Сереноа

Many men report use of saw palmetto to treat symptoms (eg, frequent urination) of benign prostatic hyperplasia (BPH). Additional claims are that saw palmetto increases sperm production, breast size, and sexual vigor. Dose is 320 mg once a day or 160 mg twice a day.

There is no scientific evidence to suggest that saw palmetto reverses BPH. A double-blind, multicenter, placebo-controlled randomized trial of 369 men found that increasing doses of a saw palmetto fruit extract did not reduce lower urinary tract symptoms more than placebo (1). In addition, a 2012 Cochrane review of 32 randomized, controlled trials, determined that saw palmetto, at double and triple doses, did not improve urinary flow measures or prostate size in men with lower urinary tract symptoms consistent with BPH (2). However, a 2018 systematic review and meta-analysis of 27 studies (5800 subjects) of a specific hexanic extract of saw palmetto found decreased nocturia and improved urine flow (3).

A 2020 meta-analysis of four studies in 1080 males reported that saw palmetto had comparable efficacy to tamsulosin in men with BPH. There were no statistically significant differences in International Prostate Symptom Scores (IPSSs), maximum flow rate, postvoid residual volume, or quality of life (4). However, a 2021 network meta-analysis of 22 randomized controlled trials (8564 subjects) comparing saw palmetto to placebo and various alpha-blockers reported lack of meaningful improvement in lower urinary tract symptoms (LUTS) and peak urine flow (5). A different 2021 meta-analysis of 27 trials (4853 subjects) reported lack of benefit for saw palmetto in treating LUTS attributable to BPH (6). Thus, there are numerous studies evaluating saw palmetto for BPH or LUTS, with varying results. Canadian Urological Association Guidelines do not endorse phytotherapies (including saw palmetto) for BPH treatment (7).

A small, randomized, controlled trial reported that saw palmetto used for 2 months prior to transurethral resection of the prostate resulted in shortened surgery duration and a more favorable postoperative course (8).

Claims that saw palmetto increases sperm production, breast size, or sexual vigor are unsupported.

Headache and diarrhea may occur, but few serious adverse effects have been reported.

One case report of a 58-year-old White man taking 900 mg of dried extract and 660 mg of berry powder to ease the symptoms of BPH reported acute liver damage due to saw palmetto (9). Another report of a 65-year-old male indicated that supplementation with saw palmetto may have been responsible for acute pancreatitis (10).

Women who are pregnant or who may become pregnant should not take saw palmetto due to potential hormonal effects.

Variability in ingredients and concentrations in saw palmetto supplements may affect safety and efficacy (11).

No interactions have been reported for saw palmetto (12); however, although strong evidence is not available, patients on warfarin should be careful when considering or taking saw palmetto because of a possible risk of hepatotoxicity or bleeding.

Saw palmetto may interact with estrogens in oral contraceptives or hormone replacement therapy and decrease their benefit.

(See also table Some Possible Dietary Supplement–Drug Interactions.)

1. 1. Barry MJ, Meleth S, Lee JY, et al; Complementary and Alternative Medicine for Urological Symptoms (CAMUS) Study Group: Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA 306(12):1344-1351, 2011. doi: 10.1001/jama.2011.1364

2. 2. Tacklind J, Macdonald R, Rutks I, et al: Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev 12:CD001423, 2012. doi: 10.1002/14651858.CD001423.

3. 3. Vela-Navarrete R, Alcaraz A, Rodriguez-Antolin A, et al: Efficacy and safety of a hexanic extract of Serenoa repens (Permixon®) for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH): systematic review and meta-analysis of randomised controlled trials and observational studies. BJU Int 10.1111/bju.14362, 2018. doi: 10.1111/bju.14362

4. 4. Cai T, Cui Y, Yu S, et al: Comparison of serenoa repens with tamsulosin in the treatment of B=benign prostatic hyperplasia: a systematic review and meta-analysis. Am J Mens Health 14(2):1557988320905407, 2020. doi:10.1177/1557988320905407

5. 5. Russo GI, Scandura C, Di Mauro M, et al: Clinical efficacy of serenoa repens versus placebo versus alpha-blockers for the treatment of lower urinary tract symptoms/benign prostatic enlargement: a systematic review and network meta-analysis of randomized placebo-controlled clinical trials. Eur Urol Focus 7(2):420-431, 2021. doi:10.1016/j.euf.2020.01.002

6. 6. Trivisonno LF, Sgarbossa N, Alvez GA, et al: Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement: a systematic review and meta-analysis. Investig Clin Urol 62(5):520-534, 2021. doi:10.4111/icu.20210254

7. 7. Elterman D, Aubé-Peterkin M, Evans H, et al: UPDATE - Canadian Urological Association guideline: male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J 16(8):245-256, 2022. doi:10.5489/cuaj.7906

8. 8. Anceschi R, Bisi M, Ghidini N, et al: Serenoa repens (Permixon®) reduces intra- and postoperative complications of surgical treatments of benign prostatic hyperplasia. Minerva Urol Nefrol 62(3):219-223, 2010.

9. 9. Lapi F, Gallo E, Giocaliere E, et al: Acute liver damage due to Serenoa repens: a case report. Br J Clin Pharmacol 69(5):558-560, 2010. doi:  10.1111/j.1365-2125.2010.03618.x

10. 10. Wargo KA, Allman E, Ibrahim F: A possible case of saw palmetto-induced pancreatitis. South Med J 103(7):683-685, 2010. doi: 10.1097/SMJ.0b013e3181e1e3ee

11. 11. 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 7(3):195-200, 2004. doi:10.1038/sj.pcan.4500746

12. 12. Izzo AA, Ernst E: Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs 69(13):1777-1798, 2009. doi: 10.2165/11317010-000000000-00000

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

1. National Institutes of Health (NIH), National Center for Complementary and Integrative Health: General information on the use of saw palmetto as a dietary supplement