Saw palmetto is used mainly for treatment of benign prostatic hyperplasia with free fatty acids and sterols being the main components (Hughes et al. 2004). Despite an uncertain mechanism, the literature does demonstrate antagonism at the androgen receptor for dihy-drotestosterone and 5a-reductase enzyme (Hughes et al. 2004). Though prostate size and prostate-specific antigen level are not decreased by saw palmetto, biopsies have demonstrated decreases in transitional zone epithelia in prostates of men treated with this agent compared to placebo (Hughes et al. 2004). When compared with finasteride, a 5a-reductase inhibitor, saw palmetto use resulted in fewer side effects and increased urine flow (Hughes et al. 2004). However, a study of patients with prostatitis/chronic pelvic pain syndrome that evaluated the safety and efficacy of saw palmetto compared to finasteride reported that at the end of the investigation, more patients opted to continue finasteride treatment rather than saw palmetto treatment. The researchers found that in patients with the studied condition, saw palmetto had no appreciable long-term improvement and, with the exception of voiding, patients on finasteride experienced significant improvement in all other analyzed parameters (Kaplan et al. 2004).
Adverse reactions to saw palmetto are rare but there are reports of mild gastrointestinal symptoms and headaches (Hughes et al. 2004). Results of a recent investigation indicated that recommended doses of saw palmetto are not likely to alter the pharmacokinetics of coadministered medications dependent on the cytochrome P-450 isoenzyme CYP2D6 or CYP3A4, such as dextromethorphan and alprazolam (Markowitz et al. 2003). Further, there are few herbal-drug interactions in the literature regarding saw palmetto, but, as always, care and responsibility should be exercised when taking this agent (Hughes et al. 2004).
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