Serenoa Repens

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Contents 1 Introduction 2 Uses 3 Contraindications 4 Dosage 5 Pharmacokinetics 6 Adverse-effects 7 Drug-interactions 8 Mechanism-of-action 9 More General Terms 10 Additional Terms 11 References

Introduction

• The dwarf palm tree grows along the southeastern coast of the US (South Carolina to Florida). Saw palmetto berries are harvested in the Fall & winter.

Uses

• Traditional use:
• urethral obstruction (5th century BC, Egypt)
• appetite stimulant
• male infertility
• sex hormone disorders

• Current use:

• relief of obstructive symptoms of BPH

• not useful to possibly effective [7,8,9]

• mild diuretic
• urinary antiseptic

Contraindications

• NOT for use in women

Dosage

• 160 mg BID with food ( lipophilic extract)
• therapeutic benefits NOT available from tea

• Active ingredients:

• 95% EtOH or n- hexane extracts of saw palmetto berries contain 85-95% fatty acids, long chain alcohols & esterified sterols
• specific active ingredient(s) unknown

Pharmacokinetics

• plasma levels peak in 1.5 hours, 1/2 life is 19 hours
• maximum benefits may not be achieved for 13-16 weeks

Adverse-effects

• generally well tolerated up to 6 months
• GI upset: nausea, vomiting, diarrhea at higher doses
• increased blood pressure (3%)
• headache (3%)
• dizziness
• urinary retention
• decreased libido, impotence, erectile dysfunction (1.5-2.2%)

Drug-interactions

• finasteride & alpha1- adrenergic agonists ? [10]
• patients taking diuretics, alpha blockers & anticoagulants have been eliminated from studies
• avoid concomitant hormonal therapies

Mechanism-of-action

• unknown
• theories

• inhibition of 5-alpha reductase type 1 activity

• ( finasteride inhibits type 2)
• no effect on PSA

• inhibits or down regulates estrogen & androgen receptors

• reduces symptoms of BPH without diminishing prostate enlargement (possibly effective) [8]
• even high doses no more effective than placebo [9]

More General Terms

• pharmaceutical herb (medicinal herb)

Additional Terms

• benign prostatic hyperplasia (BPH)
• finasteride (Proscar, Propecia)
• kallikrein-3, prostate-specific antigen (PSA), semenogelase, seminin, gamma-seminoprotein or protein E1

References

1. Victoria Rand, UCSF Fresno Lecture
2. Lowe et al Urology 48(1):12-20 1996
3. Carraro et al, The Prostate 29:231-240 1996
4. Plosker & Brogden, Drugs & Aging 9(5):379-395 1996
5. Kaiser Permanente, Northern California Regional Pharmacy & Therapeutics Committee
6. Prescriber's Letter 9(7):42 2002
7. Bent S et al, Saw palmetto for benign prostatic hyperplasia. N Engl J Med 2006, 354:557 PMID: [1]
   - Prescriber's Letter 13(3): 2006 Special Report: Natural Medicines in Clinical Management of Benign Prostatic Hyperplasia Detail-Document#: [2] (subscription needed) [3]
8. Prescriber's Letter 17(3): 2010 Natural Medicines in the Clinical Management of Benign Prostatic Hyperplasia Detail-Document#: [4] (subscription needed) [5]
9. Barry MJ et al Effect of Increasing Doses of Saw Palmetto Extract on Lower Urinary Tract Symptoms JAMA. 2011;306(12):1344-1351 <PubMed> PMID: [6] <Internet> [7]
10. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society

Serenoa repens (Saw palmetto, Permixon)