Saw Palmetto

Saw Palmetto

• Saw palmetto (Serenoa repens) is a small palm tree native to the United States that has been used to treat issues related to male and female reproductive organs.

• The part of the plant that is considered active would be the free fatty acids and sterols. Its proposed mechanism of action is that it inhibits 5-alpha-reductase; this decreased the conversion of testosterone to DHT.

• Some studies suggest that it may decrease inflammation by minimizing prostaglandin and leukotriene production.

Dosage:

• The dosage of saw palmetto used in studies is 160 mg twice a day or 320 mg once a day of which 80-90% should contain the volatile oil. Limited data is available for use in children and during pregnancy.

• The main uses of saw palmetto are discussed below:

• Benign prostate hyperplasia (BPH): The most common use of saw palmetto is to treat the symptoms of BPH including diminished stream, post-void dribbling, overflow incontinence, and urinary retention. A meta-analysis initially published in 2002 showed that saw palmetto compared to placebo did improve the symptoms of BPH as measured by the International Prostate Symptom Score.

• However, an update to the meta-analysis published in 2009 that included nine new trials showed that it did not improve symptoms compared to placebo. In 2012, two other new long-term trials included in the meta-analysis supported the second conclusion that saw palmetto compared to placebo did not improve symptoms.

• Alopecia: A systematic review published in 2020 did show some evidence that saw palmetto may benefit patients with androgenic alopecia and telogen effluvium.

• Some other limited data does show that saw palmetto can promote urination and show anti-inflammatory effects, but there is insufficient data to support its clinical use.

Safety:

• Saw palmetto is thought to be safe. Its main side effects are mild but include gastrointestinal distress, headaches, rhinitis, and fatigue. Saw palmetto does not falsely lower PSA levels. Some case reports have reported hot flashes in young girls, acute pancreatitis, liver damage, coagulopathy, and prolonged bleeding time.

Medication Interactions:

• Saw palmetto can inhibit the CYP 450 system so it can potentially effect with Warfarin, Clopidogrel, and aspirin. It is recommended to not use simultaneously with finasteride.