Pygeum (Prunus africanum, Pygeum africanum)
  
Pygeum (Prunus africanum, Pygeum africanum)
Background
The P. 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 micturition (urination) disorders, particularly symptoms associated with benign prostatic hypertrophy (BPH). 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 P. africanum extract.
The majority of trials conducted since the 1970s report improvements in BPH symptoms with the administration of P. africanum bark extract, including frequency of nocturia (nighttime urination), urine flow rate, and residual urine volume. 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.
Synonyms
African plum tree, African prune tree, African P. africanum extract, alumty, iluo, kirah, Natal tree, Pigeum africanum, Pigenil®, Pronitol®, Provol®, prunier d'afrique, Pygeum africana , Rosaceae (family) , Tadenan®, V1326, vla, wotangue.
Evidence
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.
Uses based on scientific evidenceGrade*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 controlled trials in humans (1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23), and studies that combine the results of other research (meta-analyses) (1;24;25), report pygeum to significantly reduce the number of nighttime urinary episodes (nocturia), urinary hesitancy, urinary frequency, and dysuria (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 (such as alpha-adrenergic blockers or 5-alpha reductase inhibitors), surgical approaches, or other herbs/supplements such as saw palmetto ). Although many of the available studies are not well designed or reported, the weight of scientific evidence supports the benefits of pygeum. Better research would strengthen the scientific support for this therapy, and there is ongoing study in this area. It is recommended that patients with BPH speak with their healthcare provider about the various available treatment options. Most studies have used the European brand Tadenan®. The mechanism of action of pygeum remains unclear. Early research reports reductions in urethral obstruction and improved bladder function (17;26;27;28;29). Laboratory studies report inhibition of enzymes including 5-lipoxygenase (30) or 5α-reductase (31), a mechanism similar to the prescription drug finasteride. Stimulation of secretory activity of the prostate and seminal vesicles is reported in rats and humans (32;33), and some estrogen-like properties are noted (34), as well as anti-inflammatory properties (35).
B
* 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).
Uses based on tradition or theory
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 healthcare provider.
Aphrodisiac, bladder sphincter disorders, fever, impotence, inflammation, kidney disease, malaria, male baldness, partial bladder outlet obstruction, prostate cancer, prostatic adenoma, prostatitis, psychosis, sexual performance, stomach upset, urinary tract health.
Dosing
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.
Standardization:
The active component(s) of P. africanum bark extract have not been identified.
Tadenan® (Laboratoires DEBAT, Garches, France), the most popular and commonly studied brand in Europe, is a lipophilic extract of P. africanum standardized to 13% total sterols. Other guidelines specify standardization to 14% triterpenes with 0.5% n-docosanol (3). One capsule of Tadenan® contains 50mg of standardized extract.
Other studied brands include Pigenil® (Inverni della Beffa, Milan, Italy), Harzol® (Hoyer, Germany), and Prostatonin® (Pharmaton SA, Lugano, Switzerland). Some brands may contain other herbs in addition to pygeum.
Safety of use of pygeum beyond 12 months has not been reliably studied.
Adults (18 years and older):
Capsules: 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 used and studied.
Children (younger than 18 years):
There are not enough scientific data to recommend pygeum for use in children, and pygeum is not recommended because of potential side effects.
Safety
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.
Allergies
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) (1;24;25). 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 (2;4).
Safety of use beyond 12 months has not been reliably studied.
Pregnancy and Breastfeeding
Pygeum cannot be recommended during pregnancy or breast-feeding because of a lack of scientific information and possible hormonal effects.
References
1. Andro M, Riffaud J. 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(8):796-817.
2. 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]. Wien Klin Wochenschr 1990;102 (22) :667-673.
3. Bassi P, Artibani W, De L, V, et al. [Standardized extract of Pygeum africanum in the treatment of benign prostatic hypertrophy. Controlled clinical study versus placebo]. Minerva Urol Nefrol 1987;39(1):45-50.
4. 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 1995;345(8964):1529-1532.
5. Blitz M, Garbit JL, Masson JC, et al. [Controlled study on the effect of a medical treatment on subjects consulting for the first time for prostatic adenoma]. Lyon Mediterr Med 1985;21:11.
6. Bongi G. [Tadenan in the treatment of prostatic adenoma. Anatomo-clinical study]. Minerva Urol 1972;24(4):129-139.
7. 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.
8. 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.
9. 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.
10. 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.
11. Dufour B, Choquenet C, Revol M, et al. [Controlled study of the effects of Pygeum africanum extract on the functional symptoms of prostatic adenoma]. Ann Urol (Paris) 1984;18(3):193-195.
12. Dutkiewicz S. Usefulness of Cernilton in the treatment of benign prostatic hyperplasia. Int Urol Nephrol 1996;28(1):49-53.
13. Frasseto G, Bertoglio S, Mancuso S, et al. [Study of the efficacy and tolerability of Tadenan 50 in patients with prostatic hypertrophy]. Progresso Medico 1986;42:49-53.
14. Gagliardi V, Apicella F, Pino P, et al. Terapia medica dell'ipertrofia prostatica. Sperimentazione clinica controllata. Arch Ital Urol Nefrol Andrologia 1983;55:51-59.
15. Giacobini S, von Heland M, de Natale G, et al. Valutazione clinica e morfo-funzionale del trattamento a doppio cieco con placebo, Tadenan 50 e Tadenan 50 associato a Farlutal nei pazienti con ipertrofia prostatica benigna. Antologia Medica Italiana 1986;6:1-10.
16. 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.
17. Levin RM, Riffaud JP, Bellamy F, et al. Protective effect of Tadenan on bladder function secondary to partial outlet obstruction. J Urol 1996;155(4):1466-1470.
18. Mandressi A, Tarallo U, Maggioni A, et al. Terapia medica dell'adenoma prostatico: confronto della efficacia dell'estratto di Serenoa repens (Permixon) versus l'estratto di Pigeum africanum e placebo. Valutazione in doppio cieco. Urologia 1983;50(4):752-757.
19. Maver A. [Medical treatment of fibroadenomatous hypertrophy of the prostate with a new plant substance]. Minerva Med 1972;63(37):2126-2136.
20. Mehrsai AR, Pourmand G, Taheri M. Evaluation of the clinical and urodynamic effects of Pygeum africanum (Tadenan) in the treatment of benign prostatic hyperplasia (BPH) [abstract]. Br J Urol 1997;80(suppl 2):227.
21. Ranno S, Minaldi G, Viscusi G, et al. [Efficacy and tolerability in the treatment of prostatic adenoma with Tadenan 50]. Progresso Medico 1986;42:165-169.
22. Rigatti P, Zennaro F, Fraschini O, et al. L'impegio del Tadenan nell'adenoma prostatico. Ricerca clinica controllata. Atti della Accademia medica lombarda 1983;38:1-4.
23. 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.
24. Wilt T, Ishani A, Mac DR, et al. Pygeum africanum for benign prostatic hyperplasia (Cochrane Review). Cochrane Database Syst Rev 2002;(1):CD001044.
25. 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 2000;109(8):654-664.
26. Levin RM, Das AK. A scientific basis for the therapeutic effects of Pygeum africanum and Serenoa repens. Urol Res 2000;28(3):201-209.
27. Choo M, Constantinou CE, Bellamy F. Beneficial effects of Pygeum africanum extract (PA) on dihydrotestosterone (DHT) induced modifications of micturition and prostate growth in rat [abstract]. J Urology 1999;161(4S):229.
28. Choo MS, Bellamy F, Constantinou CE. Functional evaluation of Tadenan on micturition and experimental prostate growth induced with exogenous dihydrotestosterone. Urology 2000;55(2):292-298.
29. Yoshimura Y, Yamaguchi O, Bellamy F, et al. Effect of Pygeum africanum tadenan on micturition and prostate growth of the rat secondary to coadministered treatment and post-treatment with dihydrotestosterone. Urology 2003;61(2):474-478.
30. Paubert-Braquet M, Cave A, Hocquemiller R, et al. Effect of Pygeum africanum extract on A23187-stimulated production of lipoxygenase metabolites from human polymorphonuclear cells. J Lipid Mediat Cell Signal 1994;9(3):285-290.
31. 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(1):43-51.
32. Thieblot L, Grizard G, Boucher D. [Effect of V 1326 (active principle of Pygeum africanum bark extract) on hypophyseo-genito-adrenal axis in rats]. Therapie 1977;32(1):99-110.
33. Clavert A, Cranz C, Riffaud JP, et al. [Effects of an extract of the bark of Pygeum africanum (V.1326) on prostatic secretions in the rat and in man]. Annales D'Urologie 1986;20(5):341-343.
34. Mathe G, Orbach-Arbouys S, Bizi E, et al. The so-called phyto-estrogenic action of Pygeum africanum extract. Biomed Pharmacother 1995;49(7-8):339-340.
35. Yablonsky F, Nicolas V, Riffaud JP, et al. Antiproliferative effect of Pygeum africanum extract on rat prostatic fibroblasts. J Urol 1997;157(6):2381-2387.
36. Mathe G, Hallard M, Bourut CH, et al. A Pygeum africanum extract with so-called phyto-estrogenic action markedly reduces the volume of true and large prostatic hypertrophy. Biomed Pharmacother 1995;49(7-8):341-343.
January 01, 2004 
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