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Zaagpalm (Saw Palmetto)

Wat is Zaagpalm (Saw Palmetto)?

Saw palmetto, ook wel bekend als de Amerikaanse dwergpalm, is een boom afkomstig uit West-Indië en de zuidoostkust van Noord-Amerika. De zaagpalm groeit tot een hoogte van 2 tot 3 meter en wordt gekenmerkt door doornvormige bladeren die zijn gerangschikt als een waaier (89449). De bessen, die kastanjebruin van kleur en langwerpig van vorm zijn, worden gebruikt voor medicinale toepassingen (6751,89449).

Belangrijkste kenmerken:

  • Enig bewijs voor gebruik bij het verminderen van complicaties van transurethrale resectie van de prostaat (TURP). Vaak gebruikt voor goedaardige prostaathyperplasie (BPH) (goedaardige prostaatvergroting) en andere prostaataandoeningen, androgene alopecia, seksuele disfunctie en andere aandoeningen.
  • Waarschijnlijk veilig bij gebruik oraal en op de juiste manier tot 3 jaar. Bijwerkingen kunnen zijn: duizeligheid, hoofdpijn en maag-darmklachten.
  • Geen bekende belangrijke interacties.
  • Saw palmetto wordt verondersteld anti-androgene, antiproliferatieve en ontstekingsremmende effecten te hebben.

In de eerste helft van de twintigste eeuw werd zaagpalm-thee opgenomen in de United States Pharmacopeia and National Formulary. Het werd later echter verwijderd omdat er geen actief ingrediënt kon worden geïdentificeerd om de effecten ervan te verklaren (89450).

Wat is Zaagpalm (Saw Palmetto)?

Gebruik

Oraal

Oraal wordt zaagpalm gebruikt voor goedaardige prostaathyperplasie (BPH), waardoor complicaties van transurethrale resectie van de prostaat (TURP), prostatitis, chronische prostatitis, chronisch bekkenpijnsyndroom (CP/CPPS) en prostaatkanker worden verminderd. Het wordt ook gebruikt voor androgene alopecia, hypotone blaas, slapeloosheid, seksueel verlangen en seksuele disfunctie. Het wordt ook gebruikt voor verkoudheid, hoesten, keelpijn, astma, chronische bronchitis, migraine, kanker en hirsutisme (overmatige lichaamsbeharing bij vrouwen).

Topisch

Topisch wordt zaagpalm gebruikt voor androgene alopecia en hirsutisme.

Gebruik

Werking

Het toepasbare deel van zaagpalm is de rijpe vrucht. De lipidefractie bevat vluchtige oliën en vette oliën, waarvan wordt aangenomen dat ze de actieve componenten zijn bij de behandeling van goedaardige prostaathyperplasie (BPH). Veel zaagpalm-producten zijn gestandaardiseerd op basis van het vetzuurgehalte (73313). De meeste zaagpalm-extracten die in klinische onderzoeken voor goedaardige prostaathyperplasie (BPH) worden gebruikt, zijn bessenextracten bereid met lipofiele niet-polaire oplosmiddelen die 80 tot 90 procent vrije vetzuren bevatten. Een analyse van zaagpalm-producten die in Europa in de handel verkrijgbaar zijn, laat echter zien dat het gehalte aan vrije vetzuren in deze producten varieert van ongeveer 41 tot 81 (17305).

In een analyse van zaagpalmproducten die in Europa in de handel verkrijgbaar zijn, laat aanzienlijke verschillen in chemisch profiel zien. Het gehalte aan vrije vetzuren in deze producten varieert van ongeveer 41 tot 81 procent (17305). De meeste klinische onderzoeken die zaagpalm voor klinische toepassingen evalueren, hebben zaagpalm-extracten gebruikt die 80 tot 95 procent vrije vetzuren bevatten (17684,60442).

Waterextractie, inclusief gezette thee, extraheert waarschijnlijk niet voldoende vetoplosbare actieve bestanddelen.

Andrenerge effecten
In vitro bewijs suggereert dat zaagpalm-extract alfa-adrenerge remmende eigenschappen heeft (5095). Ander bewijs suggereert echter dat zaagpalm in vivo niet werkt als een alfa1-adrenoceptorantagonist (73310).

Anti-androgene effecten
Zaagpalm heeft anti-androgene, antiproliferatieve en ontstekingsremmende eigenschappen die naar verluidt verantwoordelijk zijn voor het verbeteren van de symptomen van goedaardige prostaathyperplasie (BPH). Zaagpalm lijkt 5-alpha-reductase type 1 en 2 niet-competitief te remmen en de omzetting van testosteron in dihydrotestosteron (DHT) in vitro te voorkomen, wat de prostaatgroei zou kunnen verminderen (6765,6769,6770,6773,17308,70232,73359, 73369,73371). De 5-alfa-reductasespiegels in prostaatweefsel en serumtestosteron, DHT en PSA worden echter niet significant verlaagd door zaagpalm in vivo (2735,5093,6771,17308,73364,73373,73398,73399). Zaagpalm lijkt de totale grootte van de prostaat niet te beïnvloeden, maar krimpt het binnenste prostaatepitheel (2736,5093,73400). Zaagpalm zou de proliferatie van prostaatcellen kunnen vertragen door de fibroblastgroeifactor en epidermale groeifactor te remmen en apoptose te stimuleren (6765,6769,6770,11224,73325,73359,73376,73378,73390,73391) (73392,73399).

Remming van 5-alpha-reductase en preventie van omzetting van testosteron in DHT kan bijdragen aan de activiteit van zaagpalm bij androgene alopecia. Er wordt gesuggereerd dat deze aandoening een verhoogde gevoeligheid van de haarzakjes voor DHT met zich meebrengt, waardoor hun groeifase en grootte afneemt (15550).

Anticarcinogene effecten
In vitro bewijs suggereert dat in menselijke urologische kankercellijnen, zaagpalm-extract urokinase-type plasminogeenactivator kan remmen, een enzym dat betrokken is bij de invasie van tumorcellen (73312). Ander in vitro bewijs suggereert dat zaagpalm-extract dosisafhankelijke antiproliferatieve en / of apoptotische effecten induceert op verschillende kwaadaardige cellijnen, waaronder hormoongevoelige prostaatkanker (LNCaP), hormoonongevoelige prostaatkanker (DU-145), borstkanker (MCF -7), sterk uitgezaaide borstkanker (MDA MB231), niercelcarcinoom (Caki-1), urineblaaskanker (J82), colonkanker (HCT 116) en longkankercellijnen (A549) (73339).

Ontstekingsremmende effecten
Ontstekingsmediatoren lijken bij te dragen aan de etiologie van BPH. Bij mannen met BPH lijkt een liposterolisch extract van zaagpalm de tumornecrosefactor (TNF) -alfa en interleukine (IL) -1beta te verlagen, die markers zijn voor ontsteking in prostaatweefsel (11224). Uit laboratoriumonderzoek blijkt dat zaagpalm lipoxygenase en cyclo-oxygenase (COX) remt, die betrokken zijn bij ontstekingen (6769,6779,73328). Bovendien suggereert bewijs uit dieronderzoek dat zaagpalm mestcelaccumulatiedelen van de prostaat remt (73396).

Verhoogde COX-2-expressie wordt ook geassocieerd met een verhoogde incidentie van prostaatkanker. Voorlopig onderzoek geeft aan dat zaagpalm de proliferatie van experimentele prostaatcellen vermindert, mogelijk door COX-2-expressie te remmen (8902).

Geneesmiddelenmetabolisme effecten
Er is tegenstrijdig bewijs over de effecten van zaagpalm op cytochroom P450 (CYP450) enzymen 2D6 (CYP2D6) en 3A4 (CYP3A4). In vitro bewijs suggereert dat zaagpalm CYP2D6 en CYP3A4 zou kunnen remmen (11026). Maar bij gebruik bij gezonde vrijwilligers lijkt 320 mg / dag zaagpalm geen invloed te hebben op CYP2D6 of CYP3A4 (11225,13712). Zaagpalm lijkt ook geen invloed te hebben op CYP1A2 of CYP2E1 bij gezonde vrijwilligers (13712).

Vruchtbaarheid
Vruchtbaarheidsonderzoeken uit het laboratorium geven aan dat zaagpalm geen effect heeft op de eicellen of de beweeglijkheid van het sperma, maar het kan metabole veranderingen in het sperma veroorzaken (4239,4240).

Hormonale effecten
Enig bewijs uit dieronderzoek suggereert dat zaagpalm-fruitextract oestrogene activiteit heeft vanwege de relatief hoge concentratie bèta-sitosterol (73366). Uit menselijk onderzoek blijkt echter dat zaagpalm-extract anti-oestrogene activiteit vertoont in prostaatweefsel van mannen met BPH (6766).

Immuunmodulerende effecten
In vitro bewijs suggereert dat zaagpalm-extract het immuunsysteem stimuleert door de macrofaagfagocytose tot 2,3-voudig te verhogen en de natuurlijke killercel-synthese van interferon-gamma tot 6,3-voudig te verhogen (73341).

Werking

Veiligheid

Waarschijnlijk veilig

Wanneer oraal en op de juiste manier gebruikt. Zaagpalm is veilig gebruikt in klinische onderzoeken die tot 3 jaar duurden (2732,2735,6750,6751,6752,6762,6764,6772,6773,6777) (6778,8330,11354,14274,14275,15550,17202, 17304,17306,17684) (73309,73315,73416,73417,73363,73380,73383,73384,73385,73389) (73420,73421,73422,73423,96410,96412).

Bij rectaal en correct gebruik. Zaagpalm is veilig gebruikt in klinisch onderzoek in doses van 640 mg eenmaal daags gedurende 30 dagen (73387). De veiligheid op lange termijn van zaagpalmetto die rectaal wordt toegediend, is echter niet bekend.

Zwangerschap en lactatie

Waarschijnlijk onveilig bij oraal gebruik. Zaagpalm heeft hormonale activiteit (6766); Vermijd te gebruiken.

Effectiviteit

Transurethrale resectie van de prostaat (TURP).
Klinisch onderzoek toont aan dat het dagelijks innemen van saw palmetto (Permixon, Pierre Fabre Medicament) 320 mg gedurende 2 maanden voorafgaand aan de operatie de duur van de operatie, de ontwikkeling van intraoperatieve complicaties, bloedverlies, de duur van katheterisatie en de duur van ziekenhuisopname vermindert in vergelijking met placebo (73323,73353). Hoewel deze onderzoeken voordelen hebben gevonden, vond een kleinere studie met een lagere dosis zaagpalmetto (Prostagood Mono, Abdi Ibrahim) 160 mg oraal eenmaal daags 5 weken voorafgaand aan transurethrale resectie van de prostaat (TURP) geen voordeel voor het verlagen van het risico op perioperatieve bloeding of afname van de dichtheid van prostaatweefsel (17202).

Veiligheid

Interacties

Medicijnen

Anticoagulenten/plaatjesaggregatieremming
Zaagpalm verlengt de bloedingstijd (8659). Theoretisch zou zaagpalm het risico op bloedingen kunnen verhogen bij gelijktijdig gebruik met anticoagulantia of plaatjesaggregatieremmers. Sommige van deze medicijnen bevatten aspirine; clopidogrel (Plavix); niet-steroïde anti-inflammatoire geneesmiddelen (NSAID’s) zoals diclofenac (Voltaren, Cataflam, anderen), ibuprofen (Advil, Motrin, anderen), naproxen (Anaprox, Naprosyn, anderen); dalteparine (Fragmin); enoxaparine (Lovenox); heparine; warfarine (Coumadin); en anderen.

Anticonceptie
Zaagpalm kan anti-oestrogene effecten hebben (6766). Theoretisch zou gelijktijdig gebruik met zaagpalm de anticonceptie kunnen verstoren.

Estrogenen
Zaagpalm kan anti-oestrogene effecten hebben (6766). Theoretisch kan gelijktijdig gebruik met zaagpalm de hormoontherapie verstoren.

Kruiden en supplementen

Anticoagulenten/plaatjesaggregatieremming
Zaagpalm verlengt de bloedingstijd (8659). Theoretisch kan het gelijktijdige gebruik van zaagpalm met andere kruiden en supplementen die de bloedplaatjesaggregatie beïnvloeden, het risico op bloedingen bij sommige mensen verhogen. Sommige van deze kruiden zijn onder meer engelwortel, kruidnagel, danshen, knoflook, gember, ginkgo, Panax ginseng en anderen.

Interacties

Dosering

Volwassenen

Oraal

Androgene alopecia
Zaagpalm-extract 200 mg plus beta-sitosterol 50 mg, tweemaal daags gedurende 18 tot 24,7 maanden ingenomen, is gebruikt (15550).

Transutherale resectie van de prostaat (TURP)
Zaagpalm-extract (Permixon, Pierre Fabre Medicament) is gedurende twee maanden met 320 mg per dag gebruikt voordat de TURP-procedure werd gebruikt (73323,73353).

Chronische prostatitis en chronisch bekkenpijnsyndroom (CP/CPPS)
Zaagpalm-extract (Prostamol Uno, Profluss) is gebruikt in een dosering van 320 mg per dag (73329). Ook is een combinatie van lycopeenolie-extract 5 mg, zaagpalmetto-olie-extract 320 mg en geselenieerd natrium 50 mcg per dag gedurende acht weken gebruikt (73329).

Prostatitis
Een specifiek combinatieproduct dat 160 mg zaagpalmetto plus 120 gram brandnetel (ProstaMEV) bevat werd samen met een ander product dat 200 mg curcumine plus 100 mg quercetine (FlogMEV) bevat, gedurende twee weken gebruikt in combinatie met 600 mg prulifloxacine per dag (73346). Een combinatie van 320 mg zaagpalm, 200 mg Bacillus coagulans en 100 mg arbutine (Lactorepens) werd gedurende 30 dagen dagelijks gebruikt met 600 mg prulifloxacine per dag gedurende 21 dagen (96411). Een combinatie van zaagpalm, indole-3-carbinol en tweemaal daags 2 capsules epigallocatexin-3-gallate (Indigal Plus) is gedurende 3 maanden gebruikt met tweemaal daags 200 mg sparfloxacine gedurende 1 maand (73355).

Topisch

Androgene alopecia
Er is gebruik gemaakt van zaagpalmlotion die gedurende 50 weken tweemaal daags werd aangebracht (73435).

Aandoening Dagdosering
Vruchtbaarheid mannen, verminderd 1 - 3 x daags 150 mg
Goedaardige prostaatvergroting (BPH) 150 – 450 mg per dag
Haaruitval 1 - 3 x daags 150 mg
Dosering
Referenties
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