Saw Palmetto safety, side effects and contraindications
reviewed by X. Li, Ph. D. (credential)

Saw palmetto gains its popularity in USA and in Europe for good reasons. Besides its defined health benefits, another main reason is the safety and few side effects of saw palmetto. As we discussed in saw palmetto benefits under studies, extensive clinical trials have been conducted to evaluate the saw palmetto health benefits, these trials also monitored any potential adverse reactions saw palmetto may cause. In these trials people took standardized saw palmetto extract at the dose of 320 mg daily for up to one year, side effects have been rare and not attributed to saw palmetto^{1, 2}. A few study participants developed mild gastrointestinal symptoms, rhinitis and headache. But the same side effects were also seen with the same chance in participants who took placebo. The side effects disappear after discontinuing use of saw palmetto.

In comparative studies with Proscar, which is often prescribed as the first line treatment for benign prostatic hyperplasia (BPH), both saw palmetto and Proscar showed similar benefits. However, saw palmetto appears to have fewer adverse effects. Fewer patients who took saw palmetto withdrawn from trials than the ones who took Proscar. Moreover, patients taking Proscar more often complained the decreased sexual desire or impotency³.

Another good thing about saw palmetto is that saw palmetto does not change the level of PSA (prostate specific antigen) whereas Proscar lowers the level of PSA³. PSA is a prostate specific marker whose level goes higher when prostate cancer occurs and is thus useful in diagnosing prostate cancer. As proscar reduces the PSA level, it makes PSA detection less valuable in the prostate cancer diagnosis. As a result, prostate cancer may not be detected and thus treated in its early stage. In this aspect, saw palemtto is favored over Proscar.

Among millions of people who take the saw palmetto extract regularly, only one case has been reported to have intraoperative haemorrhage developed in association with saw palmetto⁴.

With regard to saw palmetto contraindications, so far no interaction with drugs has been observed.

Reference
1.Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review.JAMA. 1998 Nov 11;280(18):1604-9.
2. De Smet PA. Herbal remedies. N Engl J Med. 2002 Dec 19;347(25):2046-56.
3. Carraro JC, Raynaud JP, Koch G, Chisholm GD, Di Silverio F, Teillac P, Da Silva FC, Cauquil J, Chopin DK, Hamdy FC, Hanus M, Hauri D, Kalinteris A, Marencak J, Perier A, Perrin P. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate. 1996 Oct;29(4):231-40.
4. Cheema P, El-Mefty O, Jazieh AR. Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature.J Intern Med. 2001 Aug;250(2):167-9.

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