Saw palmetto extract

Saw palmetto extract is an extract of the fruit of the saw palmetto. It is marketed as a treatment for benign prostatic hyperplasia, but there is no clinical evidence that it is effective for this purpose.[1][2][3]

Uses and research

Saw palmetto extract is commonly sold as a dietary supplement intended to improve symptoms of benign prostatic hyperplasia (BPH)—also called prostate gland enlargement—which is a common condition during aging in men.[4] An enlarged prostate may cause increased frequency or urgency of urination, difficulty initiating urination, weak urine stream or a stream that stops and starts, dribbling at the end of urination, and inability to completely empty the bladder.[4] Saw palmetto extract has been studied in clinical trials as a possible treatment for people with prostate cancer and for men with lower urinary tract symptoms associated with BPH.[1][5] As of 2020, there is insufficient scientific evidence that saw palmetto extract is effective for treating cancer or BPH and its symptoms.[2][3][5]

One 2016 review of clinical studies with a standardized extract of saw palmetto (called Permixon) found that the extract was safe and may be effective for relieving BPH-induced urinary symptoms compared against a placebo.[6]

Folk medicine

Saw palmetto was used in folk medicine to treat coughs or other disorders.[1]

Precautions and contraindications

Children

The use of saw palmetto extract is not recommended in children under 12 years old because it may affect the metabolism of androgen and estrogen hormones.[7]

Pregnancy and lactation

Saw palmetto extract should not be used during pregnancy.[5][7] The effects of saw palmetto extract on androgen and estrogen metabolism can potentially impair fetal genital development.[8] Saw palmetto extract should also be avoided during breastfeeding due to a lack of available information.[8]

Surgery and bleeding risk

In a case report, a patient taking saw palmetto extract had increased bleeding time during surgery. Bleeding time returned to normal after stopping taking the herb.[9] One clinical trial pre-treated prostate surgery patients with saw palmetto for five weeks prior to the surgery, because there was evidence from earlier literature that such pre-treatment reduced operative bleeding. The trial reported no improvement compared to placebo.[10] As a general rule surgeons should ask patients to discontinue dietary supplements prior to scheduled surgery.[11]

Interactions

Saw palmetto extract has extensive interactions with other medications.[5] It may decrease the effectiveness of estrogen products by reducing estrogen levels in the body via its antiestrogenic effects.[8] It can interfere with the use of birth control pills that contain estrogen as an active ingredient. As a result, it is recommended that an additional form of birth control, such as a condom, be used to prevent pregnancy in patients taking birth control pills with saw palmetto extract. In addition, saw palmetto extract can also interfere with hormone replacement therapy by reducing the effectiveness of estrogen pills. The combination of saw palmetto extract with estrogen products should be used with caution.[8]

When used in combination with an anticoagulant or antiplatelet drug, saw palmetto extract can increase the risk of bleeding by enhancing the anticoagulation or antiplatelet effects.[5] Some examples of anticoagulant and antiplatelet drugs include aspirin, clopidogrel, nonsteroidal anti-inflammatory drugs (NSAIDs), and warfarin.[5]

References
  1. "Saw palmetto". National Center for Complementary and Integrative Health, US National Institutes of Health. 1 May 2020. Retrieved 5 October 2020.
  2. "Spotlight on saw palmetto: What the science says". NCCIH Clinical Digest for Health Professionals, National Center for Complementary and Integrative Health, US National Institutes of Health. 1 May 2020. Retrieved 5 October 2020.
  3. Tacklind J, Macdonald R, Rutks I, Stanke JU, Wilt TJ (2012). "Serenoa repens for benign prostatic hyperplasia". Cochrane Database Syst Rev. 12: CD001423. doi:10.1002/14651858.CD001423.pub3. PMC 7084061. PMID 23235581.
  4. "Benign prostatic hyperplasia". Mayo Clinic. 2 March 2019. Retrieved 5 October 2020.
  5. "Saw palmetto". Drugs.com. 4 December 2018. Retrieved 5 October 2020.
  6. Novara, Giacomo; Giannarini, Gianluca; Alcaraz, Antonio; Cózar-Olmo, José-M.; Descazeaud, Aurelien; Montorsi, Francesco; Ficarra, Vincenzo (2016). "Efficacy and safety of hexanic lipidosterolic extract of Serenoa repens (Permixon) in the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: Systematic review and meta-analysis of randomized controlled trials". European Urology Focus. 2 (5): 553–561. doi:10.1016/j.euf.2016.04.002. PMID 28723522.
  7. "Fructus Serenoae Repentis". WHO Monographs on Selected Medicinal Plants. World Health Organization. Retrieved 29 October 2014.
  8. "Saw Palmetto". Natural Standard: The Authority on Integrative Medicine. Natural Standard. Retrieved 29 October 2014.
  9. Cheema, P; El-Mefty, O; Jazieh, AR (Aug 2001). "Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature". J Intern Med. 250 (2): 167–169. doi:10.1046/j.1365-2796.2001.00851.x. PMID 11489067.
  10. Tuncel A, Ener K, Han O, Nalcacioglu V, Aydin O, Seckin S, Atan A (2009). "Effects of short-term dutasteride and Serenoa repens on perioperative bleeding and microvessel density in patients undergoing transurethral resection of the prostate". Scand. J. Urol. Nephrol. 43 (5): 377–382. doi:10.3109/00365590903164498. PMID 19921983. S2CID 8647630.
  11. Wang CZ, Moss J, Yuan CS (2015). "Commonly Used Dietary Supplements on Coagulation Function during Surgery". Medicines (Basel). 2 (3): 157–185. doi:10.3390/medicines2030157. PMC 4777343. PMID 26949700.
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