Saw Palmetto-induced Pancreatitis

Abstract

Saw palmetto is a frequently used botanical agent in benign prostatic enlargement (BPH). Although it has been reported to cause cholestatic hepatitis and many medical conditions, Saw palmetto has not been implicated in acute pancreatitis. We report a case of a probable Saw palmetto induced acute hepatitis and pancreatitis. A 55-year-old reformed alcoholic, sober for greater than 15 years, presented with severe non-radiating epigastric pain associated with nausea and vomiting. His only significant comorbidity is BPH for which he intermittently took Saw palmetto for about four years. Physical examination revealed normal vital signs, tender epigastrium without guarding or rebound tenderness. Cullen and Gray Turner signs were negative. Complete blood count and basic metabolic profile were normal. Additional laboratory values include a serum amylase: 2,152 mmol/L, lipase: 39,346 mmol/L, serum triglyceride: 38 mmol/L, AST: 1265, ALT: 1232 and alkaline phosphatase was 185. Abdominal ultrasound and magnetic resonance cholangiography revealed sludge without stones. A hepatic indole diacetic acid scan was negative. Patient responded clinically and biochemically to withdrawal of Saw palmetto. Two similar episodes of improvements followed by recurrence were noted with discontinuations and reinstitution of Saw Palmetto. Simultaneous and sustained response of hepatitis and pancreatitis to Saw palmetto abstinence with reoccurrence on reinstitution strongly favors drug effect. "Natural" medicinal preparations are therefore not necessarily safe and the importance of detailed medication history (including "supplements") cannot be over emphasized.

Hepatotoxic Botanicals - An Evidence-based Systematic Review

“…Some mild side effects have been associated with S. repens such as headache, abdominal pain, and nausea (35). Additionally, saw palmetto was found to be hepatotoxic and harboring severe side effects including acute liver damage (41), cholestatic hepatitis (113) and acute pancreatitis (16,36,224). According to Hamid,Rojter & Vierling (39), prostata is a common preparation of saw palmetto that has been implicated in protracted cholestatic hepatitis.…”

“…The spectrum of liver toxicity includes elevated liver enzymes, acute or chronic hepatitis, cholestasis, hepatic necrosis or fibrosis, cirrhosis, liver failure, and hepatic veno-occlusive disease (12,13). Some of botanicals that raised severe health concerns are Black cohosh (14), Chaparral (15), Saw palmetto (16), Comfrey (8), Germander (17) Kava (18) and many others as described in this review.…”

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“…Lipidicsterolic extracts of S. repens have not been shown to contain tyramine and should be recommended in BPH. Other rare problems with S. repens include rhabdomyolsysis and pancreatitis [46][47][48]. It might be safe to avoid use of S. repens in patients with histories of these diseases.…”

Acute liver damage due to Serenoa repens: a case report

“…Concerning the toxicity of S. repens, preparations of this herb have been associated with cholestatic hepatitis [5], as well as liver damage and pancreatitis [6]. Here we report a case of liver injury related to a commercial preparation of S. repens (marketed as a food supplement), including evaluation of the possible presence of contaminants.…”