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Clinician’s Corner: Saw Palmetto

Benign Prostatic Hypertrophy (BPH) is characterized by too frequent urination, having trouble starting or maintaining urination, and needing to urinate during the night.

The urethra, the tube that “drains” urine from the body, runs through the prostate gland in men. When the prostate gland is enlarged, obstruction of the urethra occurs and men may have trouble urinating.

Common Names: saw palmetto, American dwarf palm tree, cabbage palm, is a tree native to South Eastern United States. Latin Name: Serenoa repens, Sabal serrulata

  • USE: urinary symptoms associated with benign prostatic hyperplasia (BPH), as well as for chronic pelvic pain, bladder disorders, decreased sex drive, hair loss, hormone imbalances, and prostate cancer.
  • Medicinal part: The ripe fruit of saw palmetto is used in several forms, including ground and dried fruit or whole berries. It is available as liquid extracts, tablets, capsules, and as an infusion or a tea. The saw palmetto berry contains over 100 different compounds.

EVIDENCE (or lack thereof)

  • 2011 NCCIH-cofunded study in 369 older men demonstrated that saw palmetto extract administered at up to three times the standard daily dose (320 mg) was no more effective than placebo. The supplement should be a fat soluble saw palmetto extract that contains 85 to 95% fatty acids and sterols.
  • A 2012 study in JAMA concluded that increasing doses of a saw palmetto fruit extract did not reduce lower urinary tract symptoms more than placebo. This study reached the same conclusion as the New England Journal of Medicine in 2006, of the lack of efficacy of saw palmetto.
  • UP-To-Date® does not recommend any herbals for BPH until herbals are further studied. Given the body of evidence against herbal products, efficacy is likely tied to the placebo effect.

DRUG INTERACTIONS:

  • Saw Palmetto does have blood thinning properties, do not recommend if patient takes any blood thinning drugs such as warfarin, aspirin, Plavix, Xarelto, or NSAIDS.
  • Because of saw palmetto’s mechanism of action being anti-estrogenic and anti-androgenic, it may decrease the efficacy of oral estrogen and oral contraceptives. It is recommended that a condom be used to prevent pregnancy if partner is using birth control pills.
  • Speaking of drug interactions, certain medications need to be avoided in men of my age group, especially if they have BPH:

MEDICATIONS  to Avoid with BHP

  • Testosterone
  • Sympathomimetic agents
  • Drugs with significant anticholinergic (antimuscarinic) adverse effects:
  • Anticholinergics: same as above (benztropine, hyoscyamine)
  • Diuretics: high dose therapy may cause urinary frequency.

CAUTION: Be sure that prostate cancer has been ruled out before taking saw palmetto.

Your Thompson Pharmacist is an excellent resource for over the counter recommendations.  It is especially important to get all of your prescriptions filled at Thompson Pharmacy so our expert pharmacists can check your medication list before you take any herbal or over the counter product.  Go Ahead and Ask—at Thompson Pharmacy it’s all for YOU!