Saw Palmetto and Myalgia
Myalgia (muscle pain) is not a commonly reported or established side effect of saw palmetto (Serenoa repens) based on available clinical evidence.
Evidence from Clinical Trials and Safety Reviews
The most comprehensive safety assessment of saw palmetto found that adverse events are generally mild and similar to placebo 1. The most frequently reported adverse events include abdominal pain, diarrhea, nausea, fatigue, headache, decreased libido, and rhinitis—but myalgia is notably absent from this list 1.
In 26 randomized controlled trials, 4 non-randomized controlled trials, and 6 uncontrolled trials reviewed systematically, muscle pain or myalgia was not identified as a significant adverse event associated with saw palmetto use 1.
A large double-blind trial of 225 men treated with saw palmetto (160 mg twice daily) for one year found that the incidence of side effects was similar between saw palmetto and placebo groups, with no specific mention of myalgia 2.
Perioperative Bleeding Concerns (Not Myalgia)
It's important to distinguish between different types of adverse effects. The primary safety concern with saw palmetto relates to potential bleeding complications, not musculoskeletal symptoms 3.
The Society for Perioperative Assessment and Quality Improvement recommends holding saw palmetto for 2 weeks before surgery due to concerns about increased bleeding time and risk of hematuria or operative bleeding 3.
The mechanism involves cyclooxygenase inhibition in animal models, though the exact pathway is not fully understood 3.
However, data on bleeding risk remain conflicting, with some sources noting inconsistent evidence 3.
Common Pitfalls and Clinical Context
Do not confuse saw palmetto's lack of myalgia as a side effect with other herbal supplements that do cause muscle-related complications:
Red yeast rice (containing lovastatin) is a known cause of drug-induced rhabdomyolysis and myositis 3.
Wormwood oil, licorice, creatine monohydrate, and Hydroxycut have been shown to indirectly influence rhabdomyolysis 3.
If a patient taking saw palmetto presents with myalgia, consider alternative etiologies rather than attributing it to the supplement, including:
- Concurrent medications (particularly statins or other myotoxic drugs)
- Underlying inflammatory conditions
- Other herbal supplements the patient may be taking concurrently
Medication History Considerations
When evaluating patients with lower urinary tract symptoms, note that over 20% of men take herbal supplements like saw palmetto, which may affect PSA levels through phytoestrogenic compounds 3. However, this PSA effect is distinct from causing myalgia.