Scientific Name(s): Prunus africana (Hook. f.) Kalkm.
Common Name(s): African cherry, African plum, African prune, Pygeum, Red stinkwood
Medically reviewed by Drugs.com. Last updated on Nov 30, 2022.
Pygeum has been used to improve symptoms of benign prostatic hyperplasia (BPH) and to improve sexual function. However, only studies comparing pygeum to placebo are available.
Benign prostatic hyperplasia: 25 to 200 mg/day of P. africana extract standardized to 14% total sterols. The usual dosage is 100 mg/day in 6- to 8-week cycles.
Contraindications have not been identified.
Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.
None well documented.
GI irritation and headache have been reported.
A low incidence of toxicity has been demonstrated.
Pygeum (previously known as Pygeum africanum) is an evergreen tree native to African forest regions, Central and South American mountains, the Gulf of Guinea, and the Madagascar and Comoros islands.Allkanjari 2015 It can grow to 30 m in height.Pagano 2014 Its thick leaves are oblong in shape, dark green and glossy, and smell like almonds when crushed.van Wyk 2004 Its flowers are small and white, and the fruit is a red berry that resembles a cherry when ripe. The bark has a hydrocyanic acid–like scent and is the part of the plant used for medicinal purposes; the bark can be red, brown, or gray, with red often indicating a younger tree and darker colors indicating an older tree.Bruneton 1995, Chevallier 1996, Murray 1995 The bark also has the unique capability of regeneration as long as the vascular cambium is not destroyed.Allkanjari 2015
The hard wood of pygeum is valued in Africa and is often used to make wagons.Chevallier 1996 Powdered pygeum bark has been used by African tribes to treat urinary problems.Chevallier 1996, Murray 1995 Increased harvesting of pygeum has placed the tree at risk. Other Prunus spp. are being investigated for use as pygeum substitutes, with some success demonstrated in rats with induced BPH.Jena 2016
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 bound to n-tetracosanol and n-docosanol.Murray 1995 N-docosanol has been used in some commercial products.Murray 1995 Phytosterols present in pygeum include beta-sitosterol, beta-sitosterone, and campesterol.Bruneton 1995, Chevallier 1996, Longo 1983, Murray 1995 Tannins have also been found in the plant.Chevallier 1996 The highest activity is in the lipophilic extracts of the plant; these extracts are standardized to contain 14% triterpenes and 0.5% n-docosanol.Murray 1995
Uses and Pharmacology
P. africana extract has been used in Europe for the treatment of enlarged prostate and may possess antiproliferative, anti-inflammatory, and antiestrogenic effects.(Cheetham 2013) Its benefits in BPH may be due to an ability to prevent the binding of dihydrotestosterone in the prostate gland and/or inhibit 5-alpha reductase and aromatase.(van Wyk 2004) Other proposed mechanisms include inactivation of androgen receptors via blocking of nuclear translocation; inhibition of cellular growth factors; anti-inflammatory activity via inhibition of 5-lipoxygenase; increases in bladder elasticity; histological modification of glandular cells; and inhibition of prolactin levels and consequently blocked accumulation of cholesterol in the prostate.(Bruneton 1995, Keehn 2015, Pagano 2014) Pygeum’s anti-inflammatory properties and ability to inhibit cellular growth factors and inactivate androgen receptors may be attributed to the active compounds N-N-butylbenzenesulfonamide and atraric acid.(Keehn 2016) Pygeum may also exert protective effects in the bladder by reducing the deleterious effects of free radicals and degradative enzymes.(Allkanjari 2015, Pagano 2014)
The ferulic acid ester components are responsible for pygeum's endocrine system activity. N-docosanol reduces leutinizing hormone, testosterone, and prolactin levels. Accumulation of testosterone within the prostate and subsequent conversion to the more potent form (dihydrotestosterone) is believed to be a major factor in prostatic hyperplasia. The phytoestrogenic action of P. africana extract markedly reduces the volume of prostatic hypertrophy.(Mathé 1995) Fat-soluble components reduce cholesterol content in the prostate as well, decreasing accumulation of cholesterol metabolites.(Murray 1995)
Beta-sitosterol may be responsible for pygeum’s effects against prostatic adenomas.(Russo 2013, van Wyk 2004) Specifically, beta-sitosterol may affect membrane structure and function of tumor and host tissues, signal transduction pathways that regulate tumor growth, and apoptosis.(Shenouda 2007)
Animal and in vitro data
P. africana extract has demonstrated positive effects in animal hypophyseo-genito-adrenal axis and prostatic adenoma.(Thieblot 1971, Thieblot 1977) Pretreatment of rabbits with pygeum reduced partial outlet obstruction in bladder dysfunction secondary to BPH.(Levin 1997)
Gland size reduction has also been reported. In one study, P. africana extract was a potent inhibitor of rat prostatic fibroblast proliferation.(Yablonsky 1997) The extract also displays anti-inflammatory activity, which may affect gland size. In an in vitro study, P. africana extract inhibited growth of PC-3 (androgen insensitive) and LNCaP (androgen sensitive) cells at a 50% inhibitory concentration of 2.5 mcL/mL for both cell lines. In addition, P. africana extract induced apoptosis and downregulated estrogen receptor alpha protein expression in PC-3 cells and protein kinase C alpha protein expression in LNCaP cells. Beta-sitosterol inhibited growth of only LNCaP cells, not PC-3 cells.(Shenouda 2007)
In vitro, the N-butylbenzene-sulfonamide (NBBS) component of P. africana exhibited antagonistic activity against human androgen receptors, which are known to control prostate growth; NBBS inhibited translocation of the receptors to the cell nucleus and inhibited growth of human prostate cancer cells.(Papaioannou 2010)
In a murine model, mice fed P. africana extract for 5 months experienced a significant reduction in the incidence of prostate cancer compared with mice fed casein (35% vs 62.5%, P=0.034).(Shenouda 2007)
Most clinical trial results report improvement of BPH symptoms. Reduction in gland size and other parameters occur but are not as profound.(Murray 1995)
In clinical trials, relief from BPH symptoms with use of P. africana extract has been documented.(Barlet 1990, Bassi 1987, Carani 1991, Casella 1978, DuFour 1984, Flamm 1979, Krzeski 1993, Menchini-Fabris 1988) The extract, in combination with mepartricin, was successful in treating urinary symptomatology in 22 subjects with varying stages of prostatic adenoma.(Casella 1978) In one study (N=74), all subjects treated with phytotherapy (containing an extract of either Sabal serrulatum or P. africana) or testosterone reported alleviation of obstructive bladder symptoms caused by BPH.(Flamm 1979) In a placebo-controlled trial, P. africana extract improved symptoms of nocturnal frequency, difficulty in initiating urination, and bladder fullness compared with placebo.(DuFour 1984) In a placebo-controlled, double-blind, multicenter evaluation (263 patients in 8 locations) in which 50 mg capsules of P. africana extract were given twice daily for 60 days, 66% of patients treated with P. africana extract (vs 31% of placebo patients) showed marked clinical improvement in micturition disorders.(Barlet 1990) In another report, high-dose P. africana extract (200 mg/day) administered to 18 patients for 60 days improved urinary symptoms and sexual behavior.(Carani 1991) A combined extract of P. africana/Urtica dioica administered at half the standard dose was as safe and effective as the full dose (U. dioica 300 mg and P. africana extract 25 mg) and significantly reduced urine flow, residual urine, and nycturia in patients with BPH.(Krzeski 1993) In a 2013 sponsor-funded, phase 2, placebo-controlled, randomized clinical trial (N=57) conducted in men with BPH, a commercially available herbal formulation containing pumpkin seed oil, lycopene, saw palmetto, pygeum, and Epilobium parviflorum reduced median International Prostate Symptom Score, as well as daytime and nighttime urinary frequency. Improvements were progressive and were observed in several scores at 1 month and in all scores at 3 months.(Coulson 2013)
The American Urology Association's updated guideline for the management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (2021) could not make any positive recommendations about supplements and nutraceuticals, including pygeum africanum, due to variable results, methods, and quality of studies.(Lerner 2021) The European Association of Urology's 2022 updated guideline on management of non-neurogenic male lower urinary tract symptoms (LUTS), including benign prostatic obstruction makes no specific recommendation but references the European Union herbal monograph for the traditional use of P. africana, cortex (pygeum africanum bark) for LUTS related to BPH, after serious conditions have been excluded. This use is based on sufficient safety data and plausible efficacy from long-standing use and experience.(Gravas 2022) A meta-analysis conducted to determine the efficacy and safety of P. africana extract compared with placebo included 18 trials in men (N = 1,562) with a mean study duration of 64 days (range, 30 to122 days). Men receiving P. africana extract were twice as likely to report symptom improvement (relative risk [RR], 2.1; 95% confidence interval [CI], 1.4 to 3.1). A 19% reduction in nocturia, 24% reduction in residual urine volume, and 23% improvement in peak urine flow were noted in men receiving P. africana extract. Adverse effects and dropout rates were similar between the extract and placebo groups.(Wilt 2002) In a study of 3 men with BPH undergoing prostatectomy and 3 men without BPH undergoing cystectomy, P. africana exerted antiproliferative and apoptotic effects against prostate fibroblasts and myofibroblasts but not smooth muscle cells.(Quiles 2010)
Macrophages (inflammatory cells) produce chemotactic mediators that may contribute to BPH development. One in vitro report suggested pygeum’s ability to antagonize 5-lipoxygenase metabolite production may contribute to its therapeutic activity on inflammatory components of BPH.(Paubert-Braquet 1994)
Pygeum may help reverse sterility, which can be caused by insufficient prostatic secretions.(Chevallier 1996) In one study, P. africana extract increased prostate secretions in both rats and humans.(Clavert 1986) It also improved seminal fluid composition.(Chevallier 1996) Thus by improving an underlying problem, P. africana extract may improve sexual function.(Carani 1991, Murray 1995)
When P. africana extract was compared with saw palmetto in a double-blind trial, saw palmetto produced a greater reduction of symptoms and was better tolerated; however, P. africana extract may have greater effects on prostate secretion.(Murray 1995)
In one study, men with chronic prostatitis were randomized to receive 15 days of an appropriate antibiotic (adjusted according to sensitivities) or an antibiotic plus 30 days of either saw palmetto 320 mg/day (n=51) or P. africana extract 200 mg/day (n=23), based on cost. The only statistically significant finding between the groups was regarding a lower chronic prostatitis symptom burden, according to National Institutes of Health Chronic Prostatitis Symptom Index questionnaire scores after the second follow-up visit, among patients receiving combination therapy compared to antibiotics alone.(Stamatiou 2014)
In an in vitro study, P. africana extract exerted cytotoxic effects against head and neck cancer cell systems.(Schmidt 2013) In another in vitro study, P. africana extract exerted antibacterial activity against Staphylococcus aureus and methicillin-resistant S. aureus.(Mwitari 2013)
Benign prostatic hyperplasia
25 to 200 mg/day of P. africana extract standardized to 14% total sterols.Barlet 1990, Breza 1998, Carani 1991, Chatelain 1999, Ishani 2000, Krzeski 1993, Wilt 2002 The usual dosage is 100 mg/day in 6- to 8-week cycles.van Wyk 2004
Pregnancy / Lactation
Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.
None well documented.
GI irritation (eg, nausea, constipation, diarrhea, stomach pain) has been documented, with only a small percentage of patients discontinuing therapy.Allkanjari 2015, Murray 1995 In one clinical trial (N=263), GI adverse effects occurred in 5 patients, with only 3 patients requiring discontinuation of treatment.Barlet 1990 In addition, pygeum may cause headache.Allkanjari 2015, Keehn 2015 It is recommended that pygeum be taken only under physician supervision.Chevallier 1996
A low incidence of toxicity has been demonstrated. An animal study demonstrated kidney, skeletal muscle, and/or cardiac muscle as likely targets for P. africana toxicity with 1-month administration leading to significant increases in body weight gain, serum creatinine, lactate dehydrogenase, and total hepatic protein content.(Duborija-Kovacevic 2019)
- Pygeum africanum
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