Case Reports of Toxicity Caused By Saw Palmetto Products

A case of toxicity associated with the use of Prostata®, a preparation containing saw palmetto, zinc picolinate, pyridoxine, L-alanine, glutamic acid,

Apis mellifica pollen, silica, hydrangea extract, Panax ginseng, and Pygeum africanum, was reported in the Annals of Internal Medicine (27).

A 65-year-old man developed acute and protracted cholestatic hepatitis after taking Prostata. The man stopped taking the product after 2 weeks of use because he developed jaundice and severe pruritus. On physical exam, the patient's abdomen was not tender and his liver and spleen were not palpable. Lab results were as follows: bilirubin 8.2 mg/dL, aspartate aminotransferase 1238 IU/L, alanine aminotransferase 1364 IU/L, alkaline phosphatase 179 IU/L, y-glutamyl transferase 391 IU/L, hematocrit 41%, leukocyte count 3.3 x 103/mm3, platelet count 153,000 cells/mm3, serum protein 6.3 g/dL, albumin 3.6 g/dL, carcinoembryonic antigen less than 2 mg/^L. Serological testing was negative for hepatitis A virus immunoglobulin M (IgM), hepatitis B surface antigen, cytomegalovirus IgM, and hepatitis C virus antibodies. The patient was negative for antinuclear antibodies and antismooth muscle antibodies, but positive for antimitochondrial antibodies. Liver enzyme levels remained abnormal for more than 3 months. Liver biopsy was done after 2 months and showed parenchymal infiltrate of neutrophils and lymphocytes that involved the portal tracts, early bridging, and mild periportal fibrosis. There was no evidence of bile duct damage, cirrhosis, or granulomas. The authors postulated that the patient's cholestasis was an extension of saw palmetto's estrogenic or antiandrogen effect.

In another case report, a 53-year-old white male with meningioma developed intraoperative hemorrhage during surgery for resection of the tumor (28). During the surgery, the patient began experiencing substantial bleeding that was difficult to control. The patient was given 4 L of crystalloid fluids, 4 U of packed red blood cells, 3 U of pooled platelets, and 3 U of fresh frozen plasma. The estimated blood loss was approx 2000 mL. The patient had not received any preoperative thromboprophylaxis and all clotting tests were normal prior to the procedure. However, after surgery, the bleeding time was several times longer than normal and eventually became normal after 5 days. No medications that could have resulted in excessive bleeding were discovered as being taken; however, upon further questioning the patient disclosed that he had been taking saw palmetto for BPH, but had not mentioned it to the physician. A conclusive cause-effect relationship was not established, however.

0 0

Post a comment