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Pygeum

The pygeum tree (pronounced pie-jee-um) is a tall evergreen native to central and southern Africa. Its bark has been used since ancient times to treat problems with urination.

What Is Pygeum Used for Today?

Today, pygeum is primarily used as a treatment for benign prostatic hyperplasia (BPH), or prostate enlargement. The evidence in support of this use is no more convincing than the evidence in support the more famous, natural BPH remedy, saw palmetto . However, the pygeum tree has been so devastated by collection for use in medicine that some regard it as a threatened species. Saw palmetto is cultivated rather than collected in the wild.
At least 17 double blind, placebo-controlled trials of pygeum for BPH have been performed, involving a total of almost 1,000 people and ranging in length from 45-90 days. 3-7,17 Many of these studies were poorly reported and/or designed, making it difficult to draw reliable conclusions from their results. Acknowledging these limitations, pygeum may reduce symptoms, such as nighttime urination, urinary frequency, and residual urine volume.
Besides BPH, pygeum is also sometimes proposed for prostatitis, as well as impotence and male infertility ; 1,2 however, there is little real evidence that it works for these conditions.

What Is the Scientific Evidence for Pygeum?

At least 17 double blind trials of pygeum for BPH have been performed, involving a total of almost 1000 individuals and ranging in length from 45 to 90 days. 3-7,17 Many of these studies were poorly reported and/or designed. Nonetheless, overall the results make a meaningful case that pygeum can reduce symptoms such as nighttime urination, urinary frequency, and residual urine volume.
The best of these studies was conducted at 8 sites in Europe and included 263 men between 50 and 85 years of age. 8 Participants received 50 mg of a pygeum extract or placebo twice daily. The results showed significant improvements in residual urine volume, voided volume, urinary flow rate, nighttime urination, and daytime frequency.
We don't really know how pygeum works. Unlike the standard drug finasteride, it does not appear to work by affecting the conversion of testosterone to dihydrotestosterone. 9 Rather it is thought to reduce inflammation in the prostate, and also to inhibit prostate growth factors, substances implicated in inappropriate prostate enlargement. 10,12

Dosage

The usual dosage of pygeum is 50 mg twice per day (occasionally 100 mg twice daily) of an extract standardized to contain 14% triterpenes and 0.5% n-docosanol. A dose of 100 mg once daily appears to be as effective as the most common dosage of 50 mg twice daily. 13
There is some reason to believe that pygeum's effectiveness might be enhanced when it is combined with nettle root , another natural treatment for BPH. 14,15

Safety Issues

Pygeum appears to be essentially nontoxic, both in the short and long term. 16 The most common side effect is mild gastrointestinal distress. However, safety in young children, pregnant or nursing women, or those with severe liver or kidney disease has not been established.

References

1 Menchini-Fabris GF, Giorgi P, Andreini F, et al. New perspectives on the use of Pygeum Africanum in prostato-bladder pathology [in Italian]. Arch Ital Urol Nefrol Androl. 1988;60:313–322.

2 Carani C, Salvioli V, Scuteri A, et al. Urological and sexual evaluation of treatment of benign prostatic disease using Pygeum africanum at high doses [in Italian]. Arch Ital Urol Nefrol. 1991;63:341–345.

3 Bombardelli E, Morazzoni P. Prunus africana (Hook. f.) Kalkm. Fitoterapia. 1997;68:205–218.

4 Bongi G. Tadenan in the treatment of prostatic adenoma. Anatomo-clinical study [in Italian]. Minerva Urol. 1972;24:129–139.

5 Rizzo M. Terapia medica dell'adenoma della prostata: Valutazione clinica comparativa tra estratto di Pygeum africanum ad alte dosi e placebo. Farmacia Terapia. 1985;2:105–110.

6 Ranno S, Minaldi G, Viscusi G, et al. Efficacia e tollerabilita del trattamento dell'adenoma prostatico con Tadenan 50 [English abstract]. Prog Med. 1986;42:165–169.

7 Bassi P, Artibani W, De Luca V, et al. Standardized extract of Pygeum africanum in the treatment of benign prostatic hypertrophy. Controlled clinical study versus placebo [in Italian]. Minerva Urol Nefrol. 1987;39:45–50.

8 Barlet A, Albrecht J, Aubert A, et al. Efficacy of Pygeum africanum extract in the medical therapy of urination disorders due to benign prostatic hyperplasia: evaluation of objective and subjective parameters. A placebo-controlled double-blind multicenter study [translated from German]. Wien Klin Wochenschr. 1990;102:667–673.

9 Rhodes L, Primka RL, Berman C, et al. Comparison of finasteride (Proscar), a 5-alpha reductase inhibitor, and various commercial plant extracts in in vitro and in vivo 5-alpha reductase inhibition. Prostate. 1993;22:43–51.

10 Andro MC, Riffaud JP. Pygeum africanum extract for the treatment of patients with benign prostatic hyperplasia: a review of 25 years of published experience. Curr Ther Res. 1995;56:796–817.

12 Yablonsky F, Nicolas V, Riffaud JP, et al. Antiproliferative effect of Pygeum africanum extract on rat prostatic fibroblasts. J Urol. 1997;157:2381–2387.

13 Chatelain C, Autet W, Brackman F. Comparison of once and twice daily dosage forms of Pygeum africanum extract in patients with benign prostatic hyperplasia: a randomized, double-blind study, with long-term open label extension. Urology. 1999;54:473–478.

14 Hartmann RW, Mark M, Soldati F. Inhibition of 5 alpha-reductase and aromatase by PHL-00801 (Prostatonin), a combination of PY 102 (Pygeum africanum) and UR 102 (Urtica dioica) extracts. Phytomedicine. 1996;3:121–128.

15 Krzeski T, Kazon M, Borkowski A, et al. Combined extracts of Urtica dioica and Pygeum africanum in the treatment of benign prostatic hyperplasia: double-blind comparison of two doses. Clin Ther. 1993;15:1011–1020.

16 Bombardelli E, Morazzoni P. Prunus africana (Hook. f.) Kalkm. Fitoterapia. 1997;68:205–218.

17 Wilt T, Ishani A, MacDonald R, et al. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(1):CD001044.

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