Sabal serrulata

Related Terms

American dwarf palm tree, American saw palmetto, Arecaceae (family), Bazoton?, Beltrax Uno?, cabbage palm, dwarf palm, dwarf palm plant, Elusan? Prostate, fatty acids, Harzol?, IDS 89, Libeprosta?, LSESR, myristoleic acid, PA 109, Palmae (family), palmetto scrub, palmier de l' Amerique du nord (French), palmier nain (French), PC-SPES?, Permicaps?, Permixon?, Prostadyn?, Prostagood Mono?, Prostamen?, Prostamol Uno?, Prostasan?, Prostaserene?, Prostaserine?, ProstaX?, Remigeron?, sabal, Sabalfruchte (German), Sabal fructus, Sabal serrulata, Sabal serrulata (Michx.) Nutall ex. Schultes & Schultes, Sabal serrulatum, savpalme (Danish), saw palmetto berry, Serendar, Serenoa, Serona repens, Serenoa serrulata, Serenoa serrulata Hook F., Serenoae repentis fructus, SG 291, sterols, Strogen?, Strogen forte?, Tadenan?, Talso?, Urocaps?, Urogutt?, WS 1473, Zwegpalme.
Select combination products: Cernitin?, Cerniton AFT, indigal plus, IPBTRE, PRO 160/120 (Prostagutt? forte), Profluss?, Prostagutt?, ProstataplexT.
Note: Information on pygeum (Prunus africanum, Pygeum africanum) is available in a separate Natural Standard monograph.

Background

Saw palmetto (Serenoa repens, Serenoa serrulata) is used popularly in Europe to treat symptoms of enlarged prostate. Although it is not considered the standard of care in the United States, it is the most popular herbal treatment for this condition. More than two million American men use saw palmetto for enlarged prostate, and it is commonly recommended as an alternative treatment by the U.S. Food and Drug Administration (FDA).
Many studies report that saw palmetto may be as effective as the hormonal agent finasteride (Proscar?) and may cause fewer side effects when used to treat bladder problems. Most research has focused on the saw palmetto product Permixon?. However, results are still mixed, and further research is needed.
Saw palmetto has also been used for low sperm count, low sex drive, hair loss, bronchitis, diabetes, inflammation, migraine, and prostate cancer, although there is limited evidence supporting its effectiveness for these conditions.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Saw palmetto has been long been used to treat enlarged prostate. According to a report, more than two million American men use saw palmetto for enlarged prostate, and it is often recommended as an alternative therapy by the U.S. Food and Drug Administration (FDA). Many studies report that saw palmetto may be as effective as the hormonal agent finasteride (Proscar?) and may cause fewer side effects when used to treat bladder problems. Most studies used the saw palmetto product Permixon?. Although more recent research failed to find significant benefits of saw palmetto, the available evidence suggests that it may be an effective treatment for enlarged prostate.

 A


Saw palmetto has been long been used to treat enlarged prostate. According to a report, more than two million American men use saw palmetto for enlarged prostate, and it is often recommended as an alternative therapy by the U.S. Food and Drug Administration (FDA). Many studies report that saw palmetto may be as effective as the hormonal agent finasteride (Proscar?) and may cause fewer side effects when used to treat bladder problems. Most studies used the saw palmetto product Permixon?. Although more recent research failed to find significant benefits of saw palmetto, the available evidence suggests that it may be an effective treatment for enlarged prostate.

 A


Saw palmetto may block some hormonal effects and may be an effective treatment for hair loss, with benefits similar to the agent finasteride (Propecia?), when applied to the scalp. Early research suggests that saw palmetto may improve hair density, but evidence is limited at this time. Further research is needed before conclusions can be made.

 C


Saw palmetto may block some hormonal effects and may be an effective treatment for hair loss, with benefits similar to the agent finasteride (Propecia?), when applied to the scalp. Early research suggests that saw palmetto may improve hair density, but evidence is limited at this time. Further research is needed before conclusions can be made.

 C


Saw palmetto may help the recovery process in patients undergoing prostate surgery. Early research suggests that saw palmetto may improve the effectiveness of surgery, as well as reduce bleeding and duration of catheter use. However, results are conflicting, and more research is needed in this area.

 C


Saw palmetto may help the recovery process in patients undergoing prostate surgery. Early research suggests that saw palmetto may improve the effectiveness of surgery, as well as reduce bleeding and duration of catheter use. However, results are conflicting, and more research is needed in this area.

 C


Saw palmetto is commonly used for many types of prostate problems, including prostate cancer. Research suggests that saw palmetto may block the growth of cancer cells. However, there is limited human research on the effectiveness of saw palmetto for this condition. Evidence is lacking in support of PC-SPES?, a discontinued product that contains saw palmetto, for prostate cancer. The U.S. Food and Drug Administration (FDA) has issued a warning not to use PC-SPES? because it may contain warfarin and alprazolam, which may cause bleeding.

C


Saw palmetto is commonly used for many types of prostate problems, including prostate cancer. Research suggests that saw palmetto may block the growth of cancer cells. However, there is limited human research on the effectiveness of saw palmetto for this condition. Evidence is lacking in support of PC-SPES?, a discontinued product that contains saw palmetto, for prostate cancer. The U.S. Food and Drug Administration (FDA) has issued a warning not to use PC-SPES? because it may contain warfarin and alprazolam, which may cause bleeding.

C


There is conflicting evidence on the use of saw palmetto in treating prostate inflammation. Although some studies report that saw palmetto may improve symptoms, obvious benefit over standard drugs is lacking. Much of the research has focused on saw palmetto as part of a combination therapy. Further research is needed to understand the potential effects of saw palmetto alone.

 C


There is conflicting evidence on the use of saw palmetto in treating prostate inflammation. Although some studies report that saw palmetto may improve symptoms, obvious benefit over standard drugs is lacking. Much of the research has focused on saw palmetto as part of a combination therapy. Further research is needed to understand the potential effects of saw palmetto alone.

 C


There is limited evidence on the use of saw palmetto to treat underactive bladder. Available studies are low-quality or use saw palmetto in combination with other therapies. More research is needed in this area.

 C


There is limited evidence on the use of saw palmetto to treat underactive bladder. Available studies are low-quality or use saw palmetto in combination with other therapies. More research is needed in this area.

 C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

Adults (18 years and older)
Saw palmetto has been taken as sterol and fatty acid extracts (such as LSESR), berries (ground, dried, whole, or pulp), tincture, fluid extract, or tea. Teas prepared from saw palmetto berries may be ineffective because the purported active constituents are water-insoluble.
For enlarged prostate (benign prostatic hypertrophy), a range of 100-960 milligrams of sabal or Serenoa repens extract has been taken by mouth daily for up to 18 months. A dose of 320 milligrams of saw palmetto extract (e.g., Permixon?, Serendar, Talso?), in one dose or two divided doses (80-90% liposterolic content), by mouth daily for up to six months, has been taken in numerous studies. Dosing regimens of 160 milligrams of saw palmetto twice daily for eight weeks (PA109), nine weeks, and 12 weeks (Prostaserene?) have been taken by mouth. Reports suggest that 160 milligrams once daily by mouth may be as effective as twice daily by mouth. Libeprosta? has been taken as two 80 milligram tablets twice or three times daily by mouth. A dose of 640 milligrams of saw palmetto has also been taken by mouth daily for an unknown length of time. A dose of 640 milligrams of saw palmetto extract has been applied to the rectum once daily for 12 weeks.
In preparation for surgery, pretreatment with 320 milligrams of Serenoa repens (Permixon?) has been taken by mouth daily for at least eight weeks before surgery.
To treat prostate inflammation, 320 milligrams of prostamol (Sabal serrulata plant extract) has been taken by mouth. Also, 320 milligrams of Serenoa repens has been taken by mouth daily for eight weeks.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Interactions

Interactions with Drugs
Saw palmetto may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin?) or heparin, antiplatelet drugs such as clopidogrel (Plavix?), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin?, Advil?) or naproxen (Naprosyn?, Aleve?). Some batches of the discontinued combination herbal preparation PC-SPES?, which contains saw palmetto and seven other herbs, has been found to contain several medications including the blood thinner warfarin.
Saw palmetto may affect blood pressure. Caution is advised in people taking drugs that may affect blood pressure.
Early research found that saw palmetto lacks effect on cytochrome P450 1A2, 3A4, 2E1, or 2D6 activity.
Saw palmetto may also interact with agents that may affect hemoglobin levels, agents that may affect the immune system, agents that may affect the liver, agents that may lower seizure threshold, agents that may regulate heart rate, agents that may treat genitourinary tract disorders, agents that may treat impotence, agents that may treat stomach disorders, antibiotics, anticancer agents, anti-inflammatories, disulfiram (Antabuse?), and hormonal agents (such as androgens or antiandrogens).

Attribution

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

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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 9-28-2011;306(12):1344-1351.
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Giulianelli R, Pecoraro S, Sepe G, et al. Multicentre study on the efficacy and tolerability of an extract of Serenoa repens in patients with chronic benign prostate conditions associated with inflammation. Arch.Ital.Urol.Androl 2012;84(2):94-98.
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Lee JY, Foster HE, McVary KT, et al. Recruitment of participants to a clinical trial of botanical therapy for benign prostatic hyperplasia. J.Altern.Complement Med. 2011;17(5):469-472.
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Miroddi M, Carni A, Mannucci C, et al. Hot flashes in a young girl: a wake-up call concerning Serenoa repens use in children. Pediatrics 2012;130(5):e1374-e1376.
Morgia G, Mucciardi G, Gali A, et al. 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(4):400-406.
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