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Pygeum (Prunus africanum, Pygeum africanum)

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BackgroundReturn to top

The  Pygeum 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 urination disorders, particularly symptoms associated with benign prostatic hypertrophy (BPH), which is an enlarged prostate. 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  Pygeum africanum  extract.

The majority of trials conducted since the 1970s report improvements in BPH symptoms, including frequency of nighttime urination, urine flow rate, and left over urine volume, with the administration of  Pygeum africanum  bark extract. 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.

SynonymsReturn to top

African cherry, African  P .  africanum  extract, African plum tree, African prune tree, African stinkwood, alumty, bitter almond, bitteramandel, ciruelo africano (Spanish), ferulic acid esters of fatty acids, gwabuzito (Uganda), gwane (African), gyabazito (Uganda), Harzol®, iluo, kiburraburra (Swahili), kirah, kotofihy (Madagascar), lluo, mgambo (Swahili), mkomahoya (Swahili) mkonohoyo, mseneo, muchambati, muchati, mueri, muiri, mutimailu, Natal tree, ntasesa (Uganda), ol-koijuk (Tanzania), olkonjuku (Tanzania), phytoesterols, Pigenil®,  Pigeum africanum , Pronitol®, Prostatonin®, Provol®, prunier d'afrique,  Pygeum africana , red stinkwood, rooistinkhout (Afrikaans), Rosaceae (family), Tadenan®, tenduet (Kenya), umDumizula (South Africa), triterpenes, umkakase (Xhosa), V1326, vla, wotangue (Bakweri).

EvidenceReturn to top

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 human studies report that pygeum significantly reduces urinary hesitancy, urinary frequency, the number of times patients need to wake up at night to urinate, and 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 (eg. alpha-adrenergic blockers or 5-alpha reductase inhibitors), surgical approaches, or other herbs/supplements such as saw palmetto. There is ongoing study in this area. Patients with urinary symptoms or BPH should speak with their healthcare professional about the various available treatment options.

*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;
F: Strong scientific evidence against this use.

Grading rationale

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, cancer, fever, impotence, inflammation, kidney disease, malaria, male baldness, mental disorders, partial bladder outlet obstruction, prostate cancer, prostatic adenoma, prostatitis, psychosis, sexual performance, stomach upset, urinary tract health.

DosingReturn to top

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.

Adults (18 years and older)
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 studied. One clinical human trial has shown that  Pygeum africanum  and stinging nettle ( Urtica dioica ), when used in combination, were efficient in treating benign prostatic hypertrophy and its symptoms.

Children (younger than 18 years)
There are not enough scientific data to recommend pygeum for use in children and there are potential side effects.

SafetyReturn to top

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.

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). 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.

Safety of use beyond 12 months has not been reliably studied.

Pregnancy and Breastfeeding
Pygeum cannot be recommended during pregnancy or breastfeeding because of a lack of scientific information and possible hormonal effects.

InteractionsReturn to top

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. 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.

Interactions with Drugs
Use of pygeum with other drugs commonly used to treat symptoms of prostate enlargement, called 5-alpha-reductase inhibitors, such as terazosin (Hytrin®) or finasteride (Propecia®, Proscar®), may increase beneficial effects, although this is not well studied.

In theory, pygeum may interact with estrogen or other drugs with hormone activity (birth control pills).

Interactions with Herbs and Dietary Supplements
Pygeum may result in increased beneficial effects for the prostate if used with saw palmetto ( Serenoa repens ) or stinging nettle ( Urtica dioica ). Combination products are available containing both stinging nettle and pygeum.

Pygeum may interact with herbs/supplements containing chemicals with estrogen-like effects ("phytoestrogens").

Methodology Return to top

This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration ( Tracee Rae Abrams, PharmD (University of Rhode Island); Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Ivo Foppa, MD, ScD (Harvard School of Public Health); Jenna Hollenstein, MS, RD (Natural Standard Research Collaboration); Regina Gorenshteyn (Biogen Idec); Beth N. Kerbel, PharmD (Northeastern University); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Mamta Vora, PharmD (Northeastern University); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods, BS (Northeastern University).

Methodology details

Selected references Return to top

  1. 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 6-17-1995;345(8964):1529-1532.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. Hutchison A, Farmer R, Verhamme K, et al. The efficacy of drugs for the treatment of LUTS/BPH, a study in 6 European countries. Eur Urol 2007;51(1):207-15; discussion 215-6.
  7. 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 12-1-2000;109(8):654-664.
  8. 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.
  9. 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.
  10. Melo EA, Bertero EB, Rios LA, et al. Evaluating the efficiency of a combination of Pygeum africanum and stinging nettle (Urtica dioica) extracts in treating benign prostatic hyperplasia (BPH): double-blind, randomized, placebo controlled trial. Int Braz J Urol 2002;28(5):418-425.
  11. Natural Standard Research Collaboration, Chief Editors: Ulbricht C, Basch E, Natural Standard Herb and Supplement Reference - Evidence-Based Clinical Reviews, USA: Elsevier/Mosby, 2005.
  12. 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.
  13. Shenouda NS, Sakla MS, Newton LG, et al. Phytosterol Pygeum africanum regulates prostate cancer in vitro and in vivo. Endocrine 2007;31(1):72-81.
  14. Strong KM. African plum and benign prostatic hypertrophy. J Herb Pharmacother 2004;4(1):41-46.
  15. Wilt T, Ishani A, Mac Donald R, et al. Pygeum africanum for benign prostatic hyperplasia (Cochrane Review). Cochrane Database Syst Rev 2002;(1):CD001044.

February 01, 2008.

Natural Standard Logo This evidence-based monograph was prepared by the Natural Standard Research Collaboration. The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Talk to your health care provider before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Copyright© 2008 Natural Standard ( All Rights Reserved.