Saw Palmetto
Serenoa Repens
Trade Names
Saw Palmetto (available from numerous manufacturers), Saw Palmetto Berries, Saw Palmetto Standardized, Centrum Saw Palmetto, Proactive Saw Palmetto, Standardized Saw Palmetto ExtractCap, Saw Palmetto Extract, Saw Palmetto Power, Premium Blend Saw Palmetto, Herbal Sure Saw Palmetto, Quanterra Prostate, Super Saw Palmetto Plus
Description
Medicinal Parts: The medicinal parts are the partially dried ripe fruit, the ripe fresh fruit and the ripe dried fruit.
Flower and Fruit: The inconspicuous cream flowers are in short, densely pubescent, paniculately branched inflorescences. The fruit is deep purple to almost black. It is an ovate, 3 cm long, 1-seeded berry. It has a hard but fragile pericarp that covers a pale brown, spongy pulp. The endocarp is thin and papery. The fruit is slightly wrinkled, 1.25 to 2.5 cm long and 1.25 cm in diameter. The hard seed is pale brown, oval or globular, and has a hilum near the base. The whole panicle can weigh up to 4 kg.
Leaves, Stem and Root: The plant is a bushy palm with a maximum height of 6 m. The large, yellow-green leaves have up to 20 segments and form a crown.
Characteristics: The taste of the seeds is soapy and unpleasant.
Habitat: The plant is indigenous to the coastal regions of the southern states of the U.S., from South Carolina to Florida and southern California.
Other Names: Sabal, Shrub Palmetto
ACTIONS AND PHARMACOLOGY
COMPOUNDS
Steroids: Sterols, including beta-sitosterol, beta-sitosterol-3-O-glucosides, beta-sitosterol-3-O-diglucoside, beta-sitosterol-fatty acid esters and their glucosides, for example beta-sitosterol-3-O-myristate, beta-sistosterol-3-O-(6-O-myristly-beta-glucosides)
Flavonoids: including isoquercitrin, kaempferol-3-O-glucosides, rhoifolin
Water-soluble polysaccharides (galactoarabane with uronic acid)
Fatty oil: free fatty acids
The lipophilic components (fatty oil with phytosterines) can be found in ethanolic and hexane-extracts. The anti-exudative components (polysaccharides) are found in aqueous extracts. Ethanolic extracts contain both component groups.
EFFECTS
Anti-Androgenic Effects
The lipophilic extract of the herb inhibits binding of dihydrotestosterone (DHT) to the cytosolic androgenic receptor and alpha1-adrenoceptor in the prostate, thus preventing accumulation of the steroid, which may lead to prostate hyperplasia (Carilla, 1984; Goepel, 1999). Anti-androgenic effects of the lipophilic extract also consist of 5-alpha-reductase and 3- ketosteroid reductase inhibition. These enzymes are responsible for the conversion of testosterone to DHT and for conversion of DHT to an androgen compound, respectively (Sultan, 1984).
Anti-Estrogenic Effects
The herb lowers cytosol and nuclear receptor values for estrogen which result in an anti-estrogen effect since progesterone receptor content is linked to estrogenic activity. Anti-estrogenic agents inhibit stromatic prostate mass growth in patients with benign prostate hypertrophy (DiSilverio, 1992). There is also some evidence with inhibition of several steps involved in prolactin receptor signal transduction in ovary cells (Vacher, 1995).
Anti-Inflammatory Effects
The hexane extracts of the herb have demonstrated anti-inflammatory activity (Champault, 1984). Inhibition of the synthesis of arachidonic acid inflammatory metobolits, throuhg a double blocking of cyclooxygenas and 5-lipoxy-genase pathways results in anti-inflammatory properties. (Breu, 1992). The drug also contains anti-spasmodic properties by inhibiting calcium influx and activation of the sodium/calcium ion exchanger. Induction of protein synthesis plays a role in the antispasmotic effect with cyclic AMP as a possible mediator. Extracts of the drug may also antagonize the contracting effect of acetylcholine on urinary bladders. (Gutierrez, 1996).
CLINICAL TRIALS
Benign Prostatic Hyperplasis
The effect of Saw Palmetto on voiding symptoms and urodynamic parameters was determined in men with lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH). The study was conducted over a 6-month period with Saw Palmetto 160 mg given twice daily. Parameters evaluated included peak urinary flow rate, postvoid residual urine volume, pressure-flow study and serum prostate-specific antigen. The herb was well-tolerated and significantly improved urinary tract symptoms. There was no significant improvement in objective measures of bladder outlet obstruction (Gerber, 1998).
A 6-month, double-blind, randomized equivalence study was conducted to compare the effects of a Saw Palmetto extract (320 mg Permixon) with those of a 5 alpha-reductase inhibitor (5 mg finasteride). The study included 1098 men with moderate benign prostate hypertrophy (BPH) using the International Prostate Symptom Score (IPSS) as the primary end-point. The finasteride and Permixon treatment groups relieved the symptoms of BPH including a decrease in IPSS, improved quality of life and increased peak urinary flow rate. There was no statistical difference in improvement between the two treatment groups. Finasteride markedly decreased serum PSA levels and prostate volume while Permixon had little effect on androgen-dependent parameters. This conclusion suggests that other pathways might also be involved in the sumptomatology of BPH (Carraro, 1996).
Serenoa repens given 160 mg twic daily was compared to alfuzosin 2.5 mg three times daily to determine the effect on 63 benign prostatic hyperplasia. The double-blind, comparative, parallel-groups study determined efficacy by assessment of clinical symptoms (Boyarsky's nscale, visual analogue scale, clinical global impression), urinary flow rates (uroflowmetry) and residual urinary volume (transabdominal ultrasound). The Serenoa repens treatment group had similar improvement to that of the alfuzosin treatment group, but significant effects were in favor of the alfuzosin treatment group with overall impression and visual analogue scale (Grasso, 1995).
INDICATIONS AND USAGE
Approved by Commission E:
Saw Palmetto is used for urination problems in benign prostate hyperplasia stages I and II. This medication relieves only the difficulties associated with an enlarged prostate without reducing the enlargement.
Unproven Uses: In folk medicine, Saw Palmetto is used for inflammation of the urinary tract, bladder, testicles and mammary glands. It has been used for nocturnal enuresis, persistant cough, eczema and improvement of libido.
Homeopathic Uses: The herb is used for micturation problems and inflammation of the urinary tract.
PRECAUTIONS AND ADVERSE REACTIONS
No health hazards or side effects are known in conjunction with the proper administration of designated therapeutic dosages. Stomach complaints following intake have been observed in rare cases. Patients with hormone-dependent cancers should observe caution and speak to a physician regarding the use of Saw Palmetto because of its anti-estrogenic, estrogenic and ant-androgenic effects. The use of Saw Palmetto with pregnancy and breast feeding is not recommended due to its potential hormonal effects.
Drug Interactions: Saw Palmetto is believed to exert estrogen, androgen and alpha-adrenergic blocking effects. Because of this, the use of hormones, hormone-like drugs or adrenegic drugs concomitantly may need to be adjusted.
DOSAGE
Mode of Administration: Comminuted herb and other galenic preparations for oral use.
How Supplied:
Capsule -- 80 mg, 125 mg, 160 mg, 227 mg, 250 mg, 320 mg, 450 mg, 500 mg, 565 mg, 570 mg, 585 mg, 600 mg, 1000 mg
Liquid -- 1:1
Daily Dosage: The average daily dose is 1 to 2 gm of the drug or 320 mg of the lipophilic (hexane or ethanol 90% v/v). Dosages used in studies demonstrated efficacy at 160 mg given twice daily or 320 mg given once daily (Carraro, 1996; Gerber, 1998, Grasso, 1995).
LITERATURE
| Anonym, Welche Bedeutung haben pflanzliche Prostatamittel. In: DAZ 133(9):720. 1993. |
Aso Y, Boccon-Gibob L, Brendler CB et al. (1993) Clinical research criteria. In: Cockett AT, Aso Y, Chatelain C, Denis L, Griffith K, Murphy G (eds.), Proceedings of the second international consultation on benign prostatic hyperplasia (BPH). Paris, SCI S. 345-355. |
| Bach D, (1995) MedikamentÖse Langheitbehandlung der BPH Ergebnisse einer prospektiven 3-Jahres-Studie mit dem Sabalextrakt IDS 89. Urologe [B]35:178-183 | Bach D, Behandlung der benignen Prostatahypertrophie. In: ZPT 17(4):209-218. 1996 |
| Bach D, Ebeling L, Long-term drug treatment of benign prostatic hyperplasia - Results of a prospective 3-year multicenter study using Sabal extract IDS 89. In: Phytomedicine 3(2):105-111. 1996. |
Bauer R, Neues von "immunmodulierenden Drogen" und "Drogen mit antiallergischer und antiinflammatorischer Wirkung". In: ZPT 14(1):23-24. 1993 |
| Bazan NG, Authie D, Braquet P, Effect of Serenoa repens extract (Permixon (r)) on estradiol/testosteron-induced experimental prostate enlargement in the rat. In: Pharmacol Res 34(3/4):171-179. 1996 |
Becker H, Ebeling L, (1988) Konservative Therapie der benignen Prostata-Hyperplasie (BPH) mit Cernilton (N) - Ergebnisse einer placebokontrollierten Doppelblindstudie. Urologe [B]28:301. |
| Becker H. Ebeling L, (1991) Phytotherapie der BPH mit Cernilton(N) - Ergebnisse einer kontrollierten Verlaufsstudie. Urologe [B]31:113. | Berges RR, Windeler J, Trampisch HJ, Senge TH, (1995) Randomised, placebo-controlled, double-blind clinical trial of ß-sitosterol in patients with benign prostatic hyperplasia. Lancet 345:1529-1532. |
| Breu W, Hagenlocher M, Redl K et al., Antiphlogistische Wirkung eines mit hyperkritischem Kohlendioxid gewonnenen Sabalfrucht-Extraktes. In vitro Hemmung des Cyclooxygenase-und 5-Lipoxygenase-Metabolismus. Arzneimittelforschung 1992;42-547. | Breu W, Stadler F, Hagenlocher M et al., Der Sabalfrucht-Extrakt SG 292. Ein Phytotherapeutikum zur Behandlung der benignen Prostatahyperplasie. Z Phytother 1992; 13:107-115. |
| Carraro JC et al., Comparision of phytotherapy (Permixon (R)) with finasteride in the treatment of benign prostate hyperplasis: a randomized international study of 1,098 | Carilla E, Briley M, Fauran F et al., Binding of Permixon(R), a new treatment for prostatic benign hyperplasia, to the cytosolic androgen receptor in rat prostate. J Steroid Biochem 1984; 20:521-523. |
| Carraro J, Raynaud J, Koch G et al., 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. | Casarosa C, Cosci M, o di Coscio, Fratta M, (1988) Lack of effects of a lyposterolic extract of Serenoa repens on plasma levels of testosterone, follicle-stimulating hormone, luteinizing hormone. Clin Ther 10:5. |
| DiSilvero F, D'Eramo GD, Lubrano C et al., Evidence that Serenoa repens extract displays an anti-estrogenic activity in prostatic tissue of benign prostatic hypertrophy patients. Eur urol 1992: 21:309. | DiSilvero F, D'Eramo G, Flammia GP et al., Pharmacological combinations in the treatment of benign prostatic hypertrophy. J Urol (Paris) 1993a: 99:316-320. |
| Engelmann U, Phytopharmaka und Synthetika bei der Behandlung der benignen Prostatahypertrophie. In: ZPT 18(1):13-19. 1997 |
Gerber GS, Zagaja GP, Bales GT, et al., 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. |
| Goepel M, Hecker U, Krege S et al., Saw Palmetto extracts potently and noncompetitively inhibit human alpha1-adrenoceptors in vitro. Prostate 1999 Feb 15:38(3):208-15. | Guieterrez M, Garcia De Boto MJ, Cantabrana B et al., Mechanisms involved in the spasmolytic effect of extracts from Sabal serrulata fruit on smooth muscle. Gen Pharmacol 1996; 27:171-176. |
| Grasso M, Montesano A, Buonaguidi A et al., 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. | Guiterrez M, Hidalgo A & Cantabrana B, Spasmolytic activity of a lipidic extract from Sabal serrulata fruits further study of the mechanism underlying this activity. Planta Med 1996; 62:507-511. |
| Hänsel R et al., (1964) Planta Med 12:169. | Harnischfeger G, Stolze H, (1989) Serenoa repens - Die Sägezahnpalme. Z Phytother 10:71-76. |
| Koch E, (1995) Pharmakologie und Wirkmechanismen von Extrakten aus Sabalfrüchten (Sabal fructus); Brennesselwurzeln (Urticae radix) und Küurbissamen (Cucurbitae peponis semen) bei der Behandlung der benignen Prostatahyperplasie. In: Loew D, Rietbrock N (Hrsg) Phytopharmaka in Forschung und klinischer Anwendung. Steinkopff Verlag, Darmstadt, S 57-79. |
Mattei FM, Capone M, Acconia A, Medikamentöse Therapie der benignen Prostatahyperplasie mit einem Exktrakt der Sägepalme. In: Therapiewoche Urologie, Nephrologie 2:346-350. 1990. |
| Miersch WDE, Benigne Prostatahyperplasie. In: DAZ 133(29):2653. 1993. |
Nahrstedt A, (1993) Pflanzliche Urologica - eine kritische Übersicht. PharmZ 138:1439-1450. |
| Niederprüm HJ, Schweikert HU, Zänker KS, (1994) Testosteron 5D-reductase inhibition by free fatty acids from Sabal serrulata fruits. Phytomedicine 1:127-133. | Plosker GL, Brogden RN, Serenoa repens (Permixon (R)): A review of its pharmacological and therapeutic efficacy in benign prostatic hyperplasia. In: Drugs & Aging 9(5):379-395. 1996. |
| Revenna L et al., Effects of the lipidosterolic extract of Serenoa repens (Permixon (R)) on human prostatic cell lines. In: Prostate 29(4):219-230. 1996. |
Rhodes L, Primka RL, Berman CH, Vergult F, Gabriel M, Pierre-Malice M, Gibelin B, Comparision of Finasteride (Proscar(R)), a 5alpha-reductase inhibitor, and various commercial plant extras in in vitrol and in vivo 5alpha reductase inhibition. In: Prostate. |
| Schilcher H, (1987) Möglichkeiten und Grenzen der Phytotherapie am Beispiel pflanzlicher Urologika. Urologe [B]27:316-319. | Schilcher H, (1987) Pflanzliche Diuretika. Urologe [B]27:215-222. |
| Schilcher B, In: Schilcher H: Phytotherapie in der Urologie. Hippokrates Verlag Stuffgart. 1992. | Shimada H et al. Biological active acylglycerides from the berries of Saw Palmetto (Serenoa repens). In: JNP 60(4):417-418. 1997. |
| Sultan C, Terraza A, Devillier C et al., Inhibition of androgen metabolism and binding by a liposterolic extract of 'Serenoa repens B' in human foreskin fibroblasts. J Steroid Biochem 1984; 20:515-519. | Vacher P, Prevarskaya N, Skryma R et al., The lipidosterolic extract from Serenoa repens interferes with prolactin receptor signal transduction. J Biomed Sci 1995; 2:357-365. |
| Wagner H, Flachsbarth H, (1981) Planta Med 41:244. | Wichtl M, Pflanzliche Geriatrika. In: DAZ 132(30):1576. 1992. |
Further information in:
| Hänsel R, Keller K, Rimpler H, Schneider G (Hrsg.), Hagers Handbuch der Pharmazeutischen Praxis, 5. Aufl., Bde 4-6 (Drogen): Springer Verlag Berlin, Heidelberg, New York, 1992-1994. | Madaus G, Lehrbuch der Beiologischen Arzneimittel, Bde 1-3, Nachdruck, Georg Olms Verlag Hildesheim 1979. |
| Schulz R, Hänsel R, Rationale Phytotherapie, Springer Verlag Heidelberg 1996. | Teuscher E, Biogene Arzneimittel, 5. Aufl., Wiss. Verlagsges. Stuttgart 1997. |
| Wagner H, Wiesenauer M, Phytotherapie. Phytopharmaka und pflanzliche Homöopathika, Fischer-Verlag, Stuttgart, Jena, New York 1995. |