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Also Known As:
American Dwarf Palm Tree, Cabbage Palm, JuZhong, Palmier Nain, Sabal, Sabal Fructus, Saw Palmetto Berry. Serenoa repens, synonyms Serenoa serrulata, Sabal serrulata. Family: Arecaceae/Palmae. Orally, saw palmetto is used for symptoms of benign prostatic hyperplasia (BPH). It is also used orally as a mild diuretic, a sedative, an antiinflammatory, and as an antiseptic. Saw palmetto is used to increase breast size, to improve sexual vigor, and as an aphrodisiac. It is also used to treat chronic nonbacterial prostatitis/chronic pelvic pain syndrome, colds, coughs, irritated mucous membranes, sore throat, asthma, chronic bronchitis, migraines, cancer, and to stimulate hair growth. Saw palmetto is also used to prevent complications during transurethral resection of the prostate (TURP). In combination with other herbs, saw palmetto is used to treat prostate cancer. Vaginally, the powdered fruit is used as a uterine and vaginal tonic. LIKELY SAFE ...when used orally and appropriately. Saw palmetto has been safely used in clinical studies lasting up to a year (2732, 2735, 6750, 6751, 6752, 6762, 6764, 6772, 6773, 6777, 6778) (8330, 11354, 14274, 14275, 15550, 17202, 17304, 17306) . PREGNANCY AND LACTATION: LIKELY UNSAFE ...when used orally. Saw palmetto has hormonal activity (6766); avoid using.
People Use This For:
POSSIBLY EFFECTIVE Benign prostatic hyperplasia (BPH). Multiple clinical studies lasting up to a year show that saw palmetto provides mild to moderate improvement in urinary symptoms such as frequent urination, painful urination, hesitancy, urgency, and perineal heaviness. Studies also show that it decreases nocturia, improves peak and mean urinary flow, and lowers residual urine volume in patients with BPH (2732, 5094, 6750, 6751, 6752, 6762, 6764, 6772, 6773, 6777, 6778) (8330, 14275) . Some clinical studies also show that saw palmetto is comparable in efficacy to finasteride (Proscar) and saw palmetto might be better tolerated (6424, 6763, 14275).
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Another clinical study using saw palmetto lipid extract 106 mg. Additionally. 17305). Saw Palmetto (Centrum). and differences in the saw palmetto products used in studies. 17307). The reason for these confusing and inconsistent research findings is not clear. it appears that saw palmetto might offer modest symptom improvement for some men with BPH symptoms. 6750. INSUFFICIENT RELIABLE EVIDENCE to RATE Androgenic alopecia (alopecia areata). treatment with saw palmetto may take one to two months before significant symptomatic improvement occurs (2732. Adding saw palmetto to an alphablocker such as tamsulosin does not seem to relieve symptoms any better than the alphablocker alone (8901). many of the saw palmetto studies are small. This formulation is similar to Super Saw Palmetto (Enzymatic Therapy). saw palmetto 160 mg twice daily was ineffective for reducing symptoms in men with moderate to severe symptoms of BPH after a year of treatment (14274). Research shows significant variation in the chemical composition of commercially available saw palmetto extracts which might explain different study findings (17304. Additionally. nettle root extract 80 mg. Most clinical studies have used a liposterolic extract of saw palmetto berry containing 80% and 90% free fatty acids (Permixon). Interestingly. some clinical research shows no benefit. short term. the analysis also showed no significant difference between taking saw palmetto extract and conventional drugs used for BPH such as tamsulosin (Flomax) or finasteride (Proscar) (17304). saw palmetto does not seem to reduce prostate size or prostatespecific antigen (PSA) levels like finasteride (6424). Alphaadrenergic blockers such as prazosin (Minipress) seem to be more effective than saw palmetto for relieving some symptoms of BPH (6775. However. saw palmetto 360 mg/day was not effective for men with relatively mild BPH after 12 weeks of treatment (11314). 6776). and betacarotene 190 IU taken three times daily for 6 months found that this combination product was not effective for relieving symptoms (5093). A specific commercial product containing saw palmetto and stinging nettle root (PRO 160/120) also seems to be comparable to finasteride (Proscar) for relieving symptoms of BPH and modestly improves some BPH symptoms compared to placebo (6763. higherquality studies are more likely to show no beneficial effect of saw palmetto (17305). Although other preliminary research suggests that saw palmetto is similar in efficacy to tamsulosin (Flomax) after 12 months of treatment (11243) . pumpkin seed oil extract 160 mg. but it might not improve other measures of BPH symptoms or measures of peak urine flow. In another study. Standardized Saw Palmetto Extract (Nature's Way). 17304. In one of the highest quality studies. Differences may be due to different study methodologies. Larger. and of poor quality. 6778). Overall. while alphablockers tend to provide significant and rapid improvement. However. a metaanalysis of all saw palmetto studies suggests that saw palmetto might modestly reduce nocturia and some measures of BPH symptoms compared to placebo. Although most research shows that saw palmetto is modestly effective for improving BPH symptoms. Preliminary clinical research suggests that a combination of saw palmetto extract 200 mg plus betasitosterol 50 mg taken twice Page 2 of 6 . different symptom measurement methods. lemon bioflavonoid extract 33 mg. different patients. other men may have no symptoms relief. and others. Additionally.
5 alpha reductase levels in prostatic tissue and serum testosterone. Water extraction. It is suggested that this condition involves increased sensitivity of hair follicles to DHT. 5093) .daily improves subjective scores of hair quantity and quality in men with androgenic alopecia (15550). Preliminary clinical research suggests that saw palmetto given orally for one year doesn't help nonbacterial prostatitis and chronic pelvic pain syndrome (11354). Saw palmetto appears to noncompetitively inhibit 5 alphareductase types 1 and 2 and to prevent the conversion of testosterone to dihydrotestosterone (DHT) in vitro. which are markers of inflammation in prostate tissue (11224). More evidence is needed to rate saw palmetto for these uses. probably does not adequately extract fat soluble active constituents. Saw palmetto has antiandrogenic. 6771. Inhibition of 5 alphareductase and prevention of conversion of testosterone to DHT may contribute to activity of saw palmetto in androgenic alopecia. Many saw palmetto products are standardized based on the fatty acid content. Saw palmetto might slow prostate cell proliferation by inhibiting fibroblast growth factor and epidermal growth factor and stimulating apoptosis (6765. and antiinflammatory properties that seem to be responsible for improving symptoms of benign prostatic hyperplasia (BPH). Increased COX2 expression is also associated with an increased incidence of prostate cancer. Mechanism of Action: The applicable part of saw palmetto is the ripe fruit. Page 3 of 6 . However. 5 weeks prior to transurethral resection of the prostate (TURP). 6770. including brewed tea. which are involved in inflammation (6769. Preliminary clinical research shows that taking saw palmetto 160 mg orally once daily. 6769. 6779) . reducing their growth phase and size (15550). Inflammatory mediators appear to contribute to the etiology of BPH. Prostatitis and chronic pelvic pain syndrome. but shrinks the inner prostatic epithelium (2736. Most saw palmetto extracts used in clinical studies for benign prostatic hyperplasia (BPH) are berry extracts prepared with lipophilic nonpolar solvents containing 80% to 90% free fatty acids. a liposterolic extract of saw palmetto berry seems to lower tumor necrosis factor (TNF)alpha and interleukin (IL)1beta. The lipid fraction contains volatile oils and fatty oils. DHT. Population research suggests that people who take saw palmetto supplements do not have a lower risk of developing prostate cancer (15217). Laboratory evidence suggests that saw palmetto inhibits lipoxygenase and cyclooxygenase (COX). antiproliferative. Saw palmetto does not seem to affect overall prostate size. 6770). which might reduce prostate growth (6765. 6773. 17308). Preliminary research indicates that saw palmetto reduces the proliferation of experimental prostate cells. does not lower the risk of perioperative hemorrhage or decrease the density of prostatic tissue (17202). Prostate cancer. However. which are active in treating benign prostatic hyperplasia (BPH). 17308). 6769. In men with BPH. possibly by inhibiting COX2 expression (8902) . an analysis of saw palmetto products that are commercially available in Europe shows that the free fatty acid content in these products ranges from about 41% to 81% (17305). and PSA are not significantly reduced by saw palmetto in vivo (2735. Transurethral resection of the prostate (TURP).
nausea. there are no documented cases of spontaneous bleeding in patients taking saw palmetto. There is one case report of cholestatic hepatitis associated with the use of the multi ingredient product that contains saw palmetto (Prostata) (598). a product analysis was not conducted in order to rule out potential product contamination. But when used in healthy volunteers. 17306) . ANTICOAGULANT/ANTIPLATELET HERBS AND SUPPLEMENTS: Concomitant use of herbs and supplements that affect platelet aggregation could theoretically increase the risk of bleeding in some people. constipation. However. headaches. nettle root extract. and postural hypotension (6751. Some of these herbs include angelica. To date. lemon bioflavonoid extract. Bleeding time normalized when saw palmetto was discontinued (8659). 11354. 6766. There is also concern that saw palmetto might have antiplatelet effects and potentially increase the risk of bleeding in some patients. 6424. Interactions with Herbs & Supplements: Interactions with Drugs: Page 4 of 6 . Laboratory fertility studies indicate that saw palmetto has no effect on oocytes or sperm motility. vomiting. In vitro evidence suggests that saw palmetto might inhibit CYP2D6 and CYP3A4 (11026). diarrhea. and worsening acne (15550). Dizziness. ginkgo. clove. Adverse Reactions: Orally. A combination of saw palmetto and betasitosterol has been associated with single reports of loss of appetite. However. saw palmetto 320 mg/day does not seem to affect CYP2D6 or CYP3A4 (11225. symptoms reemerged. This strongly suggests that saw palmetto was the cause of these adverse events (14457). 6752. the adverse effects of saw palmetto are generally mild and comparable to placebo. 17304. loss of libido.Saw palmetto also seems to have antiestrogen. pumpkin seed oil extract. Panax ginseng. 6780). garlic. headache. and diarrhea are the most frequently reported adverse effects. and gastrointestinal complaints such as dizziness. 6762. 4240). ejaculation disorders. 13712). Some clinicians are concerned that saw palmetto might cause erectile dysfunction. and betacarotene (5093). and others. Upon rechallenge with saw palmetto. a patient who took saw palmetto developed acute hepatitis and pancreatitis. There is one case report of decreased ejaculatory volume associated with an herbal blend product containing saw palmetto extract. ejaculatory disturbance. Symptoms resolved when saw palmetto was discontinued. In another case. and alphaadrenergic inhibitory properties (5095. but it might induce metabolic changes in sperm (4239. or altered libido because of its potential effects on 5alpha reductase. Other side effects reported in clinical trials include asthenia. There is conflicting evidence about the effects of saw palmetto on cytochrome P450 (CYP450) enzymes 2D6 (CYP2D6) and 3A4 (CYP3A4). Saw palmetto also does not seem to affect CYP1A2 or CYP2E1 in healthy volunteers (13712). 6762. clinical studies indicate that the occurrence of impotence in men taking saw palmetto is similar to placebo and significantly less than finasteride (Proscar) (2732. antispasmodic. danshen. flatulence. ginger. 17306) . There is one report of excessive intraoperative bleeding in a patient who took saw palmetto prior to surgery.
An analysis of saw palmetto products that are commercially available in Europe shows substantial variation in chemical profile. SURGERY: There is concern that saw palmetto might have antiplatelet effects and could potentially cause excessive bleeding during surgery. 6773. 160 mg twice daily or 320 mg once daily of a lipophilic extract containing 80% to 90% fatty acids has been used in clinical trials (2732. Saw palmetto might have antiestrogenic effects (6766). Excessive intraoperative bleeding has been reported in one case in a patient who took saw palmetto before surgery (8659). 14274). others). concomitant use with saw palmetto might interfere with hormone therapy. Severity = High • Occurrence = Possible • Level of Evidence = B Theoretically. ORAL: For benign prostatic hyperplasia (BPH). Naprosyn. Advise patients to discontinue saw palmetto at least 2 weeks prior to elective surgery. saw palmetto tea was included in the United States Pharmacopeia and the National Formulary. CONTRACEPTIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. For androgenic alopecia (alopecia areata). 6752. Saw palmetto might have antiestrogenic effects (6766). PROSTATESPECIFIC ANTIGEN: Contrary to earlier concerns. 6778) (8330. 6750. Motrin. 6751. saw palmetto extract appears to have no significant effect on serum prostatespecific antigen (PSA) levels (764). naproxen (Anaprox. Cataflam. ibuprofen (Advil. 6762. Saw palmetto is reported to prolong bleeding time (8659) . Interactions with Lab Tests: Interactions with Diseases or Conditions: Dosage/Administration: Editor's Comments: In the first half of the twentieth century. Interactions with Foods: None known. concomitant use with saw palmetto might interfere with contraceptive drugs. ESTROGENS Interaction Rating = Moderate Be cautious with this combination. The majority of clinical studies Page 5 of 6 .ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. saw palmetto might increase the risk of bleeding when used concomitantly with these agents. 5094. 6764. others). 6777. Severity = High • Occurrence = Possible • Level of Evidence = D Theoretically. 200 mg twice daily combined with beta sitosterol 50 mg twice daily has been used (15550). Some of these drugs include aspirin; clopidogrel (Plavix); nonsteroidal anti inflammatory drugs (NSAIDs) such as diclofenac (Voltaren. The free fatty acid content in these products ranges from about 41% to 81% (17305). 6772. BLEEDING TIME: Saw palmetto can prolong bleeding time and increase the results of bleeding time tests (8659). Severity = Moderate • Occurrence = Possible • Level of Evidence = B Theoretically. others); dalteparin (Fragmin); enoxaparin (Lovenox); heparin; warfarin (Coumadin); and others.
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