Men's Health Flashcards
What is phytosterol/ beta-sitosterol?
- Plant sterol (steroid alcohol)
- Found in variety of plants like vegetable oil, nuts, and avocados
Active component of phytosterol?
Beta-sitosterol/ phytosterol
Medicinal uses of phytosterol
BPH tx
Mechanism of action of phytosterol for BPH
May involve inhibition of 5-alpha-reductase activity, which converts testosterone to dihydrotestosterone
Safety of phytosterol
- Considered “likely safe” when used orally and appropriately
- Shown to be safe for 18 months of tx
Efficacy of phytosterol
- “Likely effective” for treating BPH
- Shown to significantly improve urinary sx, increase urine flow, and decrease postvoid residual urine volume
- Doesn’t affect prostate size
Drug interactions w/ phytosterol
- Ezetimibe - inhibits intestinal absorption of beta-sitosterol
- Pravastatin - decreases beta-sitosterol blood levels (don’t know if occurs w/ other statins; doesn’t occur w/ simvastatin)
Contraindications to phytosterol use
Px w/ sitosterolemia (rare inherited lipid storage disease) - can increase absorption and decrease clearance of beta-sitosterol
Is phytosterol recommended for clinical use?
Well-tolerated w/ few adverse effects and contraindications, and shown to improve urinary sx so can be recommended
What does saw palmetto come from?
- Palm tree in North America w/ saw-toothed edges
- Berries are dried for medicinal use; purified lipid-soluble extract of the berry contains the active ingredients
What is the difference between the preparation of saw palmetto for clinical studies compared to commercial products?
- Clinical studies use extracts prepared w/ lipophilic, non-polar solvents containing 80-90% fatty acids
- Commercial products don’t have the same lipophilic content, so may not have same efficacy
Saw palmetto is composed of ____. Which component is most active?
- Free fatty acids
- Phytosterols
- Long-chain alcohols
- Unknown which is most active
What is thought to provide the benefit of saw palmetto?
- Sitosterol
- One of the steroidal compounds found in the plant that has anti-androgenic and oestrogenic activity
Medicinal uses of saw palmetto
- BPH tx
- Tx of prostatitis, chronic pelvic pain syndrome, and prostate cancer (along w/ other herbs)
Proposed anti-androgenic MOA for saw palmetto
- Non-competitive inhibitor of 5-alpha-reductase to prevent conversion of testosterone to dihydrotestosterone
- This may reduce prostate growth
- Saw palmetto not proven to reduce levels of 5-alpha-reductase
Proposed anti-proliferative MOA for saw palmetto
May inhibit fibroblast growth factor & epidermal growth factor to slow prostate cell proliferation, skin inner prostatic epithelia, and facilitate apoptosis
Proposed anti-inflammatory MOA for saw palmetto
Inhibition of lipoxygenase and cyclooxygenase which induce anti-inflammatory effects
How can saw palmetto be prepared?
- Dried
- Powder
- Non-standardized extracts (dry extract, fluid extract, decoction, infusion)
Safety of saw palmetto
- “Likely safe” when used in oral preparations up to 3 years
- Long-term use of rectal preparations isn’t well studied and safety is unknown
Effectiveness of saw palmetto
- Use and efficacy is poorly understood
- Lacks clinical evidence to demonstrate effective use
- Cochrane review showed saw palmetto is no more effective than placebo in relieving urinary sx or increasing urinary flow
Drug interactions w/ saw palmetto
- Hormonal activity of saw palmetto could interact w/ oral contraceptives and hormone therapy
- May increase bleeding w/ antiplatelets and anticoagulants
Contraindications to saw palmetto use
Advise to d/c saw palmetto 2 weeks prior to surgery
Is saw palmetto recommended for clinical use?
Not recommended b/c not proven to be superior to placebo
What is pygeum?
Bark extracted from African Plum tree (native to Africa)
