Pygeum
Scientific Names: Prunus Africana (synonym: Pygeum africanum) Other Common Names: African plum tree Overall Safety: π Β
Therapeutic Efficacy and Considerations:
Benign Prostatic Hyperplasia (BPH): π Clinical trials of various quality have demonstrated decreases in symptoms and improvement in urodynamics compared to placebo. Although the extent of benefit has not been well-characterized due to the lack of comparisons to standard pharmaceutical therapies, the evidence does support a recommendation for use in treatment of mild-moderate BPH. Because pygeum has little to no effect on prostate volume, it may not be as useful for patients with greatly enlarged prostates, whose symptoms are primarily obstructive. Dose: 100-200 mg/day of extract standardized to 14% total sterols given in two doses.
Pygeum is often found in combination with saw palmetto or pumpkin. These do not carry contraindications to combined use and may provide additional benefit. Such products should only be used if the doses of the individual supplements are close to standard recommended doses.
Chemistry/Pharmacology: Pygeum bark contains approximately 14% triterpenes (oleanolic, crataegolic, and ursolic acids), ferulic acid esters such as n-docosanol and n-tetracosanol, and the phytosterols, Ξ²-sitosterol, Ξ²-sitosterone, and capesterol. Triterpenes have anti-inflammatory activity via inhibition of enzymes involved in destruction of connective tissue as well as inhibition of intraprostatic prostaglandin formation. Phytosterols may compete with androgen precursors. Extracts inhibit 5-Ξ±-reductase, which transforms testosterone to the more active dihydrotestosterone (DHT) and inhibits DHTβs binding to androgen receptors. Neither of these activities occurs to a clinically significant extent. Extracts decrease the excitability of the detrusor muscle and have antiestrogenic effects which may block initiation of hyperplasia. A decrease in fibroblast proliferation within the prostate gland has been observed. Systemic effects may include a slight decrease in testosterone and prolactin (which stimulates intraprostatic DHT synthesis and testosterone uptake), although results of studies are contradictory. Prostatic secretions are increased, which may help to alleviate urethral irritation. No change in prostate gland size occurs, even when symptoms are reduced.
Drug Interactions: No interactions have been reported. Because extent of possible hormonal effects is small, conjunctive use with finasteride is not necessarily contraindicated, but patients should be counseled to monitor for possible increased side effects.
Contraindications/Precautions: As with any BPH treatment, prostate cancer must be ruled out before symptoms are treated. Because pygeum may have some hormonal effects, use in hormone-sensitive cancers is not recommended.
Adverse Effects: Well tolerated; rare GI symptoms of nausea and abdominal pain have been reported.
