Saw Palmetto

Why is this drug prescribed?
The saw palmetto plant, or "Serenca repens," is a plant used in a number of herbal remedies. The plant is similar to a palm tree that grows wild in the southwestern United States. An extract of saw palmetto called "Permixon" is similar to the drug Proscar (finasteride) and is indicated for the treatment of benign prostate enlargement in those patients who show signs of obstruction of urinary flow. After age 50, most men develop some enlargement of their prostates. The prostate is located below the bladder. As the prostate enlarges, it may slowly restrict the flow of urine.

How does saw palmetto work?
Its action is to alter the way the body handles testosterone, the major male hormone. Saw palmetto shrinks the enlarged prostate gland in many men. This can lead to gradual improvement in urine flow and symptoms over the next several months. Since each case of BPH is different, however, you should know:

  • Even though the prostate shrinks, you may NOT see an improvement in urine flow or symptoms.
  • You may need to take saw palmetto for six months or more to determine if it helps you.
  • Even though you take saw palmetto and it may help you, it is not known whether saw palmetto reduces the need for surgery.
Saw palmetto has NOT gone through the same rigorous testing required of FDA-approved drugs. Its actions, however, are thought to be similar to finasteride (Proscar), a drug used to treat prostate enlargement. If the saw palmetto does not work, it is possible that the herbs you received were not effective and that Proscar might have worked under the same circumstances.

When should it be used?
Saw palmetto is taken daily, usually in divided doses. Because saw palmetto is not controlled by the United States Food and Drug Administration, standardization may be more difficult to control. Doses should be obtained from the store or herbalist from which it is purchased.

Saw palmetto is usually less expensive than the drug counterpart, Proscar (or finstasteride), which costs about $45-50 per month. If the saw palmetto costs as much, the prescribed drug may turn out to be a better value and more reliable.

What special instructions should I follow while using this drug?
Saw palmetto should be taken indefinitely. Most patients will see an improvement in urinary flow within three to four months. The improvement may increase throughout the first 12 months. The herb should be continued to maintain the benefits.

Some patients will NOT derive any benefits from saw palmetto. If after six to eight months no improvement has occurred, discontinuing therapy should be considered. Surgery, Hytrin, and Proscar are alternative therapies.

What should I do if I forget to take a dose?
Take it as soon as you remember on the day forgotten. If the day was omitted, then take only that day's dosage. Do not double the dose.

What side effects can this drug cause?
A very small percentage of patients will notice decreased quality of erections (impotence), sex drive (libido), and decreased amount of ejaculate. No apparent side-effects with other drugs are felt to be significant. No other drug dosages need to be modified.

What follow-up is needed?
Follow-up urinary flow rates and residual checks should be done at regular intervals the first year (four to six months) and then yearly thereafter. While taking saw palmetto, you must have regular checkups. Saw palmetto is prescribed for treatment of benign enlargement of the prostate gland; not for treatment of cancer, but a man can have BPH and prostate cancer at the same time. We recommend that you be checked for prostate cancer once a year if you are over 50 years of age.

Saw palmetto can affect the PSA blood test for prostate cancer. The PSA may fall as much as 40 to 50 percent. You will need to establish a new baseline PSA for future reference. If the PSA does not fall, we have concerns that a cancer might be present or that the saw palmetto was not active.