Pygeum (Prunus africanum, Pygeum africanum)
Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
African cherry, African P. africanum extract, African plum tree, African prune tree, African stinkwood, alumty (Bamenda, Cameroon), bitter almond, bitteramandel (Kenya), ciruelo africano (Spanish), ferulic acid esters of fatty acids, gwabuzito (Uganda), gwane (African), gyabazito (Uganda), Harzol®, iluo, iron wood, kanda stick (Cameroon), kiburraburra (Swahili), kirah (Banso, Cameroon), kotofihy (Madagascar), lluo (Kom - Cameroon), mgambo (Swahili), mkomahoya (Swahili), mkonohoyo (Tanzania), mseneo (Tanzania), muchambati (Zimbabwe), muchati (Zimbabwe), mueri (Kenya), muiri, mutimailu (Kenya), Natal tree, ntasesa (Uganda), ol-koijuk (Tanzania), olkonjuku (Tanzania), phytoesterols, Pigenil®, Pigeum africanum, Pronitol®, Prostatonin®, Provol®, prunier d'afrique, Pygeum africana, red stinkwood, rooistinkhout (Afrikaans), Rosaceae (family), Tadenan®, tenduet (Kenya), umDumizula (South Africa), triterpenes, umkakase (Xhosa), V1326, vla (Oku, Cameroon), wotangue (Bakweri).
The Pygeum africanum (African plum) tree is a tall evergreen of the family Rosaceae found in central and southern Africa. Its bark has been used medicinally for thousands of years. Traditional African healers have used the bark to treat bladder and urination disorders, particularly symptoms associated with benign prostatic hypertrophy (BPH), which is an enlarged prostate. Historically, the bark was powdered and used to make a tea, which was taken by mouth for these conditions.
The African plum tree has become endangered due to the demand for its bark to process Pygeum africanum extract.
The majority of trials conducted since the 1970s report improvements in BPH symptoms, including frequency of nighttime urination, urine flow rate, and left over urine volume, with the administration of Pygeum africanum bark extract. This research has led some credibility to the common use of this agent in Europe for BPH. The herb is less commonly used in the United States where prescription drugs or the herb saw palmetto is more commonly used.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Benign prostatic hypertrophy/BPH symptoms
Pygeum (P. africanum bark extract) has been observed to moderately improve urinary symptoms associated with enlargement of the prostate gland or prostate inflammation. Numerous human studies report that pygeum significantly reduces urinary hesitancy, urinary frequency, the number of times patients need to wake up at night to urinate, and pain with urination in men who experience mild-to-moderate symptoms. However, pygeum does not appear to reduce the size of the prostate gland or reverse the process of BPH. It is unclear how pygeum compares to the effectiveness or safety of other medical therapies, such as prescription drugs (eg. alpha-adrenergic blockers or 5-alpha reductase inhibitors), surgical approaches, or other herbs/supplements such as saw palmetto. There is ongoing study in this area. Patients with urinary symptoms or BPH should speak with their healthcare professional about the various available treatment options.
*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.
Aphrodisiac, bladder sphincter disorders, cancer, fever, impotence, inflammation, kidney disease, malaria, male baldness, mental disorders, partial bladder outlet obstruction, prostate cancer, prostatic adenoma, prostatitis, psychosis, sexual performance, stomach upset, urinary tract disorders, urinary tract health.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
For treating benign prostatic hypertrophy, 75 to 200 milligram capsules of standardized pygeum extract taken daily by mouth either as a single dose or divided into two equal doses have been studied. One clinical human trial has shown that Pygeum africanum and stinging nettle (Urtica dioica), when used in combination, were efficient in treating benign prostatic hypertrophy and its symptoms.
Children (younger than 18 years)
There are not enough scientific data to recommend pygeum for use in children and there are potential side effects.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
People with known allergies to pygeum should avoid this herb.
Side Effects and Warnings
Pygeum has been well tolerated in most studies, with adverse effects similar to placebo (sugar pill). Some people may experience stomach discomfort including diarrhea, constipation, stomach pain, or nausea. Stomach upset is usually mild and does not typically cause people to stop using pygeum.
Safety of use beyond 12 months has not been reliably studied.
Pregnancy and Breastfeeding
Pygeum cannot be recommended during pregnancy or breastfeeding because of a lack of scientific information and possible hormonal effects.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Use of pygeum with other drugs commonly used to treat symptoms of prostate enlargement, called 5-alpha-reductase inhibitors, such as terazosin (Hytrin®) or finasteride (Propecia®, Proscar®), may increase beneficial effects, although this is not well studied.
In theory, pygeum may interact with estrogen or other drugs with hormone activity (birth control pills). Although not well studied in humans, pygeum may have anti inflammatory and anti-cancer effects.
Interactions with Herbs and Dietary Supplements
Pygeum may result in increased beneficial effects for the prostate if used with saw palmetto (Serenoa repens) or stinging nettle (Urtica dioica). Combination products are available containing both stinging nettle and pygeum.
Pygeum may interact with herbs/supplements containing chemicals with estrogen-like effects ("phytoestrogens").
Although not well studied in humans, pygeum may have anti inflammatory and anti-cancer effects.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
Berges RR, Windeler J, Trampisch HJ, et al. Randomised, placebo-controlled, double-blind clinical trial of beta- sitosterol in patients with benign prostatic hyperplasia. Beta- sitosterol Study Group. Lancet 6-17-1995;345(8964):1529-1532. View Abstract
Brackman F, Autet W. Once and twice daily dosage regimens of Pygeum africanum extract (PA): a double-blind study in patients with benign prostatic hyperplasia (BPH) [abstract]. J Urology 1999;161(4S):361.
Breza J, Dzurny O, Borowka A, et al. Efficacy and acceptability of tadenan (Pygeum africanum extract) in the treatment of benign prostatic hyperplasia (BPH): a multicentre trial in central Europe. Curr Med Res Opin 1998;14(3):127-139. View Abstract
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(3):473-478. View Abstract
Dedhia RC, McVary KT. Phytotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol 2008 Jun;179(6):2119-25. View Abstract
Donkervoort T, Sterling A, van Ness,J, et al. A clinical and urodynamic study of tadenan in the treatment of benign prostatic hypertrophy. Eur Urol 1977;3(4):218-225. View Abstract
Edwards JL. Diagnosis and management of benign prostatic hyperplasia. Am Fam Physician 2008 May 15;77(10):1403-10. View Abstract
Hutchison A, Farmer R, Verhamme K, et al. The efficacy of drugs for the treatment of LUTS/BPH, a study in 6 European countries. Eur Urol 2007;51(1):207-15; discussion 215-6.
Ishani A, MacDonald R, Nelson D, et al. Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis. Am J Med 12-1-2000;109(8):654-664. View Abstract
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(6):1011-1020. View Abstract
Melo EA, Bertero EB, Rios LA, et al. Evaluating the efficiency of a combination of Pygeum africanum and stinging nettle (Urtica dioica) extracts in treating benign prostatic hyperplasia (BPH): double-blind, randomized, placebo controlled trial. Int Braz J Urol 2002;28(5):418-425. View Abstract
Natural Standard Research Collaboration, Chief Editors: Ulbricht C, Basch E, Natural Standard Herb and Supplement Reference - Evidence-Based Clinical Reviews, USA: Elsevier/Mosby, 2005.
Shenouda NS, Sakla MS, Newton LG, et al. Phytosterol Pygeum africanum regulates prostate cancer in vitro and in vivo. Endocrine 2007;31(1):72-81. View Abstract
Strong KM. African plum and benign prostatic hypertrophy. J Herb Pharmacother 2004;4(1):41-46. View Abstract
Wilt T, Ishani A, Mac Donald R, et al. Pygeum africanum for benign prostatic hyperplasia (Cochrane Review). Cochrane Database Syst Rev 2002;(1):CD001044. View Abstract
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017