Pygeum
RosaceaePrunus africana
Also known as: Pygeum africanum, African Cherry, African Plum
clinical_notes Clinical Summary
Pygeum (Prunus africana) is an evergreen African tree whose bark extract has 60+ years of clinical use for benign prostatic hyperplasia.
A Cochrane systematic review of 18 RCTs in 1,562 men found that standardized Pygeum preparations reduced nocturia by 19%, residual urine volume by 24%, and increased peak urinary flow by 23%, with adverse effects comparable to placebo.
Mechanisms include 5-lipoxygenase inhibition, anti-inflammatory effects on prostatic stromal cells, and antiproliferative effects on fibroblasts; it is EMA-approved as a traditional herbal medicine for mild LUTS.
Pregnancy Safety
Not indicated in pregnancy; used only for male benign prostatic hyperplasia. Antiandrogenic and aromatase-modulating activity are theoretically contraindicated in pregnancy.
Lactation Safety
Not applicable; indicated only for male BPH. Avoid in women.
warning Contraindications
- Pregnancy (avoid)Theoretical
- Undiagnosed prostate symptoms (caution)Clinically Proven
- Severe hepatic impairment (caution)Theoretical
- Known hypersensitivity to Rosaceae family (avoid)Theoretical
vital_signs Clinical Profile
Primary Indications
- check_circle Benign prostatic hyperplasia (BPH) — lower urinary tract symptoms
- check_circle Nocturia
- check_circle Reduced peak urinary flow
- check_circle Residual urine volume
- check_circle Prostatitis (adjunctive)
- check_circle Chronic pelvic pain syndrome
Therapeutic Actions
System Affinities
- check_circle genitourinary
- check_circle male reproductive
- check_circle prostatic
labs Active Constituents
β-sitosterol and other phytosterols
Pentacyclic triterpenes
Ferulic acid esters
Atranorin
Fatty acids
Tannins
history_edu Traditional Use
No TCM data available for this herb yet.
Traditional Uses Across Healing Systems
While many herbs lack controlled clinical trials, centuries of traditional practice across cultures provide valuable insight into their therapeutic applications.
Bark decoction used orally for 'old man's disease' (urinary retention and difficulty), chest pain, malaria, stomach ache, fever, gonorrhea, and as a purgative. Some communities use it for madness and heart conditions.
Traditional preparation: macerate or decoct bark in milk or water; drink once daily.
Standardized extract (Tadenan) introduced in France in 1966 for BPH and lower urinary tract symptoms; now approved as a traditional herbal medicine by EMA HMPC
EMA Committee on Herbal Medicinal Products issued a monograph in 2016 recognizing traditional use for mild LUTS associated with BPH after exclusion of serious conditions.
spa Parts Used
bark
- BPH/LUTS
- All primary therapeutic indications
Bark is wild-harvested from mature trees (typically >15 years old). Sustainability concerns: CITES Appendix II-listed species due to overharvesting. Extracts standardized to 14% total sterols and 0.5% n-docosanol. Solvent: chloroform or supercritical CO2 extraction.
leaf
- Minor traditional use for fever and pain
Not the primary medicinal part.
shield Safety
Contraindications — Evidence Basis
Pregnancy
Not applicable as BPH is a male-only condition; however, the extract should not be taken by women of childbearing potential given lack of reproductive safety data and antiandrogenic/aromatase-modulating activity.
Undiagnosed prostate symptoms
Should not be used empirically for lower urinary tract symptoms without prior urological evaluation to rule out prostate cancer or other serious pathology.
Severe hepatic impairment
Animal toxicity studies identified potential hepatic/renal/myocardial effects at high doses; limited human hepatic safety data.
Known hypersensitivity to Rosaceae family
Cross-reactivity possible in patients allergic to other Prunus species (cherry, almond, peach, apricot).
Monitoring Parameters
Monitor during use, especially with prolonged or high-dose therapy.
International Prostate Symptom Score (IPSS) and uroflowmetry
Baseline, at 8 weeks, and every 6 monthsObjective measurement of BPH symptom response; clinical trials used IPSS and Qmax as primary endpoints
flagThreshold: Lack of improvement after 8–12 weeks: reconsider treatment or refer to urology
PSA (prostate specific antigen)
Baseline and annually during useRule out prostate cancer prior to and during phytotherapy for LUTS; Pygeum does not substantially alter PSA values (unlike 5α-reductase inhibitors)
flagThreshold: Rising PSA: refer for urological evaluation
Toxicity
No defined human toxic dose at therapeutic range. Animal studies (Wistar rats) show target organ effects on kidney, skeletal muscle, and myocardium at high chronic doses.
Mild: GI upset, nausea, abdominal pain, constipation, diarrhea, headache. High-dose animal studies show renal and cardiac histological changes.
Discontinue use; symptomatic supportive care; assess renal function if prolonged high-dose use.
Adverse Effects
CYP Metabolism
Limited clinical pharmacokinetic data. Preclinical studies suggest Pygeum may inhibit several drug-metabolizing enzymes, and some components modulate androgen and aromatase pathways. Exercise caution when combined with androgens or 5α-reductase inhibitors (finasteride/dutasteride) — though this combination has been used with good tolerability in clinical practice.
swap_horiz Interactions
Finasteride
Class: 5α-reductase inhibitor
Pygeum (Prunus africana) bark extract and finasteride both act on the androgen/5α-reductase pathway driving benign prostatic hyperplasia. Pygeum contains atraric acid (an androgen receptor antagonist), N-butylbenzenesulfonamide, ferulic acid esters and β-sitosterol, which complement finasteride's 5α-reductase inhibition. Combined effects on urinary flow and prostate size are additive rather than antagonistic.
Combination is generally well tolerated; monitor IPSS, urinary flow and PSA (recognize that both therapies may lower PSA). Most clinical experience supports co-administration, but formal pharmacokinetic studies are lacking — assess response at 3-6 months.
Tamsulosin
Class: Alpha-1 adrenergic blocker
Pygeum may improve bladder contractility and reduce prostatic inflammation via 5-lipoxygenase inhibition, while tamsulosin relaxes prostatic and bladder-neck smooth muscle. Combined urinary symptom improvement can be additive, but the shared impact on lower urinary tract function and vascular smooth muscle raises theoretical risk of orthostatic hypotension and dizziness.
Monitor blood pressure (standing and supine) and for dizziness when initiating combination therapy. Consider starting tamsulosin at the lowest dose at bedtime. If symptoms improve substantially on combination, re-evaluate need for continued pharmacotherapy after 3-6 months.
Warfarin
Class: Anticoagulant (vitamin K antagonist)
Prunus africana contains phytosterols and small amounts of coumarin derivatives; while no clinical interaction with warfarin has been documented, theoretical antiplatelet/antithrombotic activity of plant phytosterols plus displacement of warfarin from albumin by tannins could elevate INR in susceptible patients.
No dose adjustment typically required, but check INR 1-2 weeks after initiating pygeum in an anticoagulated patient and then monthly. Advise patients to report any unusual bruising or bleeding.
Testosterone (exogenous)
Class: Androgen replacement
Pygeum constituents (atraric acid, N-butylbenzenesulfonamide) act as androgen receptor antagonists and inhibit prostate cancer cell growth in vitro. Co-administration with exogenous testosterone may partially blunt androgen receptor-mediated effects, potentially reducing therapeutic efficacy in hypogonadal replacement.
In men receiving testosterone replacement therapy, counsel patients that pygeum may modulate prostate androgen signaling. Monitor testosterone levels, PSA, and symptomatic response to TRT; avoid combination if treatment goal is maximal androgen response.
Aspirin
Class: Antiplatelet / NSAID
Pygeum inhibits 5-lipoxygenase, reducing prostate leukotriene synthesis. Aspirin inhibits cyclooxygenase. Although the enzymes are distinct, combined eicosanoid inhibition may theoretically increase bleeding risk, and both can cause mild GI upset as the most common adverse effect of pygeum.
Generally safe to combine; watch for GI side effects and unusual bruising. Stop pygeum at least 1-2 weeks before any elective surgical procedure if the patient is also on aspirin.
hub Combinations
Synergistic pairings can enhance therapeutic outcomes, while knowing suitable substitutes helps when specific herbs are unavailable or contraindicated.
Classical Formulas
1Stinging Nettle
Strong EvidenceCombined Urtica dioica and Pygeum (e.g., Prostatonin PHL-00801) has been studied clinically for BPH with aromatase and 5α-reductase inhibition
Krzeski 1993 double-blind trial of combined extracts; Hartmann 1996 mechanistic study
Possible Substitutes
1Saw Palmetto
Moderate EvidenceSaw palmetto is an acceptable alternative if Pygeum is unavailable (due to CITES/sustainability) or not tolerated; comparable evidence for BPH symptom improvement
Meta-analyses support comparable efficacy; Pygeum may be slightly less effective than saw palmetto per Medscape summary
Synergistic Combinations
2Lycopene
Limited EvidenceLycopene (carotenoid) provides antioxidant prostate protection complementing Pygeum's structural/inflammatory effects
Combined prostate-support supplements commonly include both
Saw Palmetto
Moderate EvidenceSaw palmetto provides 5α-reductase inhibition while Pygeum provides anti-inflammatory and 5-LOX inhibition; comprehensive multi-mechanism support for BPH
Widely used combination in European and North American integrative urology; individual RCT evidence strong for each
Traditional Pairings
1Pumpkin Seed
Limited EvidencePumpkin seed (Cucurbita pepo) provides zinc and phytosterols that complement Pygeum's anti-inflammatory action on the prostate
Widely co-formulated in BPH nutraceuticals; modest independent RCT evidence for pumpkin seed
science Studies
Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis
Meta-AnalysisThis systematic review and meta-analysis pooled data from 18 randomized controlled trials involving 1,562 men with symptomatic benign prostatic hyperplasia (BPH). Compared to placebo in 6 studies, Pygeum africanum produced a moderately large improvement in combined urologic symptoms and flow measures (effect size -0.8 SD), with men more than twice as likely to report overall symptom improvement (RR=2.1). Nocturia was reduced by 19%, residual urine volume by 24%, and peak urine flow increased by 23%. Adverse effects were mild and comparable to placebo, supporting Pygeum africanum as a modestly effective and well-tolerated treatment option for BPH-associated lower urinary tract symptoms.
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
RCTThis 2-month randomized double-blind trial with 209 symptomatic BPH patients compared Pygeum africanum extract 50 mg twice daily versus 100 mg once daily, followed by a 10-month open-label extension. Both regimens demonstrated comparable efficacy with approximately 36-38% improvements in International Prostate Symptom Score (IPSS) and 28% improvements in quality of life in both groups. Peak urine flow rate increased by 16-19% in each group with a satisfactory safety profile maintained throughout. At 12 months, further efficacy improvements were documented, supporting the clinical utility of Pygeum africanum bark extract across flexible dosing schedules for BPH management.
medication Dosing
capsule
100 mg standardized extract (14% triterpenes, 0.5% n-docosanol)
Once daily or 50 mg twice daily
Both dosing schedules demonstrated equal efficacy at 2 months with continued improvement to 12 months. Take with food.
decoction
Traditional African preparation: ~1–2 g bark in 250 mL water
Once daily
Ethnobotanical preparation not standardized; modern extracts preferred for consistency.
Disclaimer: This information is largely AI-generated and reviewed by human experts at Evara Health. It is intended for educational and clinical reference purposes only and should not replace professional medical advice.
© 2026 Evara Health. All rights reserved.