When is Serenoa repens (Saw Palmetto) contraindicated?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Article Review Status
Submitted
Under Review
Approved

Last updated: March 27, 2025 • View editorial policy

From the Guidelines

Saw palmetto is contraindicated in individuals with certain medical conditions, such as hormone-sensitive cancers, and those taking certain medications, including blood thinners, due to potential interactions and increased risk of bleeding, as evidenced by the most recent study published in 2021 1. When considering the use of saw palmetto, several factors must be taken into account to minimize potential risks.

  • Individuals with hormone-sensitive conditions, such as breast cancer, prostate cancer, or endometriosis, should avoid saw palmetto as it may affect hormone levels.
  • Those taking blood thinners, like warfarin or aspirin, hormone medications, including birth control pills or hormone replacement therapy, or medications metabolized by the liver, should consult their healthcare provider before using saw palmetto due to potential interactions.
  • People scheduled for surgery should stop taking saw palmetto at least two weeks before the procedure, as it may increase bleeding risk, a recommendation supported by the Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement 1.
  • Additionally, individuals with liver disease should exercise caution when considering saw palmetto. While saw palmetto is generally considered safe for most adults when taken in recommended doses, typically 160-320 mg daily of standardized extract, it can cause side effects including headache, dizziness, nausea, and digestive issues. Always inform your healthcare provider about all supplements you're taking to avoid potential drug interactions, as emphasized in a critical review on the use of dietary supplements in living kidney donors 2.

From the Research

Contraindications of Serenoa repens (Saw Palmetto)

  • Serenoa repens, commonly known as Saw Palmetto, is contraindicated in certain situations due to its potential to cause adverse effects.
  • The use of Saw Palmetto may be contraindicated in patients with a history of bleeding disorders or those taking anticoagulant medications, as it may increase the risk of bleeding 3, 4.
  • Saw Palmetto may also be contraindicated in patients with a history of pancreatitis, as there have been reports of acute pancreatitis associated with its use 5, 6.
  • Additionally, patients with certain medical conditions, such as diabetes, hypertension, and hyperlipidemia, should use Saw Palmetto with caution and under medical supervision, as it may interact with other medications or exacerbate these conditions 6.

Potential Interactions and Side Effects

  • Saw Palmetto may interact with certain medications, including blood thinners, and increase the risk of bleeding 3, 4.
  • The use of Saw Palmetto has been associated with mild gastrointestinal side effects, such as nausea and abdominal pain 5, 7.
  • In rare cases, Saw Palmetto may cause more serious side effects, including acute pancreatitis and coagulopathy 5, 6, 3.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.