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Saw palmetto


What is it?

Saw palmetto is a plant. Its ripe fruit is used to make medicine.

Saw palmetto is best known for its use in decreasing symptoms of an enlarged prostate (benign prostatic hypertrophy, BPH). According to many research studies, it is effective for this use.

Saw palmetto is used for treating certain types of prostate infections. It is also sometimes used, in combination with other herbs, to treat prostate cancer.

Some people use saw palmetto for colds and coughs, sore throat, asthma, chronic bronchitis, chronic pelvic pain syndrome, and migraine headache. It is also used to increase urine flow (as a diuretic), to promote relaxation (as a sedative), and to enhance sexual drive (as an aphrodisiac).

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for SAW PALMETTO are as follows:

Possibly effective for...

  • Prostate surgery (transurethral resection of the prostate; TURP). Research shows that taking 320 mg of saw palmetto daily for 2 months before prostate surgery can reduce the time spent in surgery, blood loss, the development of problems during surgery, and the total time spent in the hospital. However, one small study found that taking 160 mg daily 5 weeks before surgery does not lower the risk of problems during surgery.

Possibly ineffective for...

  • Enlarged prostate (benign prostatic hyperplasia; BPH). There is conflicting and contradictory research about the benefits of saw palmetto for prostate symptoms. Some research has shown that saw palmetto might modestly improve symptoms such as going to the bathroom at night in some men with BPH. However, higher quality and more reliable research seems to indicate that saw palmetto has little or no benefit for reducing these symptoms. Any benefit is modest at best.

Insufficient evidence to rate effectiveness for...

  • Prostate swelling and chronic pelvic pain syndrome. Some early research found that saw palmetto can improve prostate swelling symptoms. Other early research found that taking saw palmetto, selenium, and lycopene, but not saw palmetto alone, can improve symptoms of prostate swelling and chronic pelvic pain syndrome. Taking certain herbal combinations containing saw palmetto seems to improve the effects of sparfloxacin or prulifloxacin in treating prostate swelling symptoms due to infection. However, saw palmetto doesn’t seem to improve prostate swelling symptoms not due to infection.
  • Prostate cancer. Research studies to date have found that taking saw palmetto doesn’t seem to prevent prostate cancer.
  • Baldness. Some men report that using saw palmetto with beta-sitosterol makes them grow more and better hair.
  • Bladder control (neurogenic bladder). Early research suggests that taking 90-120 drops of a combination of echinacea and saw palmetto for 77 days improves the amount of urine the bladder can hold and the amount left in the bladder after urination in women with neurogenic bladder.
  • Colds and coughs.
  • Sore throat.
  • Asthma.
  • Chronic bronchitis.
  • Migraine headache.
  • Increasing breast size.
  • Reducing bleeding after prostate surgery.
  • Other conditions.
More evidence is needed to rate the effectiveness of saw palmetto for these uses.

How does it work?

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Saw palmetto doesn’t shrink the overall size of the prostate, but it seems to shrink the inner lining that puts pressure on the tubes that carry urine.

Are there safety concerns?

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Saw palmetto is LIKELY SAFE for most people. Side effects are usually mild. Some people have reported dizziness, headache, nausea, vomiting, constipation, and diarrhea. Some people have reported that saw palmetto causes impotence. However, these side effects do not seem to occur any more often with saw palmetto than with a sugar pill.

There is some concern that saw palmetto might cause liver or pancreas problems in some people. There have been two reports of liver damage and one report of pancreas damage in people who took saw palmetto. However, there is not enough information to know if saw palmetto was the actual cause of these side effects.

Saw palmetto is POSSIBLY SAFE when administered into the rectum appropriately for up to 30 days. However, it is not known if it is safe to use for longer periods of time.

Special precautions & warnings:

Pregnancy and breast-feeding: Saw palmetto is LIKELY UNSAFE when used during pregnancy or breast-feeding. It acts like a hormone, and this could be dangerous to the pregnancy. Don’t use during pregnancy or breast-feeding.

Surgery: Saw palmetto might slow blood clotting. There is some concern that it might cause extra bleeding during and after surgery. Stop using saw palmetto at least 2 weeks before a scheduled surgery.

Are there interactions with medications?

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Moderate

Be cautious with this combination.

Birth control pills (Contraceptive drugs)
Some birth control pills contain estrogen. Saw palmetto might decrease the effects of estrogen in the body. Taking saw palmetto along with birth control pills might decrease the effectiveness of birth control pills. If you take birth control pills along with saw palmetto, use an additional form of birth control such as a condom.

Some birth control pills include ethinyl estradiol and levonorgestrel (Triphasil), ethinyl estradiol and norethindrone (Ortho-Novum 1/35, Ortho-Novum 7/7/7), and others.

Estrogens
Saw palmetto seems to decrease estrogen levels in the body. Taking saw palmetto along with estrogen pills might decrease the effectiveness of estrogen pills.

Some estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol, and others.

Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)
Saw palmetto might slow blood clotting. Taking saw palmetto along with medications that also slow clotting might increase the chances of bruising and bleeding.

Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.

Are there interactions with herbs and supplements?

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Herbs and supplements that might slow blood clotting
Using saw palmetto with other herbs that can slow blood clotting might increase the risk of bleeding in some people. These other herbs include angelica, clove, danshen, garlic, ginger, ginkgo, Panax ginseng, red clover, turmeric, vitamin E, willow, and others.

Are there interactions with foods?

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There are no known interactions with foods.

What dose is used?

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The following doses have been studied in scientific research:

BY MOUTH:
  • For benign prostatic hyperplasia (BPH): 160 mg twice daily or 320 mg once daily.
  • For the treatment of bald spots: 200 mg twice daily combined with beta-sitosterol 50 mg twice daily.

Other names

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American Dwarf Palm Tree, Baies du Chou Palmiste, Baies du Palmier Scie, Cabbage Palm, Chou Palmiste, Ju-Zhong, Palma Enana Americana, Palmier de Floride, Palmier Nain, Palmier Nain Américain, Palmier Scie, Sabal, Sabal Fructus, Sabal serrulata, Saw Palmetto Berry, Serenoa repens, Serenoa serrulata.

Methodology

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To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.methodology (http://www.nlm.nih.gov/medlineplus/druginfo/natural/methodology.html).

References

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To see all references for the Saw palmetto page, please go to http://www.nlm.nih.gov/medlineplus/druginfo/natural/971.html.

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  2. Comar OB and Di Rienzo A. Mepartricina versus Serenoa repens: studio sperimentale doppio cieco su 20 casi di iperplasia prostatica benigna. Riv Ital Biol Med 1986;6:122-125.
  3. Metzker H, Kieser M, and Hölscher U. Wirksamkeit eines Sabal-Urtica-kombinationspraparates bei der behandlung der benignen prostatahyperplasie (BPH). Urologe 1996;36:292-300.
  4. Mattei FM, Capone M, and Acconcia A. Medikamentose therapie der benignen prostatahyperplasie mit einem extrakt der sagepalme. TW Urol Nephrol 1990;2:346-350.
  5. Löbelenz J. Extractum Sabal fructus bei benigner Prostatahyperplasie (BPH): Klinische Prüfung im Stadium I und II. Therapeutikon 1992;6(1-2):34, 37.
  6. Gabric V and Miskic H. Behandlung des benignen Prostataadenoms und der chronischen Prostatitis. Placebokontrollierte randomisierte doppelblindstudie mit Prostagutt. Therapiewoche 1987;37:1775-1788.
  7. Emili E, Lo Cigno M, and Petrone U. Risultati clinici su un nuovo farmaco nella terapia dell'ipertrofia della prostata (Permixon). Urologia 1983;50:1042-1048.
  8. Boccafoschi C and Annoscia S. Confronto fra estratto di Serenoa repens e placebo mediante prova clinica controllata in pazienti con adenomatosi prostatica. Urologia 1983;50:1257-1268.
  9. Pannunzio E, D'Ascenzo R, Giardinetti F, and et al. Serenoa repens vs. gestonorone caproato nel trattamento dell'ipertrofia prostatica benigna. Studio randomizzato. Urologia 1986;53:696-705.
  10. Descotes J, Rambeaud J, Deschaseaux P, and et al. Placebo-controlled evaluation of the efficacy and tolerability of Permixon in benign prostatic hyperplasia after exclusion of placebo responders. Clin Drug Invest 1995;9:291-297.
  1. Roveda S and Colombo P. Clinical controlled trial on therapeutical bioequivalence and tolerability of Serenoa repens oral capsules 160mg or rectal capsules 640mg. Arch Med Interna 1994;46:61-75.
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  3. Braeckman J, Denis L, de Leval J, and et al. A double-blind, placebo-controlled study of the plant extract Serenoa repens in the treatment of benign hyperplasia of the prostate. Eur J Clin Res 1997;9:247-259.
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  5. Sokeland J and Albrecht J. Kombination aus Sabal und Urticaextrakt vs. finasterid bei BPH (Stad I bis II nach Alken). Urologe 1997;36 :327-333.
  6. Cukier J, Ducassou J, Le Guillou M, and et al. Permixon versus placebo; resultats d'une etude multicentrique. C R Ther Pharmacol Clin 1985;4:15-21.
  7. Tasca, A., Barulli, M., Cavazzana, A., Zattoni, F., Artibani, W., and Pagano, F. [Treatment of obstructive symptomatology caused by prostatic adenoma with an extract of Serenoa repens. Double-blind clinical study vs. placebo]. Minerva Urol.Nefrol. 1985;37:87-91. View abstract.
  8. MacDonald, R., Tacklind, J. W., Rutks, I., and Wilt, T. J. Serenoa repens monotherapy for benign prostatic hyperplasia (BPH): an updated Cochrane systematic review. BJU.Int. 2012;109:1756-1761. View abstract.
  9. Kul'chavenia, E. V., Breusov, A. A., Brizhatiuk, E. V., and Kholtobin, D. P. [Approaches to raising efficacy of treatment of patients with chronic prostatitis associated with intracellular infections]. Urologiia. 2010;:55-58. View abstract.
  10. Anceschi, R., Bisi, M., Ghidini, N., Ferrari, G., and Ferrari, P. Serenoa repens (Permixon(R)) reduces intra- and postoperative complications of surgical treatments of benign prostatic hyperplasia. Minerva Urol.Nefrol. 2010;62:219-223. View abstract.
  11. Timmermans, L. M. and Timmermans, L. G., Jr. [Determination of the activity of extracts of Echinaceae and Sabal in the treatment of idiopathic megabladder in women]. Acta Urol Belg. 1990;58:43-59. View abstract.
  12. Lapi, F., Gallo, E., Giocaliere, E., Vietri, M., Baronti, R., Pieraccini, G., Tafi, A., Menniti-Ippolito, F., Mugelli, A., Firenzuoli, F., and Vannacci, A. Acute liver damage due to Serenoa repens: a case report. Br.J.Clin.Pharmacol. 2010;69:558-560. View abstract.
  13. Cai, T., Mazzoli, S., Bechi, A., Addonisio, P., Mondaini, N., Pagliai, R. C., and 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;33:549-553. View abstract.
  14. Shi, R., Xie, Q., Gang, X., Lun, J., Cheng, L., Pantuck, A., and Rao, J. Effect of saw palmetto soft gel capsule on lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized trial in Shanghai, China. J.Urol. 2008;179:610-615. View abstract.
  15. Lopatkin, N. A., Sivkov, A. V., Medvedev, A. A., Walter, K., Schlefke, S., Avdeichuk, IuI, Golubev, G. V., Mel'nik, K. P., Elenberger, N. A., and Engelman, U. [Combined extract of Sabal palm and nettle in the treatment of patients with lower urinary tract symptoms in double blind, placebo-controlled trial]. Urologiia. 2006;:12, 14-12, 19. View abstract.
  16. Engelmann, U., Walther, C., Bondarenko, B., Funk, P., and Schlafke, 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;56:222-229. View abstract.
  17. Aliaev, IuG, Vinarov, A. Z., Lokshin, K. L., and Spivak, L. G. [Efficiency and safety of prostamol-Uno in patients with chronic abacterial prostatitis]. Urologiia. 2006;:47-50. View abstract.
  18. Debruyne, F., Boyle, P., Calais, da Silva, Gillenwater, J. G., Hamdy, F. C., Perrin, P., Teillac, P., Vela-Navarrete, R., Raynaud, J. P., and Schulman, C. [Evaluation of the clinical benefit of Permixon and tamsulosin in severe BPH patients--PERMAL study subset analysis]. Prog.Urol. 2004;14:326-331. View abstract.
  19. Pecoraro, S., Annecchiarico, A., Gambardella, M. C., and Sepe, G. [Efficacy of pretreatment with Serenoa repens on bleeding associated with transurethral resection of prostate]. Minerva Urol.Nefrol. 2004;56:73-78. View abstract.
  20. Glemain, P., Coulange, C., Billebaud, T., Gattegno, B., Muszynski, R., and Loeb, G. [Tamsulosin with or without Serenoa repens in benign prostatic hyperplasia: the OCOS trial]. Prog.Urol. 2002;12:395-403. View abstract.
  21. Gerber, G. S., Kuznetsov, D., Johnson, B. C., and Burstein, J. D. Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology 2001;58:960-964. View abstract.
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  23. Morgia, G., Mucciardi, G., Gali, A., Madonia, M., Marchese, F., Di, Benedetto A., Romano, G., Bonvissuto, G., Castelli, T., Macchione, L., and 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;84:400-406. View abstract.
  24. Suter A, Saller R, Riedi E, Heinrich M. Improving BPH symptoms and sexual dysfunctions with a saw palmetto preparation? Results from a pilot trial. Results from a pilot trial. Phytother Res 2012 Apr 23. doi: 10.1002/ptr.4696. View abstract.
  25. Barry MJ, Meleth S, Lee JY, et al. Effect of increasing doses of saw palmetto on lower urinary tract symptoms: a randomized trial. JAMA 2011;306:1344-51. View abstract.
  26. Habib FK, Ross M, Ho CK, et al. Serenoa repens (Permixon) inhibits the 5alpha-reductase activity of human prostate cancer cell lines without interfering with PSA expression. Int J Cancer 2005;114:190-4. View abstract.
  27. Lopatkin N, Sivkov A, Walther C, et al. 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;23:139-46. View abstract.
  28. Avins AL, Bent S, Staccone S, et al. A detailed safety assessment of a saw palmetto extract. Complement Ther Med 2008;16:147-54. View abstract.
  29. Habib FK, Wyllie MG. Not all brands are created equal: a comparison of selected components of different brands of Serenoa repens extract. Prostate Cancer Prostatic Dis 2004;7:195-200. View abstract.
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  31. Tuncel A, Ener K, Han O, et al. Effects of short-term dutasteride and Serenoa repens on perioperative bleeding and microvessel density in patients undergoing transurethral resection of the prostate. Scand J Urol Nephrol 2009;43:377-82. View abstract.
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  33. Bonnar-Pizzorno RM, Littman AJ, Kestin M, White E. Saw palmetto supplement use and prostate cancer risk. Nutr Cancer 2006;55:21-7. View abstract.
  34. Jibrin I, Erinle A, Saidi A, Aliyu ZY. Saw palmetto-induced pancreatitis. South Med J 2006;99:611-2. View abstract.
  35. Wilt T, Ishani A, Mac Donald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev 2002;:CD001423. View abstract.
  36. Bent S, Kane C, Shinohara K, et al. Saw palmetto for benign prostatic hyperplasia. N Engl J Med 2006;354:557-66. View abstract.
  37. Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo assessment of botanical supplementation on human cytochrome P450 phenotypes: Citrus aurantium, Echinacea purpurea, milk thistle, and saw palmetto. Clin Pharmacol Ther 2004;76:428-40. . View abstract.
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  42. Markowitz JS, Donovan JL, Devane CL, et al. Multiple doses of saw palmetto (Serenoa repens) did not alter cytochrome P450 2D6 and 3A4 activity in normal volunteers. Clin Pharmacol Ther 2003;74:536-42. View abstract.
  43. Vela Navarrete R, Garcia Cardoso JV, Barat A, et al. BPH and Inflammation: pharmacological effects of Permixon on histological and molecular inflammatory markers. Results of a double blind pilot clinical assay. Eur Urol 2003;44:549-55.. View abstract.
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  45. Goldmann WH, Sharma AL, Currier SJ, et al. Saw palmetto berry extract inhibits cell growth and Cox-2 expression in prostatic cancer cells. Cell Biol Int 2001;25:1117-24. View abstract.
  46. Glemain P, Coulange C, Grapin FN, Muszynski RC. No benefit in combining tamsulosin with Serenoa repens versus tamsulosin alone on storage/filling and voiding lower urinary tract symptoms. [Abstract]. J Urol 2001;167:374.
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  50. Paubert-Braquet M, Mencia Huerta JM, Cousse H, Braquet P. Effect of the lipidic lipidosterolic extract of Serenoa repens (Permixon) on the ionophore A23187-stimulated production of leukotriene B4 (LTB4) from human polymorphonuclear neutrophils. Prostaglandins Leukot Essent Fatty Acids 1997;57:299-304. View abstract.
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Last reviewed - 10/10/2014




Page last updated: 10 December 2014