Saw Palmetto Supplement

Scientific Name: Serenoa repens

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Order: Arecales

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Family: Arecaceae

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The fruits of saw palmetto are primarily used in herbal medicines. This small palm is common in the understory of evergreen forests in Florida. Saw palmetto is sometimes called sabal.

Strong:

insufficient information

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Good:

• Benign Prostatic Hyperplasia (BPH) [1-33]
  • Concentrated extracts of saw palmetto and saw palmetto blends with Cucurbita pepo; stinging nettle; lycopene; Cucurbita pepo / Epilobium parviflorum / lycopene / Prunus africana; Tribulus terrestris / Eisenia bicyclis / glucosamine; or cernitin / beta-sitosterol / vitamin E may be more effective. One NIH funded study [Bent et al. 2006] found that saw palmetto may not be effective, and long-term use may also not be effective

• Lower Urinary Tract Symptoms (LUTS) [34-46]
  • Concentrated extracts of saw palmetto and blends with stinging nettle or Tribulus terrestris / Eisenia bicyclis / glucosamine may be more effective. One NCCAM co-funded study [Barry et al. 2011] found that saw palmetto might not be effective

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Promising:

insufficient information

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Conflicting (Unclear):

insufficient information

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Limited Evidence:

• Baldness [47-48]
• Chronic Bacterial Prostatitus, a combination of saw palmetto with stinging nettle / quercetin / curcumin [49]
• Chronic Prostatitus/Chronic Pelvic Pain Syndrome [50-51]
• Oily Skin, a cream containing saw palmetto / sesame seeds / argan oil [52]

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No Evidence:

• Increases Testosterone [53]

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No Clinical Research:

All other conditions.

Side effects may include:

• Abdominal Pain
• Back Pain
• Constipation
• Diarrhea
• Fatigue
• Headache
• Nausea
• Painful Urination
• Rhinitis
• Urine Retention

Precautions and Adverse Events:

• Avoid or contact a licensed healthcare practitioner, if you have cancer, pancreatitis, prostate cancer, or hormone dependent conditions.

• Saw Palmetto may increase the risk of bleeding, cause blood in urine, cause pancreatitis, cause a hemorrhage after surgery, cause impotence (erectile dysfunction), decrease sex drive.

• There was a case of a young girl who had hot flashes and early onset of her menstrual cycle due to saw palmetto.

• Saw palmetto may have caused several cases of intraoperative floppy-iris syndrome.

• A hair loss cream containing saw palmetto caused an allergic reaction in a woman.

[54-65]

There is not enough research on the use of supplements containing saw palmetto during pregnancy and breast-feeding, so consult a licensed healthcare practitioner before use or avoid use. [54-65]

Major:

insufficient information

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Moderate:

• Warfarin

[66-71]

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Potential:

• Hormone-Like Drugs (such as drugs containing estrogen)
• Iron-Containing Products; since saw palmetto contains tannins, take iron and saw palmetto at least several hours apart to prevent non-absorption of iron
• Several studies have found that saw palmetto may NOT interact with drugs, but others have found that there may be some risks

[66-71]

Saw palmetto is not a "drug", so the best doses have not been thoroughly established. Make sure to follow the specific product instructions and take as directed on the label, or consult a licensed healthcare practitioner before use.

[Afendi et al. 2012]

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Bertaccini A, Giampaoli M, Cividini R, Gattoni GL, Sanseverino R, Realfonso T, Napodano G, Fandella A, Guidoni E, Prezioso D, Galasso R, Cicalese C, Scattoni V, Armenio A, Conti G, Corinti M, Spasciani R, Liguori G, Lampropoulou N, Martorana G. Observational database serenoa repens (DOSSER): overview, analysis and results. A multicentric SIUrO (Italian Society of Oncological Urology) project. Arch Ital Urol Androl. 2012 Sep;84(3):117-22. 6. Carbin BE, Larsson B, Lindahl O. Treatment of benign prostatic hyperplasia with phytosterols. Br J Urol. 1990 Dec;66(6):639-41. 7. Carraro JC, Raynaud JP, Koch G, Chisholm GD, Di Silverio F, Teillac P, Da Silva FC, Cauquil J, Chopin DK, Hamdy FC, Hanus M, Hauri D, Kalinteris A, Marencak J, Perier A, Perrin P. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate. 1996 Oct;29(4):231-40; discussion 241-2. 8. Coulson S, Rao A, Beck SL, Steels E, Gramotnev H, Vitetta L. A phase II randomised double-blind placebo-controlled clinical trial investigating the efficacy and safety of ProstateEZE Max: a herbal medicine preparation for the management of symptoms of benign prostatic hypertrophy. Complement Ther Med. 2013 Jun;21(3):172-9. 9. Debruyne F, Koch G, Boyle P, Da Silva FC, Gillenwater JG, Hamdy FC, Perrin P, Teillac P, Vela-Navarrete R, Raynaud JP. Comparison of a phytotherapeutic agent (Permixon) with an alpha-blocker (Tamsulosin) in the treatment of benign prostatic hyperplasia: a 1-year randomized international study. Eur Urol. 2002 May;41(5):497-506; discussion 506-7. 10. Di Silverio F, D'Eramo G, Lubrano C, Flammia GP, Sciarra A, Palma E, Caponera M, Sciarra F. Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertrophy patients. Eur Urol. 1992;21(4):309-14. 11. Engelmann U, Walther C, Bondarenko B, Funk P, Schläfke S. Efficacy and safety of a combination of sabal and urtica extract in lower urinary tract symptoms. A randomized, double-blind study versus tamsulosin. Arzneimittelforschung. 2006;56(3):222-9. 12. Giannakopoulos X, Baltogiannis D, Giannakis D, Tasos A, Sofikitis N, Charalabopoulos K, Evangelou A. The lipidosterolic extract of Serenoa repens in the treatment of benign prostatic hyperplasia: a comparison of two dosage regimens. Adv Ther. 2002 Nov-Dec;19(6):285-96. 13. Giulianelli R, Pecoraro S, Sepe G, Leonardi R, Gentile BC, Albanesi L, Brunori S, Mavilla L, Pisanti F, Giannella R, Morello P, Tuzzolo D, Coscione M, Galasso F, D'Angelo T, Ferravante P, Morelli E, Miragliuolo A; Cooperative Ur.O.P Group. Multicentre study on the efficacy and tolerability of an extract of Serenoa repens in patients with chronic benign prostate conditions associated with inflammation. Arch Ital Urol Androl. 2012 Jun;84(2):94-8. 14. Grasso M, Montesano A, Buonaguidi A, Castelli M, Lania C, Rigatti P, Rocco F, Cesana BM, Borghi C. Comparative effects of alfuzosin versus Serenoa repens in the treatment of symptomatic benign prostatic hyperplasia. Arch Esp Urol. 1995 Jan-Feb;48(1):97-103. 15. Helfand BT, Lee JY, Sharp V, Foster H, Naslund M, Williams OD, McVary KT; CAMUS Study Group. Associations between improvements in lower urinary tract symptoms and sleep disturbance over time in the CAMUS trial. J Urol. 2012 Dec;188(6):2288-93. 16. Hizli F, Uygur MC. A prospective study of the efficacy of Serenoa repens, tamsulosin, and Serenoa repens plus tamsulosin treatment for patients with benign prostate hyperplasia. Int Urol Nephrol. 2007;39(3):879-86. 17. Hutchison A, Farmer R, Verhamme K, Berges R, Navarrete RV. The efficacy of drugs for the treatment of LUTS/BPH, a study in 6 European countries. Eur Urol. 2007 Jan;51(1):207-15; discussion 215-6. 18. Marks LS, Hess DL, Dorey FJ, Luz Macairan M, Cruz Santos PB, Tyler VE. Tissue effects of saw palmetto and finasteride: use of biopsy cores for in situ quantification of prostatic androgens. Urology. 2001 May;57(5):999-1005. 19. Marks LS, Partin AW, Epstein JI, Tyler VE, Simon I, Macairan ML, Chan TL, Dorey FJ, Garris JB, Veltri RW, Santos PB, Stonebrook KA, deKernion JB. Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. J Urol. 2000 May;163(5):1451-6. 20. Morgia G, Cimino S, Favilla V, Russo GI, Squadrito F, Mucciardi G, Masieri L, Minutoli L, Grosso G, Castelli T. Effects of Serenoa repens, selenium and lycopene (Profluss®) on chronic inflammation associated with benign prostatic hyperplasia: results of "FLOG" (Flogosis and Profluss in Prostatic and Genital Disease), a multicentre Italian study. Int Braz J Urol. 2013 Mar-Apr;39(2):214-21. 21. Preuss HG, Marcusen C, Regan J, Klimberg IW, Welebir TA, Jones WA. Randomized trial of a combination of natural products (cernitin, saw palmetto, B-sitosterol, vitamin E) on symptoms of benign prostatic hyperplasia (BPH). Int Urol Nephrol. 2001;33(2):217-25. 22. Pytel YA, Vinarov A, Lopatkin N, Sivkov A, Gorilovsky L, Raynaud JP. Long-term clinical and biologic effects of the lipidosterolic extract of Serenoa repens in patients with symptomatic benign prostatic hyperplasia. Adv Ther. 2002 Nov-Dec;19(6):297-306. 23. Reece Smith H, Memon A, Smart CJ, Dewbury K. The value of permixon in benign prostatic hypertrophy. Br J Urol. 1986 Feb;58(1):36-40. 24. Romics I, Schmitz H, Frang D. Experience in treating benign prostatic hypertrophy with Sabal serrulata for one year. Int Urol Nephrol. 1993;25(6):565-9. 25. Sökeland J. Combined sabal and urtica extract compared with finasteride in men with benign prostatic hyperplasia: analysis of prostate volume and therapeutic outcome. BJU Int. 2000 Sep;86(4):439-42. 26. Stepanov VN, Siniakova LA, Sarrazin B, Raynaud JP. Efficacy and tolerability of the lipidosterolic extract of Serenoa repens (Permixon) in benign prostatic hyperplasia: a double-blind comparison of two dosage regimens. Adv Ther. 1999 Sep-Oct;16(5):231-41. 27. Strauch G, Perles P, Vergult G, Gabriel M, Gibelin B, Cummings S, Malbecq W, Malice MP. Comparison of finasteride (Proscar) and Serenoa repens (Permixon) in the inhibition of 5-alpha reductase in healthy male volunteers. Eur Urol. 1994;26(3):247-52. 28. Suter A, Saller R, Riedi E, Heinrich M. Improving BPH symptoms and sexual dysfunctions with a saw palmetto preparation? Results from a pilot trial. Phytother Res. 2013 Feb;27(2):218-26. 29. Vela-Navarrete R, Garcia Cardoso JV, Barat A, Manzarbeitia F, López Farré A. BPH and inflammation: pharmacological effects of Permixon on histological and molecular inflammatory markers. Results of a double blind pilot clinical assay. Eur Urol. 2003 Nov;44(5):549-55. 30. Vela-Navarrete R, Escribano-Burgos M, Farré AL, García-Cardoso J, Manzarbeitia F, Carrasco C. Serenoa repens treatment modifies bax/bcl-2 index expression and caspase-3 activity in prostatic tissue from patients with benign prostatic hyperplasia. J Urol. 2005 Feb;173(2):507-10. 31. Veltri RW, Marks LS, Miller MC, Bales WD, Fan J, Macairan ML, Epstein JI, Partin AW. Saw palmetto alters nuclear measurements reflecting DNA content in men with symptomatic BPH: evidence for a possible molecular mechanism. Urology. 2002 Oct;60(4):617-22. 32. Weisser H, Behnke B, Helpap B, Bach D, Krieg M. Enzyme activities in tissue of human benign prostatic hyperplasia after three months' treatment with the Sabal serrulata extract IDS 89 (Strogen) or placebo. Eur Urol. 1997;31(1):97-101. 33. Willetts KE, Clements MS, Champion S, Ehsman S, Eden JA. Serenoa repens extract for benign prostate hyperplasia: a randomized controlled trial. BJU Int. 2003 Aug;92(3):267-70. 34. Argirović A, Argirović D. Does the addition of Serenoa repens to tamsulosin improve its therapeutical efficacy in benign prostatic hyperplasia? Vojnosanit Pregl. 2013 Dec;70(12):1091-6. 35. Barry MJ, Meleth S, Lee JY, Kreder KJ, Avins AL, Nickel JC, Roehrborn CG, Crawford ED, Foster HE Jr, Kaplan SA, McCullough A, Andriole GL, Naslund MJ, Williams OD, Kusek JW, Meyers CM, Betz JM, Cantor A, McVary KT; Complementary and Alternative Medicine for Urological Symptoms (CAMUS) Study Group. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011 Sep 28;306(12):1344-51. 36. Bercovich E, Saccomanni M. Analysis of the results obtained with a new phytotherapeutic association for LUTS versus control. Urologia. 2010 Jul-Sep;77(3):180-6. Erratum in: Urologia. 2010 Oct-Dec;77(4):287. 37. Debruyne F, Boyle P, Calais Da Silva F, Gillenwater JG, Hamdy FC, Perrin P, Teillac P, Vela-Navarrete R, Raynaud JP, Schulman CC. Evaluation of the clinical benefit of permixon and tamsulosin in severe BPH patients-PERMAL study subset analysis. Eur Urol. 2004 Jun;45(6):773-9; disucssion 779-80. 38. Djavan B, Fong YK, Chaudry A, Reissigl A, Anagnostou T, Bagheri F, Waldert M, Fajkovic H, Marihart S, Harik M, Spaller S, Remzi M. Progression delay in men with mild symptoms of bladder outlet obstruction: a comparative study of phytotherapy and watchful waiting. World J Urol. 2005 Sep;23(4):253-6. 39. Engelmann U, Walther C, Bondarenko B, Funk P, Schläfke S. Efficacy and safety of a combination of sabal and urtica extract in lower urinary tract symptoms. A randomized, double-blind study versus tamsulosin. Arzneimittelforschung. 2006;56(3):222-9. 40. Gerber GS, Kuznetsov D, Johnson BC, Burstein JD. Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology. 2001 Dec;58(6):960-4; discussion 964-5. 41. Gerber GS, Zagaja GP, Bales GT, Chodak GW, Contreras BA. Saw palmetto (Serenoa repens) in men with lower urinary tract symptoms: effects on urodynamic parameters and voiding symptoms. Urology. 1998 Jun;51(6):1003-7. 42. Giannakopoulos X, Baltogiannis D, Giannakis D, Tasos A, Sofikitis N, Charalabopoulos K, Evangelou A. The lipidosterolic extract of Serenoa repens in the treatment of benign prostatic hyperplasia: a comparison of two dosage regimens. Adv Ther. 2002 Nov-Dec;19(6):285-96. 43. Giulianelli R, Pecoraro S, Sepe G, Leonardi R, Gentile BC, Albanesi L, Brunori S, Mavilla L, Pisanti F, Giannella R, Morello P, Tuzzolo D, Coscione M, Galasso F, D'Angelo T, Ferravante P, Morelli E, Miragliuolo A; Cooperative Ur.O.P Group. Multicentre study on the efficacy and tolerability of an extract of Serenoa repens in patients with chronic benign prostate conditions associated with inflammation. Arch Ital Urol Androl. 2012 Jun;84(2):94-8. 44. Hutchison A, Farmer R, Verhamme K, Berges R, Navarrete RV. The efficacy of drugs for the treatment of LUTS/BPH, a study in 6 European countries. Eur Urol. 2007 Jan;51(1):207-15; discussion 215-6. 45. Lopatkin N, Sivkov A, Schläfke S, Funk P, Medvedev A, Engelmann U. Efficacy and safety of a combination of Sabal and Urtica extract in lower urinary tract symptoms--long-term follow-up of a placebo-controlled, double-blind, multicenter trial. Int Urol Nephrol. 2007;39(4):1137-46. 46. Lopatkin N, Sivkov A, Walther C, Schläfke S, Medvedev A, Avdeichuk J, Golubev G, Melnik K, Elenberger N, Engelmann U. Long-term efficacy and safety of a combination of sabal and urtica extract for lower urinary tract symptoms--a placebo-controlled, double-blind, multicenter trial. World J Urol. 2005 Jun;23(2):139-46. 47. Prager N, Bickett K, French N, Marcovici G. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. J Altern Complement Med. 2002 Apr;8(2):143-52. Erratum in: J Altern Complement Med. 2006 Mar;12(2):199. 48. Rossi A, Mari E, Scarno M, Garelli V, Maxia C, Scali E, Iorio A, Carlesimo M. Comparitive effectiveness of finasteride vs Serenoa repens in male androgenetic alopecia: a two-year study. Int J Immunopathol Pharmacol. 2012 Oct-Dec;25(4):1167-73. 49. Cai T, Mazzoli S, Bechi A, Addonisio P, Mondaini N, Pagliai RC, Bartoletti R. Serenoa repens associated with Urtica dioica (ProstaMEV) and curcumin and quercitin (FlogMEV) extracts are able to improve the efficacy of prulifloxacin in bacterial prostatitis patients: results from a prospective randomised study. Int J Antimicrob Agents. 2009 Jun;33(6):549-53. 50. Kaplan SA, Volpe MA, Te AE. A prospective, 1-year trial using saw palmetto versus finasteride in the treatment of category III prostatitis/chronic pelvic pain syndrome. J Urol. 2004 Jan;171(1):284-8. 51. Morgia G, Mucciardi G, Galì A, Madonia M, Marchese F, Di Benedetto A, Romano G, Bonvissuto G, Castelli T, Macchione L, Magno C. Treatment of chronic prostatitis/chronic pelvic pain syndrome category IIIA with Serenoa repens plus selenium and lycopene (Profluss) versus S. repens alone: an Italian randomized multicenter-controlled study. Urol Int. 2010;84(4):400-6. 52. Dobrev H. Clinical and instrumental study of the efficacy of a new sebum control cream. J Cosmet Dermatol. 2007 Jun;6(2):113-8. 53. Brown GA, Vukovich MD, Reifenrath TA, Uhl NL, Parsons KA, Sharp RL, King DS. Effects of anabolic precursors on serum testosterone concentrations and adaptations to resistance training in young men. Int J Sport Nutr Exerc Metab. 2000 Sep;10(3):340-59. 54. Agbabiaka TB, Pittler MH, Wider B, Ernst E. Serenoa repens (saw palmetto): a systematic review of adverse events. Drug Saf. 2009;32(8):637-47. 55. Cheema P, El-Mefty O, Jazieh AR. Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature. J Intern Med. 2001 Aug;250(2):167-9. 56. DerMarderosian A, Beutler JA. The review of natural products: the most complete source of natural product information. 7th ed. St. Louis, MO, USA: Wolters Kluwer Health; 2012. 57. Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Ann Intern Med. 2002 Jan 1;136(1):42-53. 58. Fetrow CW, Avila JR. The complete guide to herbal medicines. Spring House, PA, USA: Springhouse Corporation; 2000. 59. Gruenwald J, Brendler T, Jaenicke C, editors. PDR for herbal medicines. 4th ed. Montvale, NJ, USA: Thomson Healthcare; 2007. 60. Jibrin I, Erinle A, Saidi A, Aliyu ZY. Saw palmetto-induced pancreatitis. South Med J. 2006 Jun;99(6):611-2. 61. Miroddi M, Carnì A, Mannucci C, Moleti M, Navarra M, Calapai G. Hot flashes in a young girl: a wake-up call concerning Serenoa repens use in children. Pediatrics. 2012 Nov;130(5):e1374-6. 62. Sinclair RD, Mallari RS, Tate B. Sensitization to saw palmetto and minoxidil in separate topical extemporaneous treatments for androgenetic alopecia. Australas J Dermatol. 2002 Nov;43(4):311-2. 63. Tsai HH, Lin HW, Simon Pickard A, Tsai HY, Mahady GB. Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: a systematic literature review. Int J Clin Pract. 2012 Nov;66(11):1056-78. 64. Villanueva S, González J. Coagulopathy induced by saw palmetto: a case report. Bol Asoc Med P R. 2009 Jul-Sep;101(3):48-50. 65. Wargo KA, Allman E, Ibrahim F. A possible case of saw palmetto-induced pancreatitis. South Med J. 2010 Jul;103(7):683-5. 66. Agbabiaka TB, Pittler MH, Wider B, Ernst E. Serenoa repens (saw palmetto): a systematic review of adverse events. Drug Saf. 2009;32(8):637-47. 67. DerMarderosian A, Beutler JA. The review of natural products: the most complete source of natural product information. 7th ed. St. Louis, MO, USA: Wolters Kluwer Health; 2012. 68. Fetrow CW, Avila JR. The complete guide to herbal medicines. Spring House, PA, USA: Springhouse Corporation; 2000. 69. Gruenwald J, Brendler T, Jaenicke C, editors. PDR for herbal medicines. 4th ed. Montvale, NJ, USA: Thomson Healthcare; 2007. 70. Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: a systematic review. Drugs. 2001;61(15):2163-75. 71. Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs. 2009;69(13):1777-98. 72. Afendi FM, Okada T, Yamazaki M, Hirai-Morita A, Nakamura Y, Nakamura K, Ikeda S, Takahashi H, Altaf-Ul-Amin M, Darusman LK, Saito K, Kanaya S. KNApSAcK family databases: integrated metabolite-plant species databases for multifaceted plant research. Plant Cell Physiol. 2012 Feb;53(2):e1.