Serenoa repens (Saw palmetto, Permixon)
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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
- mild diuretic
- urinary antiseptic
* does not appear to be more effective than placebo[13]
Contraindications
NOT for use in women
Dosage
- 160 mg BID with food (lipophilic extract)
- therapeutic benefits NOT available from tea
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, constipation[11] at higher doses
- increased blood pressure (3%)
- headache (3%)
- dizziness
- urinary retention
- decreased libido, impotence, erectile dysfunction (1.5-2.2%)
Drug interactions
- finasteride & alpha-1-adrenergic agonists ?[10]
- patients taking diuretics, alpha blockers & anticoagulants have been eliminated from studies
- avoid concomitant hormonal therapies
Mechanism of action
- active ingredients:
- theories
- inhibition of 5-alpha reductase type 1 activity
- (finasteride inhibits type 2)
- no effect on PSA
- inhibits or down regulates estrogen & androgen receptors
- inhibition of 5-alpha reductase type 1 activity
- reduces symptoms of BPH without diminishing prostate enlargement (possibly effective)[8]
- even high doses no more effective than placebo[9]
More general terms
Additional terms
Component of
References
- ↑ Victoria Rand, UCSF Fresno Lecture
- ↑ Lowe et al Urology 48(1):12-20 1996
- ↑ Carraro et al, The Prostate 29:231-240 1996
- ↑ Plosker & Brogden, Drugs & Aging 9(5):379-395 1996
- ↑ Kaiser Permanente, Northern California Regional Pharmacy & Therapeutics Committee
- ↑ Prescriber's Letter 9(7):42 2002
- ↑ 7.0 7.1 Bent S et al, Saw palmetto for benign prostatic hyperplasia. N Engl J Med 2006, 354:557 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16467543
Prescriber's Letter 13(3): 2006 Special Report: Natural Medicines in Clinical Management of Benign Prostatic Hyperplasia Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220305&pb=PRL (subscription needed) http://www.prescribersletter.com - ↑ 8.0 8.1 8.2 Prescriber's Letter 17(3): 2010 Natural Medicines in the Clinical Management of Benign Prostatic Hyperplasia Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260310&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 9.0 9.1 9.2 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: https://www.ncbi.nlm.nih.gov/pubmed/21954478 <Internet> http://jama.ama-assn.org/content/306/12/1344.abstract
- ↑ 10.0 10.1 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ 11.0 11.1 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ 12.0 12.1 Tacklind J, Macdonald R, Rutks I, Stanke JU, Wilt TJ. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2012 Dec 12;12:CD001423. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23235581
MacDonald R, Tacklind JW, Rutks I, Wilt TJ Serenoa repens monotherapy for benign prostatic hyperplasia (BPH): an updated Cochrane systematic review. BJU Int. 2012 Jun;109(12):1756-61. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22551330 - ↑ 13.0 13.1 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.