Saw palmetto interaction with prescription drugs

Saw Palmetto

Saw palmetto comes from a palm-like plant that grows in the southeast United States. The berries of this plant are used to make the capsule form of saw palmetto. Saw palmetto is also known as American Dwarf Palm Tree, Baies du Palmier Scie, Cabbage Palm, Chou Palmiste, Ju-Zhong, Palma Enana Americana, Palmier Nain, Palmier Scie, Sabal, Serenoa, and other names.

Saw palmetto blocks certain effects of certain hormones in the body and also has some anti-inflammatory actions.

Saw palmetto has been used in alternative medicine as a possibly effective aid in preventing complications from prostate surgery (such as blood loss or problems during surgery) and reducing the time spent in surgery and in the hospital after surgery.

Saw palmetto has been used to treat symptoms of enlarged prostate (benign prostatic hypertrophy, or BPH), such as increased night-time urination or decreased urinary flow. However, research has shown that saw palmetto may not be effective in treating this condition.

Other uses not proven with research have included treating sore throat, cough, cold symptoms, asthma, bronchitis, migraine headache, male-pattern baldness, chronic pelvic pain and prostate swelling, bladder problems, prostate cancer, and other conditions.

It is not certain whether saw palmetto is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. Saw palmetto should not be used in place of medication prescribed for you by your doctor.

Saw palmetto is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Saw palmetto may also be used for other purposes not listed in this product guide.

Follow all directions on the product label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before using saw palmetto, talk to your healthcare provider. You may not be able to use saw palmetto if you have certain medical conditions., such as:

  • a bleeding or blood clotting disorder (such as hemophilia);
  • liver disease; or
  • a pancreas disorder.

Saw palmetto is a hormone and is not likely to be safe to use during pregnancy. Do not use saw palmetto if you are pregnant.

Saw palmetto can make birth control pills less effective. Ask your doctor about using non hormonal birth control (condom, diaphragm with spermicide) to prevent pregnancy.

Saw palmetto may pass into breast milk and may harm a nursing baby. Do not use this product without medical advice if you are breast-feeding a baby.

Do not give any herbal/health supplement to a child without medical advice.

Warning: Supplements and medications may not mix

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Americans are taking more prescription medications. They also are taking more supplements — everything from vitamin and mineral pills to fish and flax seed oils. The natural result: More are combining drugs and supplements. That may be riskier than many consumers realize.

Some are risking dangerous internal bleeding by combining certain supplements with blood-thinning drugs. Others are unknowingly reducing the effectiveness of medications they take to fight cancer, control infections or prevent pregnancy.

“It’s a serious concern, and the risk is growing,” says Dima Qato, an assistant professor of pharmacy at the University of Illinois in Chicago. Qato led a recent study, published in JAMA Internal Medicine, documenting increased mixing of all sorts of medications and supplements among U.S. adults ages 62 to 85. The study found that 87% used at least one prescription medication, 38% took at least one non-prescription drug, and 64% used at least one supplement. Many took multiple drugs and supplements.

The researchers looked for combinations known to the be dangerous and found that the most common involving a supplement was a mix of blood-thinning medication warfarin and supplements of omega-3 fish oils. The combination, which increases bleeding risks, was taken by 8 in 1,000 older adults in 2010-2011, up from 1 in 1,000 in 2005-2006. The researchers also found about 4 in 1,000 combining niacin supplements with the cholesterol-lowering drug simvastatin, which can increase side effects.

In a statement, Andrea Wong, vice president of scientific and regulatory affairs at the Council for Responsible Nutrition, which represents supplement makers, said the results “show that the prevalence of older adults taking a combination of drugs and supplements with a potential for interaction is low, suggesting that the actual risk to consumers is low.”

But Qato says that “the trend is not reassuring” and that the analysis included only the most-used supplements and drugs and the most serious known reactions. Many combinations have never been studied, she says: “Their safety is largely unknown.”

Chun-Su Yuan, director of the Tang Center for Herbal Medicine Research at the University of Chicago, agrees: “Patients need to know that there are potential adverse events. They don’t know. And they assume that these products are natural, so they are naturally safe, but that’s not always the case.”

The consequences might be particularly serious for patients with life-threatening illnesses such as cancer. Some supplements are known to make certain chemotherapy drugs less effective or to increase their side effects, says K. Simon Yeung, a research pharmacist and acupuncturist at Memorial Sloan Kettering Cancer Center in New York. Others could have unknown effects, he says: “Cancer patients should know that many of these products have not been studied in a cancer care setting.”

All the experts, including those at the supplement industry group, urge consumers to discuss the supplements they take with their health care providers. A separate report published alongside Qato’s study found that 25% of adults using herbal medicines and other supplements did not do that. Doctors also have a responsibility to ask patients about supplement use, the experts agree.

Health care professionals and patients can find information about most supplements at the website of the National Center for Complementary and Integrative Health, which is part of the National Institutes of Health. Memorial Sloan Kettering also has a website, About Herbs, which details potential uses and risks of herbal remedies and other supplements.

Here’s what you need to know about several popular supplements. (All information is from About Herbs, unless otherwise noted):

Calcium
Possible benefits: Prevention of bone loss, cancer and heart disease (study results are mixed, especially for cancer and heart disease).
Possible drug interactions:

May reduce absorption of some medicines, including bisphosphonates (for osteoporosis) and certain antibiotics.

Garlic
Possible benefits: May reduce cholesterol and blood pressure (study results are mixed).
Possible drug interactions: May increase bleeding risks with anti-clotting drugs (blood thinners). Reduces effectiveness of the anti-HIV medication saquinavir. Lowers blood sugar, so may affect insulin needs.
Note: In most cases, herbs used in cooking are not a concern, but some reports have documented increased post-surgical bleeding in patients eating large amounts of garlic.

Ginger
Possible benefits: Studies suggest it help relieve nausea and vomiting. It may also stimulate appetite and ease digestion, but studies are lacking.
Possible drug interactions: May increase bleeding risks associated with anti-clotting drugs. May affect insulin needs. May reduce blood levels of cyclosporine antibiotics.

Omega-3 fatty acids (including fish oil)
Possible benefits: May protect against cardiovascular disease (though the NCCIH says study results have been mixed). May decrease some cancer and mental health risks.
Possible drug interactions: May increase bleeding risks with anti-clotting drugs. May increase some of the side effects of steroids such as prednisone and hydrocortisone. May blunt effects of the chemotherapy drug cisplatin.
Saw palmetto
Possible benefits: May promote urine flow and reduce symptoms associated with an enlarged prostate (though recent studies have shown results no better than with placebo, according to the NCCIH).
Possible drug interactions: May increase bleeding risks with anti-clotting drugs. Interferes with enzymes affecting the metabolism of other drugs.

St. John’s wort
Possible benefits: May reduce depression (studies are mixed). May reduce symptoms of premenstrual syndrome and chronic fatigue syndrome.
Possible drug interactions: Can reduce blood levels and effectiveness of many drugs, including birth control pills, cholesterol-lowering statins and some anti-HIV drugs. Can increase side effects of some antidepressants and cause increased sedation when combined with alcohol.

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Uses and dosage of saw palmetto

Saw palmetto has a range of uses. Most of them relate to the effect it is believed to have on testosterone.

Lowered testosterone levels cause a variety of conditions, which can be treated by stabilizing the levels of this hormone.

Some people think that saw palmetto prevents testosterone from being broken down. When testosterone cannot break down naturally, the levels of the hormone in the body go up.

Enlarged prostate

Share on PinterestAn extract from the saw palmetto berries may be turned into a liquid, a tea, or a tablet.

Some people take saw palmetto to manage benign prostatic hyperplasia (BPH), which is a non-cancerous enlargement of the prostate gland.

The prostate is a small walnut-shaped gland in the male reproductive system. As a man ages and his testosterone levels decrease, it is quite common for the prostate gland to increase in size.

Some men may experience BPH, where the prostate becomes larger than it should. When this happens, the prostate can put pressure on the urethra, causing discomfort and other symptoms. These include:

  • frequent urination
  • problems starting or maintaining urination
  • the need to get up in the night to urinate

Because saw palmetto is believed to boost testosterone levels, men with BPH may try taking saw palmetto because they think it will shrink the prostate and relieve urinary symptoms.

Prostate cancer

As saw palmetto seems to have an impact on male hormone levels, it may also help reduce the growth of cancerous cells in the prostate.

For this reason, some men who have prostate cancer take supplements of saw palmetto in addition to traditional treatment.

Anyone with concerns about prostate cancer should always speak to a doctor. It is important to seek a proper diagnosis and suitable treatment before trying an alternative remedy.

Sex drive

Testosterone plays a role in both men and women’s sex drive. It is linked to fertility because it affects the production of both sperm and eggs.

As such, people may take saw palmetto in an attempt to increase their testosterone levels. This can help them experience an increased libido or a greater desire for sex.

Hair loss

As men age, it is natural for them to lose some of their hair. This natural process occurs because of a hormone called dihydrotestosterone (DHT), which is a by-product of the breakdown of testosterone.

Men experiencing hair loss may try taking saw palmetto to stabilize their testosterone levels and slow down the hair loss process.

Minor ailments

People may also take saw palmetto for a range of other ailments, including:

  • coughs, colds, and sore throats
  • bronchitis
  • headaches
  • sleeping troubles

The use of saw palmetto to treat these conditions is based on tradition, but researchers know little about its active ingredients, or if it improves the symptoms related to these illnesses.

Saw Palmetto

Background

  • Saw palmetto is a small palm tree native to the southeastern United States. Its fruit was used medicinally by the Seminole Tribe of Florida.
  • Currently, saw palmetto is used as a dietary supplement for urinary symptoms associated with an enlarged prostate gland (also called benign prostatic hyperplasia or BPH), as well as for chronic pelvic pain, decreased sex drive, migraine, hair loss, and other conditions.
  • Extracts of the fruit of saw palmetto are used in tablets or capsules. Saw palmetto has also been used as ground, dried, or whole berries, a liquid extract, or a tea.

How Much Do We Know?

  • Rigorous, well-conducted studies have evaluated saw palmetto for urinary tract symptoms associated with prostate enlargement in men.
  • Much less is known about the use of saw palmetto as a dietary supplement for other health purposes or by other groups of people.

What Have We Learned?

  • The scientific evidence does not support using saw palmetto for any health condition.
  • High-quality scientific studies have shown that saw palmetto is no more effective than a placebo (an inactive substance) in relieving urinary tract symptoms caused by prostate enlargement. These studies include a 2011 NIH-funded study that tested saw palmetto in amounts up to three times the usual dose.

What Do We Know About Safety?

  • Saw palmetto is well tolerated by most users. It may cause mild side effects, including digestive symptoms or headache.
  • Saw palmetto does not appear to affect readings of prostate-specific antigen (PSA) levels, even when taken in higher-than-usual amounts. PSA is a protein produced by the prostate gland. PSA levels have been used to screen for prostate cancer and are also used to monitor patients who have been diagnosed with prostate cancer.
  • Saw palmetto has not been shown to interact with medications.
  • Information on the safety of saw palmetto comes primarily from studies in men. Little is known about the safety or side effects of saw palmetto in women or children.

Keep in Mind

  • Urinary tract symptoms can have several causes, including conditions such as prostate cancer that need prompt treatment. If you’re having problems with urination, it’s important to tell your health care provider.
  • Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Generic Name: saw palmetto (SAW pal MET toe)
Brand Name: Prostate SR

Medically reviewed by Drugs.com on Aug 5, 2019 – Written by Cerner Multum

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Important Information

Follow all directions on the product label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

Before using saw palmetto, talk to your healthcare provider. You may not be able to use saw palmetto if you have certain medical conditions., such as:

  • a bleeding or blood clotting disorder (such as hemophilia);

  • liver disease; or

  • a pancreas disorder.

Saw palmetto is a hormone and is not likely to be safe to use during pregnancy. Do not use saw palmetto if you are pregnant.

Saw palmetto can make birth control pills less effective. Ask your doctor about using non hormonal birth control (condom, diaphragm with spermicide) to prevent pregnancy.

Saw palmetto may pass into breast milk and may harm a nursing baby. Do not use this product without medical advice if you are breast-feeding a baby.

Do not give any herbal/health supplement to a child without medical advice.

How should I take saw palmetto?

When considering the use of herbal supplements, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.

If you choose to use saw palmetto, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label.

Saw palmetto may be taken with food if it upsets your stomach.

Do not use different forms (capsules, tablets, tinctures, topical forms, etc) of saw palmetto at the same time without medical advice. Using different formulations together increases the risk of an overdose.

Saw palmetto can affect blood-clotting and may increase your risk of bleeding. If you need surgery, dental work, or a medical procedure, stop taking saw palmetto at least 2 weeks ahead of time.

Call your doctor if the condition you are treating with saw palmetto does not improve, or if it gets worse while using this product.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra saw palmetto to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking saw palmetto?

Avoid using saw palmetto together with other herbal/health supplements that can also affect blood-clotting. This includes angelica (dong quai), capsicum, clove, danshen, garlic, ginger, ginkgo, horse chestnut, panax ginseng, poplar, red clover, turmeric, vitamin E, and willow.

Saw palmetto side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Although not all side effects are known, saw palmetto is thought to be likely safe for most people.

Stop using saw palmetto and call your healthcare provider at once if you have:

  • easy bruising or bleeding (nosebleeds, bleeding gums);

  • any bleeding that will not stop;

  • signs of stomach bleeding–bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

  • pancreas problems–severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate; or

  • liver problems–nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Common side effects may include:

  • nausea, vomiting, diarrhea, constipation;

  • headache, dizziness; or

  • impotence, sexual problems.

This is not a complete list of side effects and others may occur. Tell your doctor, pharmacist, herbalist, or other healthcare provider about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect saw palmetto?

Do not take saw palmetto without medical advice if you are using any of the following medications:

This list is not complete. Other drugs may interact with saw palmetto, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this product guide.

Further information

  • Consult with a licensed healthcare professional before using any herbal/health supplement. Whether you are treated by a medical doctor or a practitioner trained in the use of natural medicines/supplements, make sure all your healthcare providers know about all of your medical conditions and treatments.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 4.02.

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The shrinking case for saw palmetto

PRACTICE CHANGER

Advise men with benign prostatic hyperplasia (BPH) not to take saw palmetto for urinary symptoms. Explain that it has not been found to alleviate symptoms, even at triple the standard dose.1

A: Based on evidence from a high-quality randomized controlled trial (RCT)1 and a 2009 meta-analysis.2

1. Barry MJ, Meleth S, Lee JY, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011;306:1344-1351.

ILLUSTRATIVE CASE

A 66-year-old man comes to your office complaining of urinary frequency and straining to begin urination. He was recently diagnosed with BPh by a urologist, but is hesitant to begin taking a prescription drug. The patient, who is on a fixed income, asks you if saw palmetto extract might relieve his urinary symptoms. What should you tell him?

Roughly 40% of American men older than 60 years and nearly 90% of men older than 80 suffer from BPH and the troublesome lower urinary tract symptoms (LUTS) that it causes.3 Established medical and surgical options, as well as over-the-counter (OTC) plant-based products, are used for symptom relief. The OTC remedy most commonly used for BPH is Serenoa repens, derived from the saw palmetto dwarf palm tree. In a 2007 survey, 1.6 million US adults reported using saw palmetto extract, often as a treatment for BPH, in the 30 days prior to the survey.4

Until now, more questions than answers
As a family physician, you undoubtedly have many patients who are taking or considering taking saw palmetto for relief of BPH symptoms. The significant adverse effects of alpha-blockers and 5-alpha-reductase inhibitors, which are typically prescribed for LUTS—including decreased libido and dizziness—may help account for their interest in this alternative treatment.5,6

Until recently, evidence of saw palmetto’s efficacy has been limited and conflicting, despite widespread use of the extract. That has left many of us wondering whether we should recommend that men with BPH try saw palmetto despite the limited evidence; whether it is effective for some, but not all, BPH symptoms; and whether an increase in dose would increase its efficacy.

A 2002 Cochrane meta-analysis of 21 trials of saw palmetto extract for LUTS reported reduced nocturia, improved self-reported symptoms, and increased peak uroflow compared with placebo, without significant adverse effects.7 An updated Cochrane review published in 2009 included several more rigorous trials—and had very different results: This meta-analysis, which was based on 30 trials, found a reduction in nocturia, but failed to show improvement in other self-reported symptoms or peak uroflow.2

The largest trial included in the 2009 review was the Saw Palmetto Treatment for Enlarged Prostates (STEP) study,8 a one-year study with 225 participants. Its findings: no improvement in the treatment group compared with the placebo group in symptom scores or any secondary endpoints, and no important toxicity.8 Of note, the STEP study and most trials included in the 2009 Cochrane review used the standard saw palmetto extract dose of 160 mg twice daily.1,2

STUDY SUMMARY: Saw palmetto is ineffective, even at triple the dose

Barry et al conducted a 72-week double-blind, multicenter placebo-controlled trial to assess the effect of double (640 mg/d) and triple (960 mg/d) the standard dose of saw palmetto extract on BPH symptoms.1 The study included 369 men with moderate LUTS who had not recently received treatment for BPH. Exclusion criteria included a history of invasive BPH treatment, recent treatment with either an alpha-blocker or a 5-alpha-reductase inhibitor; recent phytotherapy, including saw palmetto; and a history of prostate or bladder cancer. Participants were randomized to receive either saw palmetto extract or an identical-looking placebo gel cap. Doses started at 320 mg/d and were increased to 640 mg/d at 24 weeks and 960 mg/d at 48 weeks.

The primary outcome was the change in the American Urological Association Symptom Index (AUASI) score from baseline to 72 weeks. AUASI, a scale of 0 to 35 in which higher numbers represent increased symptoms, is the same scoring tool used in both the Cochrane review and the STEP trial. Secondary measures included other symptom scales, peak uroflow, and poststudy satisfaction. The treatment and placebo groups had statistically identical baseline characteristics, and the sample size was large enough to detect clinically significant differences.

The AUASI score decreased by a mean of 2.20 points (95% confidence interval , -3.04 to -0.36) in the group that received saw palmetto and by 2.99 points (95% CI, -3.81 to -2.17) in the placebo group—a mean difference of 0.79 in favor of the placebo group (P=.91). The proportion of participants achieving a 3-point reduction in AUASI score was statistically similar between the 2 groups (P=0.66). There was no significant dose response difference between the 2 groups, and saw palmetto proved to be no better than placebo for any of the secondary outcomes.

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