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Serenoa repens (Saw palmetto, Permixon)

The dwarf palm tree grows along the southeastern coast of the US (South Carolina to Florida). Saw palmetto berries are harvested in the Fall & winter. Uses: Traditional use: 1) urethral obstruction (5th century BC, Egypt) 2) appetite stimulant 3) male infertility 4) sex hormone disorders Current use: 1) relief of obstructive symptoms of BPH - not useful to possibly effective [7,8,9,12]* 2) mild diuretic 3) urinary antiseptic * does not appear to be more effective than placebo [13] Contraindications: NOT for use in women Dosage: 1) 160 mg BID with food (lipophilic extract) 2) therapeutic benefits NOT available from tea Pharmacokinetics: 1) plasma levels peak in 1.5 hours, 1/2 life is 19 hours 2) maximum benefits may not be achieved for 13-16 weeks Adverse effects: 1) generally well tolerated up to 6 months 2) GI upset: nausea, vomiting, diarrhea, constipation [11] at higher doses 3) increased blood pressure (3%) 4) headache (3%) 5) dizziness 6) urinary retention 7) decreased libido, impotence, erectile dysfunction (1.5-2.2%) Drug interactions: 1) finasteride & alpha-1-adrenergic agonists ? [10] 2) patients taking diuretics, alpha blockers & anticoagulants have been eliminated from studies 3) avoid concomitant hormonal therapies Mechanism of action: 1) active ingredients: a) 95% EtOH or n-hexane extracts of saw palmetto berries contain 85-95% fatty acids, long chain alcohols & esterified sterols b) specific active ingredient(s) unknown 2) theories a) inhibition of 5-alpha reductase type 1 activity - (finasteride inhibits type 2) - no effect on PSA b) inhibits or down regulates estrogen & androgen receptors 3) reduces symptoms of BPH without diminishing prostate enlargement (possibly effective) [8] 4) even high doses no more effective than placebo [9]

Related

benign prostatic hyperplasia (BPH)

General

pharmaceutical herb; medicinal herb; herbal supplement; botanical

References

  1. Victoria Rand, UCSF Fresno Lecture
  2. Lowe et al Urology 48(1):12-20 1996
  3. Carraro et al, The Prostate 29:231-240 1996
  4. Plosker & Brogden, Drugs & Aging 9(5):379-395 1996
  5. Kaiser Permanente, Northern California Regional Pharmacy & Therapeutics Committee
  6. Prescriber's Letter 9(7):42 2002
  7. Bent S et al, Saw palmetto for benign prostatic hyperplasia. N Engl J Med 2006, 354:557 PMID: 16467543 - Prescriber's Letter 13(3): 2006 Special Report: Natural Medicines in Clinical Management of Benign Prostatic Hyperplasia Detail-Document#: 220305 (subscription needed) http://www.prescribersletter.com
  8. Prescriber's Letter 17(3): 2010 Natural Medicines in the Clinical Management of Benign Prostatic Hyperplasia Detail-Document#: 260310 (subscription needed) http://www.prescribersletter.com
  9. Barry MJ et al Effect of Increasing Doses of Saw Palmetto Extract on Lower Urinary Tract Symptoms JAMA. 2011;306(12):1344-1351 PMID: 21954478 http://jama.ama-assn.org/content/306/12/1344.abstract
  10. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  11. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  12. Tacklind J, Macdonald R, Rutks I, Stanke JU, Wilt TJ. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2012 Dec 12;12:CD001423. Review. PMID: 23235581 - MacDonald R, Tacklind JW, Rutks I, Wilt TJ Serenoa repens monotherapy for benign prostatic hyperplasia (BPH): an updated Cochrane systematic review. BJU Int. 2012 Jun;109(12):1756-61. PMID: 22551330
  13. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.

Component-of

PC-SPES