Pygeum (Prunus africana): Uses, Evidence and Safety

Key points first

• Pygeum is an extract of tree bark used for urinary symptoms linked to an enlarged prostate. Evidence is limited: the main review found small, short trials with different products. [1]
• Urinary symptoms can have serious causes. The EU herbal monograph says pygeum is for use after serious conditions have been excluded by a doctor, and that a doctor should be consulted if symptoms worsen or if fever, spasms, blood in the urine, painful urination or urinary retention occur. [2]
• The tree is a threatened species. A European assessment report says that, owing to overexploitation and other factors, Prunus africana is listed in Appendix II of CITES, the convention on international trade in endangered species. [3]

Overview

Pygeum is made from the bark of an evergreen tree called the African plum tree. [4] [3] Extracts of the bark have traditionally been used for inflammation, kidney diseases, urinary problems and prostate inflammation. [4] This page covers the herb. For prostate herbs as a group, see herbs for prostate and urinary symptoms, and for symptoms themselves see urinary symptoms and enlarged prostate.

Names, plant part and conservation

The accepted scientific name is Prunus africana (Hook.fil.) Kalkman, in the rose family (Rosaceae). [5] An older name, Pygeum africanum Hook f., is still used on products and in older studies. [3] The part used is the dried bark of the trunk, stems and branches. [3] Common names include pygeum and African plum tree or African prune. [3]

On conservation, the EMA report quoted above notes the CITES Appendix II listing. [3] Whether a given product is sustainably harvested is not described in the sources we read. See at-risk medicinal plants and conservation and African herbal medicine overview.

Traditional use (not proof of effect)

NCCIH says bark extracts have traditionally been used for inflammation, kidney diseases, urinary problems and prostate gland inflammation. [4] A cancer center review lists traditional use for lower urinary tract symptoms with BPH (benign prostatic hyperplasia, a non-cancerous enlarged prostate). [6] The EU monograph describes the product as a traditional herbal medicine based exclusively on long-standing use. [2] These sources do not name the peoples whose knowledge underlies this use.

What research shows

Forms and why the form matters

The EU monograph covers a soft extract made with a specific solvent, in solid forms taken by mouth, and does not cover raw bark or teas. [2] The EU monograph gives a traditional single dose of 50 mg and a daily dose of 100 mg of extract for adult men. [2] That is the official monograph amount for that extract (EMA, European Union, 2016), not advice for a person. A clinician or pharmacist decides what is right for an individual. Other products may differ in strength and make-up, as the Cochrane review noted. [1]

Safety

• Common effects: clinical studies found pygeum generally well tolerated, with mild effects such as diarrhea, nausea, constipation and headache. [4] The EU monograph lists rare digestive upset. [2]
• Allergy: the EU monograph lists hypersensitivity to the active substance as a contraindication. [2]
• Medicines: the EU monograph says no interactions have been reported. [2] Drug interactions from clinical trials or case studies were not reported in the EU assessment either. [3] Absence of reports is not proof of safety. Ask a pharmacist (how interactions work).
• PSA test: whether pygeum affects the PSA blood test is not described in the sources we read. Tell your clinician about any prostate herb before testing.
• Women, children, pregnancy and breastfeeding: the EU monograph says there is no relevant use in women, adolescents and children under 18, and that pregnancy and lactation are not relevant. [2]
• Long-term use: the EU monograph says long-term use is possible. [2]
• Liver, kidney, surgery: not described in the sources we read.
• Quality: see quality testing and certifications.