doubling time: 1 g vs 3 g extractProstaten 104
- DGrade DEndothelial function, blood pressure and oxidised LDL (subgroups)Heart markersn 84
- DGrade DSunburn threshold (minimal erythema dose) after UVBSkinn 74
- DGrade DBlood lipids (subgroups)Heart markersn 67
- DGrade DPost-meal blood sugar after breadBlood sugarn 16
- 7 more graded outcomes, in the evidence chapter
Key facts
- What they are
- Ellagitannins in pomegranate; LactMed lists punicalagin among the polyphenols in pomegranate juice2
- Typical tested amount
- 1,000 mg of POMx extract and 240 mL of the tested pomegranate juice each contained 100 mg punicalagin A/B4
- Best single trial
- Rheumatoid arthritis: 500 mg/day of POMx for 8 weeks lowered DAS28 disease activity vs placebo in 55 patients (grade C)3
- Newer trials
- 740 mg/day of extract lowered IL-6 and systolic pressure in 76 older adults; 1,500 mg/day of peel extract with a diet reduced liver fat in 76 adults with NAFLD (both grade C)1516
- Null results
- An extract did not lower post-meal blood sugar (16 people), a pre-surgery prostate trial missed its main oxidative-stress marker (70 men), and 15 pooled trials (673 people) found no overall effect on insulin resistance9717
- Safety
- NCCIH: pomegranate extract may be safe; digestive symptoms and allergic reactions can occur1
What it is
Punicalagins are ellagitannin polyphenols found in pomegranate; some pomegranate extracts state their punicalagin content.
How it works
ProposedPunicalagin strongly inhibited human alpha-amylase in laboratory tests, yet an extract did not lower blood sugar after bread in people. Urolithin A, a pomegranate metabolite, was found in prostate tissue more often after POMx than placebo (21 of 33 vs 12 of 35 men). Health effects of punicalagins and their metabolites are proposed, not established.79
Forms, side by side
3 forms named in our sources. The rest show what our data holds, and say plainly where it holds nothing yet.
Punicalagins (Pomegranate Ellagitannins) forms compared
3 forms| 3 forms | Pomegranate extract (punicalagin-containing) | Hydroxytyrosol + punicalagin combination | Pomegranate juice |
|---|---|---|---|
| Absorption in people | Urolithin A, a pomegranate metabolite, reached prostate tissue more often after POMx than placebo.7 | No human absorption data in our sources.5 | 240 mL of the tested juice held 100 mg punicalagin A/B.4 |
| GI tolerance | NCCIH says pomegranate extract may be safe; digestive symptoms can occur. Diarrhoea affected 13.5% at 3 g/day vs 1.9% at 1 g/day in one trial.18 | No adverse effects reported over 8-week periods at 195 mg punicalagin a day.6 | NCCIH: pomegranate juice is believed to be safe.1 |
| Studied for | Rheumatoid arthritis activity, UV sensitivity, prostate markers, inflammation and blood pressure in older adults, NAFLD | Endothelial function, blood pressure and lipids (subgroups) | See the pomegranate page; lowered the glucose response to bread where an extract did not |
- Pomegranate extract (punicalagin-containing)
- Absorption in people
- Urolithin A, a pomegranate metabolite, reached prostate tissue more often after POMx than placebo.7
- GI tolerance
- NCCIH says pomegranate extract may be safe; digestive symptoms can occur. Diarrhoea affected 13.5% at 3 g/day vs 1.9% at 1 g/day in one trial.18
- Studied for
- Rheumatoid arthritis activity, UV sensitivity, prostate markers, inflammation and blood pressure in older adults, NAFLD
- Hydroxytyrosol + punicalagin combination
- Pomegranate juice
What the human research says
Human trials only, one row per outcome. The form line shows what each trial actually tested. Grades follow our evidence-grading policy.
Trial map
10 graded outcomes, largest study first10 graded outcomes: 6 improved, 4 no effect. The largest, a 2025 meta-analysis of 673 people on insulin resistance (HOMA-IR) and insulin sensitivity, found no effect.
1Insulin resistance (HOMA-IR) and insulin sensitivity
No effect · Grade C · Meta-analysis, 673 people, 2025
Participants in 15 RCTs (healthy, overweight, NAFLD, type 2 diabetes, PCOS and others)
Dose, result and source| Outcome | Found | People | Study | Who was studied |
|---|---|---|---|---|
| Insulin resistance (HOMA-IR) and insulin sensitivity | No effect | 673 | Grade C · Meta-analysis, 2025 | Participants in 15 RCTs (healthy, overweight, NAFLD, type 2 diabetes, PCOS and others) |
| PSA doubling time: 1 g vs 3 g extract | No effect | 104 | Grade D · RCT, 2013 | Men with rising PSA after initial therapy for localized prostate cancer, no metastases |
| Endothelial function, blood pressure and oxidised LDL (subgroups) | Improved | 84 | Grade D · Crossover RCT, 2019 | Middle-aged, apparently healthy adults (Madrid) |
| Inflammatory markers and blood pressure in older adults | Improved | 76 | Grade C · RCT, 2025 | Adults aged 55 to 70 |
| Liver fat and metabolic risk factors in NAFLD | Improved | 76 | Grade C · RCT, 2023 | Adults with NAFLD on a 500-kcal-deficit diet (Iran) |
| Sunburn threshold (minimal erythema dose) after UVB | Improved | 74 | Grade D · RCT, 2019 | Women aged 30 to 45 with skin types II to IV |
| Prostate tissue oxidative stress before surgery | No effect | 70 | Grade C · RCT, 2013 | Men with prostate cancer awaiting radical prostatectomy |
| Blood lipids (subgroups) | Improved | 67 | Grade D · Crossover RCT, 2022 | Adults aged 45 to 65 (84 randomized, 67 completed) |
| Rheumatoid arthritis disease activity (DAS28) | Improved | 55 | Grade C · RCT, 2017 | Adults with rheumatoid arthritis (Shiraz, Iran) |
| Post-meal blood sugar after bread | No effect | 16 | Grade D · Crossover RCT, 2017 | Healthy volunteers |
Every graded row
10 rowsShowing 10 of 10 outcomes. Human trials only.
CGrade CInsulin resistance (HOMA-IR) and insulin sensitivityBlood sugarNo effectMeta-analysis · 15 studies
n 673 · 2025
No effect Pomegranate products did not improve HOMA-IR or insulin sensitivity overall; subgroups with PCOS (HOMA-IR and fasting insulin) and with type 2 diabetes or NAFLD (fasting insulin) improved.
- Design
- Meta-analysis, 15 studies, n = 673, 2025
- Population
- Participants in 15 RCTs (healthy, overweight, NAFLD, type 2 diabetes, PCOS and others)
- Form
- Pomegranate juice, seed oil, peel or fruit extract capsules and peel-enriched bread
- Dose
- Varied
- Duration
- At least 4 weeks
- Source
- Reference 17 · PubMed 39499092 (opens PubMed)
CGrade CInflammatory markers and blood pressure in older adultsHeart markersImprovedRCT
n 76 · 2025
Improved IL-6 and IL-1β fell with the extract (significant treatment-by-time interaction) and systolic pressure fell by 5.22 mmHg; CRP and TNF-α did not change significantly.
- Design
- RCT, n = 76, 2025
- Population
- Adults aged 55 to 70
- Form
- Pomegranate extract capsules vs maltodextrin placebo
- Dose
- 740 mg/day
- Duration
- 12 weeks
- Source
- Reference 15 · PubMed 40218993 (opens PubMed)
CGrade CLiver fat and metabolic risk factors in NAFLDLiverImprovedRCT
n 76 · 2023
Improved Weight (mean change −5.10 kg), waist, total cholesterol, fasting blood sugar, liver steatosis and liver stiffness fell more than with placebo, and HDL rose; fasting insulin and HOMA-IR did not differ.
- Design
- RCT, n = 76, 2023
- Population
- Adults with NAFLD on a 500-kcal-deficit diet (Iran)
- Form
- Pomegranate peel extract capsules vs placebo
- Dose
- 1,500 mg/day
- Duration
- 8 weeks
- Source
- Reference 16 · PubMed 37605174 (opens PubMed)
CGrade CProstate tissue oxidative stress before surgeryProstatePrimary endpoint not metRCT
n 70 · 2013
No effect Benign tissue 8-OHdG was 16% lower with POMx (P = 0.095), not statistically significant; Ki67, NF-kB, pS6 kinase and PSA changes did not differ. Urolithin A was detected in prostate tissue in 21 of 33 men on POMx vs 12 of 35 on placebo.
- Design
- RCT, n = 70, 2013
- Population
- Men with prostate cancer awaiting radical prostatectomy
- Form
- POMx pomegranate extract tablets
- Dose
- 2 tablets a day
- Duration
- Up to 4 weeks
- Source
- Reference 7 · PubMed 23985577 (opens PubMed)
CGrade CRheumatoid arthritis disease activity (DAS28)JointsDAS28 lower (P < 0.001)RCT
n 55 · 2017
Improved DAS28 disease activity fell vs placebo (P < 0.001); HAQ disability score (P = 0.007) and morning stiffness (P = 0.04) also improved and glutathione peroxidase rose. CRP, MMP3 and MDA did not differ between groups.
- Design
- RCT, n = 55, 2017
- Population
- Adults with rheumatoid arthritis (Shiraz, Iran)
- Form
- POMx pomegranate extract capsules
- Dose
- 500 mg/day (2 x 250 mg)
- Duration
- 8 weeks
- Source
- Reference 3 · PubMed 27577177 (opens PubMed)
DGrade DPSA doubling time: 1 g vs 3 g extractProstateNo effectRCT
n 104 · 2013
No effect Median PSA doubling time lengthened from 11.9 to 18.5 months overall, with no difference between doses (P = 0.554); without a placebo arm the change cannot be attributed to the extract. Diarrhoea occurred in 1.9% (1 g) and 13.5% (3 g).
- Design
- RCT, n = 104, 2013
- Population
- Men with rising PSA after initial therapy for localized prostate cancer, no metastases
- Form
- POMx pomegranate extract
- Dose
- 1 g or 3 g a day
- Duration
- Up to 18 months
- Source
- Reference 8 · PubMed 22689129 (opens PubMed)
DGrade DEndothelial function, blood pressure and oxidised LDL (subgroups)Heart markersImprovedCrossover RCT
n 84 · 2019
Improved In people with endothelial dysfunction, flow-mediated dilation improved vs placebo (2.36 vs 0.76%); in those with high oxLDL, oxLDL fell vs placebo; prehypertensive and hypertensive participants had lower blood pressure (systolic -15.75 mmHg). Whole-group results are not reported in the abstract.
- Design
- Crossover RCT, n = 84, 2019
- Population
- Middle-aged, apparently healthy adults (Madrid)
- Form
- Hydroxytyrosol + punicalagin capsules (olive and Pomanox pomegranate extracts)
- Dose
- 195 mg punicalagin + 9.9 mg hydroxytyrosol a day
- Duration
- 8 weeks per period
- Source
- Reference 5 · PubMed 30884808 (opens PubMed)
DGrade DSunburn threshold (minimal erythema dose) after UVBSkinImprovedRCT
n 74 · 2019
Improved Minimal erythema dose rose significantly with both the extract and the juice compared with placebo; skin bacteria shifted at family and genus level.
- Design
- RCT, n = 74, 2019
- Population
- Women aged 30 to 45 with skin types II to IV
- Form
- POMx extract (100 mg punicalagin A/B per 1,000 mg) or pomegranate juice vs placebo
- Dose
- 1,000 mg/day extract
- Duration
- 12 weeks
- Source
- Reference 4 · PubMed 31601842 (opens PubMed)
DGrade DBlood lipids (subgroups)Heart markersImprovedCrossover RCT
n 67 · 2022
Improved Triglycerides fell in people with high triglycerides (200.67 to 155.33 mg/dL), LDL fell in those with LDL of 160 mg/dL or more (179.13 to 162.93 mg/dL), and HDL rose in those with low HDL; placebo showed no such changes.
- Design
- Crossover RCT, n = 67, 2022
- Population
- Adults aged 45 to 65 (84 randomized, 67 completed)
- Form
- Hydroxytyrosol + punicalagin capsules
- Dose
- 195 mg punicalagin + 9.9 mg hydroxytyrosol a day
- Duration
- 8 weeks per period
- Source
- Reference 6 · PubMed 35565844 (opens PubMed)
DGrade DPost-meal blood sugar after breadBlood sugarNo effectCrossover RCT
n 16 · 2017
No effect The extract did not lower the blood glucose response to bread, whereas pomegranate juice lowered it by 33.1% in a parallel study of 16 people.
- Design
- Crossover RCT, n = 16, 2017
- Population
- Healthy volunteers
- Form
- Pomegranate polyphenol extract supplement (compared with juice in a separate study)
- Dose
- Not stated in the abstract
- Duration
- Single meal
- Source
- Reference 9 · PubMed 29021286 (opens PubMed)
What the numbers add up to
Each point is worked out from the data and the sources numbered on this page, with the arithmetic shown under it. It adds no new data and is not medical advice.
Studied doses
Doses used in research, shown against the official limits. They describe the studies, not a recommendation for you.
Studied doses in research, not advice. These are amounts used in research, not personal advice. Your clinician or pharmacist can say what fits you.
Doses studied in human trials
Doses studied in human trials ranged from 500 mg a day of pomegranate extract for 8 weeks to 3 g a day for up to 18 months, with 740 mg and 1,500 mg a day in newer trials; 1,000 mg of extract supplied about 100 mg of punicalagins, and a combination product supplied 195 mg of punicalagins a day.34581516
Interactions and safety
Published interactions only: each row cites a source. No row means none was found in our sources, not that a combination is safe.
What Punicalagins meets
3 cited rows 2 tested togetherMedicines 3
Supplements and foods 1
- Reference summary
- Tested together in a graded trial
Choose a medicine or supplement above to read its cited rows here.
Also cited: 2 tested together
Sildenafil
ReviewReference summary
Sildenafil, for example Viagra, Revatio: A 2025 review describes a man who developed priapism (a painful erection lasting hours that needed emergency care) after drinking 200 mL of pomegranate juice with sildenafil. Pomegranate components inhibit CYP3A4, the main enzyme that clears sildenafil, in lab studies, although studies in people have not shown pomegranate juice raising exposure to drugs cleared this way.
Source 12, Int J Mol Sci (2025); Source 13, J Clin Psychiatry (2014)
Tacrolimus
ReviewReference summary
Tacrolimus, for example Prograf, Envarsus: A 2021 review of tacrolimus–herb interactions reports that pomegranate juice increased tacrolimus availability in human or animal studies by acting on CYP enzymes and the P-gp drug transporter. Tacrolimus has a narrow safe range, so its blood levels are monitored.
Source 14, Pharmazie (2021)
Warfarin
ReviewReference summary
Warfarin, for example Coumadin, Jantoven: Case reports link pomegranate juice to changes in INR in people taking warfarin, and a 2015 review suggests asking about recent pomegranate juice when INR is unstable. Lab studies show pomegranate inhibits CYP2C9, an enzyme that clears warfarin. These reports involve juice, not punicalagin extracts.
Source 10, J Pharm Pract (2015); Source 11, Molecules (2023)
HydroxytyrosolHydroxytyrosol page
Tested together
Endothelial function, blood pressure and oxidised LDL (subgroups). Graded on the Punicalagins page; tested together is not a claim that they work better together.
Tested together
Blood lipids (subgroups). Graded on the Punicalagins page; tested together is not a claim that they work better together.
Interactions
3 agents| Agent | What the source says | Evidence |
|---|---|---|
| Medicines3 | ||
| Warfarine.g. Coumadin, Jantoven | Case reports link pomegranate juice to changes in INR in people taking warfarin, and a 2015 review suggests asking about recent pomegranate juice when INR is unstable. Lab studies show pomegranate inhibits CYP2C9, an enzyme that clears warfarin. These reports involve juice, not punicalagin extracts.1011 | Review |
| Sildenafile.g. Viagra, Revatio | A 2025 review describes a man who developed priapism (a painful erection lasting hours that needed emergency care) after drinking 200 mL of pomegranate juice with sildenafil. Pomegranate components inhibit CYP3A4, the main enzyme that clears sildenafil, in lab studies, although studies in people have not shown pomegranate juice raising exposure to drugs cleared this way.1213 | Review |
| Tacrolimuse.g. Prograf, Envarsus | A 2021 review of tacrolimus–herb interactions reports that pomegranate juice increased tacrolimus availability in human or animal studies by acting on CYP enzymes and the P-gp drug transporter. Tacrolimus has a narrow safe range, so its blood levels are monitored.14 | Review |
Check with what you take
Kept on this device onlyAdd what you take. We list every interaction our evidence profiles cite between Punicalagins and your picks, and between your picks.
- Loading names…
Add a supplement or medicine you take to check it against Punicalagins.
Starting from one medicine? The interaction checker rates how serious each pair is, on a curated list of 19 entries for 11 medicines. This cabinet has no severity rating: it lists every interaction row our supplement pages cite.
Who should be careful
4 groups- Pregnancy and breastfeeding
- NCCIH says drinking pomegranate juice during pregnancy or breastfeeding may be safe, but little is known about other forms such as extracts. LactMed reports no adverse reactions in breastfed infants after maternal pomegranate ingestion.12
- Pomegranate allergy
- Allergic reactions to pomegranate have been reported.1
- Root, stem and peel products
- NCCIH says pomegranate root, stem and peel may not be safe in large amounts because they contain substances that can have harmful effects.1
- People on medicines
- NCCIH advises anyone taking medicine to talk with a health care provider before using an herbal product, since some herbs and medicines interact in harmful ways.1
How to read the label
What to check on the Supplement Facts panel.
How to read the label
3 checksLook for the punicalagin number
Extract vs juice
In a blood-sugar test the juice worked and an extract did not, so results for one form may not carry over to the other.9
Frequently asked questions
Short answers to common questions; the numbers link to the sources below.
Common questions
7 answersDo punicalagins help cholesterol?
Only in subgroups of one trial of a combination with olive hydroxytyrosol (195 mg punicalagins a day): triglycerides and LDL fell in people whose levels were high.6
Do they affect prostate cancer?
Do pomegranate extracts lower blood pressure or inflammation?
In a 12-week trial of 76 adults aged 55 to 70, 740 mg/day of extract lowered IL-6, IL-1β and systolic pressure (by 5.22 mmHg), but not CRP. It is a single trial, and the punicalagin content was not stated.15
Are punicalagin supplements safe?
Do punicalagins interact with medicines?
Are punicalagin supplements better than pomegranate juice?
Sources
17 sources: trial abstracts, NIH fact sheets and reference databases. Numbers in the text link here.
Sources cited on this page
17 sources- 1Pomegranate: Usefulness and Safety (last updated April 2025)Fact sheet National Center for Complementary and Integrative Health (NCCIH), 2025 · nccih.nih.gov
- 2Pomegranate. Drugs and Lactation Database (LactMed).Database NICHD, 2023 · PMID 37748009
- 3Pomegranate extract alleviates disease activity and some blood biomarkers of inflammation and oxidative stress in Rheumatoid Arthritis patients.RCT Eur J Clin Nutr, 2017 · PMID 27577177
- 4Pomegranate Juice and Extract Consumption Increases the Resistance to UVB-induced Erythema and Changes the Skin Microbiome in Healthy Women: a Randomized Controlled Trial.RCT Sci Rep, 2019 · PMID 31601842
- 5Supplementation with Hydroxytyrosol and Punicalagin Improves Early Atherosclerosis Markers Involved in the Asymptomatic Phase of Atherosclerosis in the Adult Population: A Randomized, Placebo-Controlled, Crossover Trial.Crossover RCT Nutrients, 2019 · PMID 30884808
- 6Oral Supplement Containing Hydroxytyrosol and Punicalagin Improves Dyslipidemia in an Adult Population without Co-Adjuvant Treatment: A Randomized, Double-Blind, Controlled and Crossover Trial.Crossover RCT Nutrients, 2022 · PMID 35565844
- 7A double-blind, randomized, neoadjuvant study of the tissue effects of POMx pills in men with prostate cancer before radical prostatectomy.RCT Cancer Prev Res (Phila), 2013 · PMID 23985577
- 8A randomized phase II study of pomegranate extract for men with rising PSA following initial therapy for localized prostate cancer.RCT Prostate Cancer Prostatic Dis, 2013 · PMID 22689129
- 9Pomegranate juice, but not an extract, confers a lower glycemic response on a high-glycemic index food: randomized, crossover, controlled trials in healthy subjects.Crossover RCT Am J Clin Nutr, 2017 · PMID 29021286
- 10A Comprehensive Review of Potential Warfarin-Fruit Interactions.Review J Pharm Pract, 2015 · PMID 25112306
- 11Impact of Pomegranate Juice on the Pharmacokinetics of CYP3A4- and CYP2C9-Mediated Drugs Metabolism: A Preclinical and Clinical Review.Review Molecules, 2023 · PMID 36903363
- 12Hazardous Interactions Between Food, Herbs, and Drugs in the First Stage of Biotransformation: Case Reports of Adverse Drug Interactions in Humans.Review Int J Mol Sci, 2025 · PMID 40507996
- 13Potentially significant versus clinically significant drug interactions: pomegranate juice as a case in point.Review J Clin Psychiatry, 2014 · PMID 24813412
- 14Tacrolimus and herbs interactions: a review.Review Pharmazie, 2021 · PMID 34620272
- 15Effects of Pomegranate Extract on Inflammatory Markers and Cardiometabolic Risk Factors in Adults Aged 55-70 Years: A Randomised Controlled Parallel Trial.RCT Nutrients, 2025 · PMID 40218993
- 16Pomegranate (Punica granatum L.) peel extract ameliorates metabolic syndrome risk factors in patients with non-alcoholic fatty liver disease: a randomized double-blind clinical trial.RCT Nutr J, 2023 · PMID 37605174
- 17Lack of Efficacy of Pomegranate Supplementation on Insulin Resistance and Sensitivity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Meta-analysis Phytother Res, 2025 · PMID 39499092
What changed
Every dated change to this page: what changed, who made it and why.
Change log
3 entries| Date | Change | Who and why |
|---|---|---|
| evidence, key facts, studied doses, FAQ, summary | Added a 2025 trial in older adults (PMID 40218993), a 2023 peel-extract NAFLD trial (PMID 37605174) and a 2025 insulin-resistance meta-analysis (PMID 39499092); two FAQs on blood pressure and medicines. All PMIDs checked with NCBI esummary and abstracts read. | Writer: Kymata Health EditorialTrigger: A–Z page audit |
| Interactions | Added warfarin, sildenafil and tacrolimus interaction entries from five reviews of pomegranate–drug interactions (two read in PMC full text). All PMIDs checked with NCBI esummary. The reports involve pomegranate juice, not punicalagin extracts. | Writer: Kymata Health EditorialTrigger: Update |
| all | Initial editorial evidence review. Every PMID checked against NCBI E-utilities esummary (title and year) and each cited abstract read; numbers taken from the abstracts (and, where noted, the full text for funding and participant counts). Industry links disclosed: Probelte Pharma and Euromed (hydroxytyrosol-punicalagin trial), POM Wonderful ties (2013 phase II PSA trial). Safety from NCCIH and LactMed only. Where to buy: we didn’t list a product; the only punicalagin-labelled product we found also lists caffeine per capsule, which we could not confirm. | Writer: Kymata Health EditorialTrigger: new page |
Supplement & Nutrient Encyclopedia. Educational information only; it is not medical advice and does not replace a clinician. Dietary supplements are not intended to diagnose, treat, cure or prevent any disease. Statements about supplements have not been evaluated by the FDA.