About Herbs, Botanicals & Other Products

Scientific Name
Pygeum africanum, Prunus africana
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Common Name

African plum tree

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Brand Name

Tadenan®

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Clinical Summary

Derived from the bark of the tree, pygeum extracts are traditionally used to manage lower urinary tract symptoms associated with benign prostatic hypertrophy (BPH).
In vitro and in vivo studies indicate that pygeum extracts antagonize androgen receptor (7), and have antiproliferative and apoptotic effects against prostate cancer cells (8) (9) (10).
Clinical studies suggest improvement in urinary symptoms associated with BPH (4) (5) (6) (11). However, additional larger studies are needed to demonstrate usefulness of pygeum compared to standard treatments in current use for BPH.

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Purported Uses
  • Benign prostatic hypertrophy (BPH)
  • Inflammation
  • Sexual performance
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Constituents
  • Triterpenes (14%): Oleanolic, crataegolic, and ursolic acids
  • Ferulic acid
  • Phytosterols: Beta-sitosterol, beta-sitosterone and campesterol
  • Tannins
    (1)
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Mechanism of Action

Phytosterols present in pygeum compete with androgen precursors and also inhibit prostaglandin biosynthesis thereby reducing inflammation. The triterpenes exhibit anti-inflammatory activity in vitro and ferulic acid esters were shown to reduce the level of cholesterol in the prostate, thereby limiting androgen synthesis. The phytosterol and triterpene components appear to work synergistically to improve the symptoms of BPH (2). Atraric acid and N-butylbenzene-sulfonamide, compounds isolated from Pygeum, have been identified as antagonists of androgen receptor, which plays an important role in development of prostate diseases (12).

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Adverse Reactions
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Herb-Drug Interactions

None reported

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Literature Summary and Critique

Ishani A, et al. Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis. Am J Med 2000;109:654-64.
A total of 18 randomized, controlled trials involving 1,562 men were analyzed. Seventeen of the studies were double-blind. The mean study duration was 64 days. Compared with placebo in 6 studies, Pygeum africanum provided a moderately large improvement in the combined outcome of urologic symptoms and flow measures. Nocturia was reduced by 19% and residual urine volume by 24%; peak urine flow increased by 23%. Adverse effects due to Pygeum africanum were similar to those of placebo.

Brackman F, et al. 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;54:473-8.
In a randomized, double-blind, placebo-controlled study of 209 men with BPH, once and twice daily dosages of pygeum were evaluated. The results showed that both dosages significantly decreased International Prostate Symptom Scores (IPSS), nocturia, and improved quality of life by approximately 44%, 12%, and 36%, respectively. No differences in clinical efficacy were observed.

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References
  1. Foster S, et al. Tyler’s Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. New York: Haworth Herbal Press; 1999.
  2. Schulz V, et al. Rational Phytotherapy: A Physicians Guide to the Use of Herbs and Related Remedies, 3rd ed. Berlin (Germany): Springer; 1998.
  3. Fagelman E, Lowe FC. Herbal medications in the treatment of benign prostatic hyperplasia (BPH). Urol Clin N Am 2002;29:23-9.
  4. Ishani A, et al. Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis. Am J Med 2000;109:654-64.
  5. Brackman F, et al. 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;54:473-8.
  6. Barlet 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 Wochenshr 1990;102:667-73.
  7. Papaioannou M, Schleich S, Prade I, et al. The natural compound atraric acid is an antagonist of the human androgen receptor inhibiting cellular invasiveness and prostate cancer cell growth. J Cell Mol Med. 2009 Aug;13(8B):2210-23.
  8. Boulbès D, Soustelle L, Costa P, et al. Pygeum africanum extract inhibits proliferation of human cultured prostatic fibroblasts and myofibroblasts. BJU Int. 2006 Nov;98(5):1106-13.
  9. Shenouda NS, Sakla MS, Newton LG, et al. Phytosterol Pygeum africanum regulates prostate cancer in vitro and in vivo. Endocrine. 2007 Feb;31(1):72-81.
  10. Quiles MT, Arbós MA, Fraga A, et al. Antiproliferative and apoptotic effects of the herbal agent Pygeum africanum on cultured prostate stromal cells from patients with benign prostatic hyperplasia (BPH). Prostate. 2010 Jul 1;70(10):1044-53.
  11. Wilt T, Ishani A, Mac Donald R, Rutks I, Stark G. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(1):CD001044.
  12. Roell D, Baniahmad A. The natural compounds atraric acid and N-butylbenzene-sulfonamide as antagonists of the human androgen receptor and inhibitors of prostate cancer cell growth. Mol Cell Endocrinol. 2011 Jan 30;332(1-2):1-8.
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How It Works

Bottom Line: Pygeum africanum relieves the symptoms of benign prostatic hypertrophy (BPH), but whether long term use is safe is not known.

Several compounds present in Pygeum africanum reduce inflammation by stopping the production of prostaglandins, indicators of inflammation in the body. These compounds also work synergistically to reduce levels of testosterone in the prostate. This is why Pygeum is used to treat benign prostatic hypertrophy (BPH), in which growth of the prostate is enhanced by testosterone.

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Purported Uses
  • To treat benign prostatic hypertrophy (BPH)
    Several clinical trials show that Pygeum africanum is effective in improving urination symptoms and flow in patients with BPH. Few of these clinical trials have studied the use of pygeum for longer than two months, however, so the long-term effectiveness and safety of this herb is not certain.
  • To reduce inflammation
    Laboratory studies show that chemicals in pygeum have anti-inflammatory effects, but there is no proof from clinical trials that this effect occurs in humans.
  • To improve sexual performance
    No scientific evidence supports this use. Pygeum africanum might actually counter the effects of testosterone in the body.
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Research Evidence

Benign prostatic hypertrophy (BPH):
A meta-analysis, which is a systematic review of all of the clinical trials that have been performed with a therapy, looked at the use of Pygeum africanum to treat benign prostatic hypertrophy (BPH). In six out of the 18 randomized, controlled trials that were analyzed, Pygeum africanum was more effective at relieving urinary symptoms than a placebo pill, with no major side effects. For example, nocturia (needing to urinate at night) was reduced by 19% and urine flow increased by 23%.

A clinical trial studied the effects of pygeum extract on 209 men with benign prostatic hypertrophy (BPH). The men were randomly assigned to take either 50 mg of pygeum twice a day or 100 mg once a day. After two months, both groups had improvements in prostate symptoms, quality of life, and nocturia (needing to urinate at night). However, this study does not have a control group taking a placebo pill to which the researchers could compare these results.

In a clinical trial conducted at many different hospitals, 263 men with benign prostatic hypertrophy (BPH) were given either 50 mg of pygeum twice a day or a placebo pill. After two months, men taking pygeum had a significant improvement in urination symptoms and flow compared to men taking the placebo.

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Patient Warnings
  • This product is regulated by the FDA as a dietary supplement. Unlike approved drugs, supplements are not required to be manufactured under specific standardized conditions. This product may not contain the labeled amount or may be contaminated. In addition, it may not have been tested for safety or effectiveness.
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Side Effects
  • Nausea
  • Stomach upset
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Special Point
  • When used for benign prostatic hypertrophy (BPH), it may take several weeks for you to see any beneficial effects.
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Dosage (Inside MSKCC Only)
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Aliases
Tadenan®
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E-mail your questions and comments to aboutherbs@mskcc.org.
Last updated: September 28, 2011