Pygeum

Scientific Name(s): Pygeum africanum Hook. f., or Prunus africana (Hook. f.) Kalkm. Family: Rosaceae

Common Name(s): Pygeum , African plum tree

Uses

Pygeum has been used to improve symptoms of benign prostatic hypertrophy and to improve sexual function. Usual dosage is 100 mg/day in 6- to 8-week cycles.

Dosing

Pygeum is available as the standardized preparations Tadenan and Pigenil. It has been studied in clinical trials for benign prostatic hypertrophy at daily doses of 25 to 200 mg.

Contraindications

Contraindications have not yet been identified.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

GI irritation has been reported with the use of pygeum.

Toxicology

In human trials, a low incidence of toxicity has been demonstrated.

Botany

Pygeum is an evergreen tree native to African forest regions. It can grow to 150 feet in height. The thick leaves are oblong in shape; the flowers are small and white. Pygeum fruit is a red berry, resembling a cherry when ripe. The bark (red, brown or gray) is the part of the plant used for medicinal purposes. It has a hydrocyanic acid-like odor. 1 , 2 , 3

History

The hard wood of pygeum is valued in Africa and is often used to make wagons. 1 Powdered pygeum bark is used by African natives to treat urinary problems. 1 , 3

Chemistry

The major bark components are fat soluble compounds. Triterpenes are present (14%), including ursolic, oleanolic and crataegolic acids. The lipid fraction contains fatty acids, which are 12 to 24 carbons in length. The ferulic acid esters are those bound to n-tetracosanol and n-docosanol. 3 N-docosanol has been used in some patent medicines. 4 Phytosterols present in pygeum include beta-sitosterol, beta-sitosterone and campesterol. 1 , 2 , 3 , 5 Tannins have also been found in the plant. 1

Uses and Pharmacology

In France, Pygeum africanum extract (PAE) has become the primary course of treatment for enlarged prostate. In contrast, surgery is the main option in other Western countries. 1 Drugs used to alleviate symptoms of benign prostatic hypertrophy (BPH) include anticholinergics, muscle relaxants, calcium antagonists, prostaglandin inhibitors, beta-agonists, tricyclic antidepressants and alpha blockers. 6 Usual dosage of PAE is 100 mg/day in 6- to 8-week cycles. 2 The highest activity is found in the lipophilic extracts of the plant. These extracts are standardized to contain 14% triterpenes and 0.5% n-docosanol. 3

Pygeum is also therapeutic as an anti-inflammatory, to increase prostatic secretions and to decrease certain hormones in the glandular area, which reduces the hypertrophy. Other actions of pygeum include increase in bladder elasticity and histological modifications of glandular cells. 2

The ferulic acid ester components are responsible for pygeum's endocrine system activity. N-docosanol reduces LH, testosterone and prolactin levels. This is important because accumulation of testosterone within the prostate and subsequent conversion to the more potent form is believed to be a major factor in prostatic hyperplasia. PAE's “phyto-estrogenic” action markedly reduces volume of prostatic hypertrophy. 7 Fat soluble components reduce cholesterol content within the prostate as well, decreasing accumulation of cholesterol metabolites. 3

Animal data

PAE has had positive results in animal “hypophyseo-genito-adrenal axis” and prostatic adenoma. 8 , 9 Pretreatment of rabbits with pygeum reduces partial outlet obstruction in bladder dysfunction secondary to BPH. 10

Gland size reduction has also been reported for pygeum. PAE was found to be a potent inhibitor of rat prostatic fiberblast proliferation. 11 The extract also displays anti-inflammatory activity, which may affect gland size.

Clinical data

Pygeum clinical trials (mostly European), are encouraging, but more research is needed in the United States.

Most trial results report improvement of BPH symptoms. Reduction in gland size and other parameters occur, but are not as profound. 3

In human trials, symptomatic relief from BPH using PAE has been documented. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 The extract, in combination with mepartricin, was successful in treating urinary symptomatology in 22 subjects with varying stages of prostatic adenoma. 14 In a 74-patient study, extracts of both pygeum and testosterone alleviated obstructive bladder symptoms caused by BPH. 15 Using PAE, nocturnal frequency, difficulty in initiation of urination and bladder fullness were improved over placebo in 60 patients. 16 In a placebo controlled, double-blind, multi-center evaluation, pygeum capsules (50 mg) were given twice daily for 60 days. Out of 263 patients in eight locations, 66% (vs 31% placebo) showed marked clinical improvement in micturitional disorders. 17 High dose PAE (200 mg/day) administered to 18 patients for 60 days improved both urinary symptoms and sexual behavior in another report. 18 PAE in combination with Urtica dioica in half doses was found to be as safe and effective as full doses (300 mg urtica and 25 mg PAE) in treating urine flow, residual urine and nycturia. 19

It has been demonstrated that macrophages (inflammatory cells) produce chemotactic mediators that worsen BPH development. In one recent report, the proposed mechanism is that pygeum antagonizes 5-lipoxygenase metabolite production (in vitro), which decreases inflammation. 20

Pygeum may help reverse sterility, which can be caused by insufficient prostatic secretions. 1 PAE has increased prostate secretions in both rats and humans. 21 It has also been shown to improve seminal fluid composition. 1 By improving an underlying problem, PAE may improve sexual function. 3 , 18

When compared with saw palmetto in a double-blind trial, it was demonstrated that saw palmetto produced greater reduction of symptoms and was better tolerated; however, PAE may have greater effects on prostate secretion. 3

Dosage

Pygeum is available as the standardized preparations Tadenan and Pigenil. It has been studied in clinical trials for benign prostatic hypertrophy at daily doses of 25 to 200 mg. 22 , 23 , 24 , 25 , 26 , 27

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

No side effects were reported in 18 patients taking 200 mg/day of pygeum for 60 days. 18 Gastrointestinal irritation ranging from nausea to severe stomach pain has been documented but with only a small percentage discontinuing therapy. 3 In 263 patients, GI adverse effects occurred in five patients with only three patients having to stop treatment. 17 It is recommended that pygeum be taken only under professional supervision. 1

Toxicology

In human trials, a low incidence of toxicity has been demonstrated as well.

Bibliography

1. Chevallier A. Encyclopedia of Medicinal Plants . New York, NY: DK Publishing 1996;257.
2. Bruneton J. Pharmacognosy, Phytochemistry, Medicinal Plants . Paris, France: Lavoisier Publishing 1995;142.
3. Murray M. The Healing Power of Herbs . Rocklin, CA: Prima Publishing 1995;286-293.
4. Pierini N, et al. Boll Chim Farm . 1982;121:27-34.
5. Longo R, et al. Farmaco . 1983;38:287-292.
6. Dagues F, et al. Rev Prat . 1995;45:337-341.
7. Mathe G, et al. Biomed Pharmacother . 1995;49:339-343.
8. Thieblot L, et al. Therapie . 1971;26:575-580.
9. Thieblot L, et al. Therapie . 1977;32:99-110.
10. Levin R, et al. Eur Urol . 1997;32 (Suppl 1):15-21.
11. Yablonsky F, et al. J Urol . 1997;157:2381-2387.
12. Bassi P, et al. Minerva Urol Nefrol . 1987;39:45-50.
13. Menchini-Fabris G, et al. Arch Ital Urol Nefrol Androl . 1988;60:313-322.
14. Casella G, et al. Arch Sci Med . 1978;135:95-98.
15. Flamm J, et al. Wien Klin Wochenschr . 1979;91:622-627.
16. DuFour B, et al. Ann Urol . 1984;18:193-195.
17. Barlet A, et al. Wien Klin Wochenschr . 1990;102:667-673.
18. Carani C, et al. Arch Ital Urol Nefrol Androl . 1991;63:341-345.
19. Krzeski T, et al. Clin Ther . 1993;15:1011-1020.
20. Paubert-Braquet M, et al. J Lipid Mediat Cell Signal . 1994;9:285-290.
21. Clavert A, et al. Ann Urol . 1986;20:341-343.
22. Wilt T, Ishani A, MacDonald R, Rutks I, Stark G. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev . 2002;CD001044.
23. 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 [in German]. Wien Klin Wochenschr . 1990;102:667-673.
24. Krzeski T, Kazon M, Borkowski A, Witeska A, Kuczera J. 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.
25. Breza J, Dzurny O, Borowka A, et al. Efficacy and acceptablity of tadenan ( Pygeum africanum extract) in the treatment of benign prostatic hyperplasia (BPH): a multicentre trial in central Europe. Curr Med Res Opin . 1998;14:127-139.
26. 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.
27. Ishani A, MacDonald R, Nelson D, Rutks I, Wilt TJ. Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systemic review and quantitative meta-analysis. Am J Med . 2000;109:654-664.

Copyright © 2009 Wolters Kluwer Health

Hide
(web3)