A 63-year-old man comes to the clinic for a new patient visit. He is pleasant and says he "has never felt healthier." The patient presents a list of regularly taken medications, which include atenolol, sildenafil, terbinafine, minoxidil (topical), aspirin, and saw palmetto. He has no known drug allergies and has a remote history of cholecystectomy. He drinks an ounce of bourbon before bed each night. The patient has a remote 15-pack-year smoking history and has never used illicit drugs. He is married, has 3 grown children, and was recently transferred to this city to assume direction of a local factory. Physical examination is remarkable for a soft midsystolic murmur that is loudest in the second right intercostal space. There is some bony enlargement of the distal interphalangeal joints bilaterally. The patient wishes to discuss his medication list in more depth and indicates an increasing interest in alternative medicines. The patient is counseled appropriately regarding his use of alternative medicines. Which of the following side effects is most strongly associated with saw palmetto?

Question

A 63-year-old man comes to the clinic for a new patient visit.  He is pleasant and says he "has never felt healthier."  The patient presents a list of regularly taken medications, which include atenolol, sildenafil, terbinafine, minoxidil (topical), aspirin, and saw palmetto.  He has no known drug allergies and has a remote history of cholecystectomy.  He drinks an ounce of bourbon before bed each night.  The patient has a remote 15-pack-year smoking history and has never used illicit drugs.  He is married, has 3 grown children, and was recently transferred to this city to assume direction of a local factory.  Physical examination is remarkable for a soft midsystolic murmur that is loudest in the second right intercostal space.  There is some bony enlargement of the distal interphalangeal joints bilaterally.  The patient wishes to discuss his medication list in more depth and indicates an increasing interest in alternative medicines. The patient is counseled appropriately regarding his use of alternative medicines.  Which of the following side effects is most strongly associated with saw palmetto?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c15f_20eb_8f63_41014749c4e7_MD0005_00 Saw palmetto is generally well tolerated and typically causes only mild side effects, similar to those seen with placebo (eg, gastrointestinal discomfort, headache, dizziness). Other less frequent adverse effects may include hypertension (3.1%), cholestatic hepatitis, and pancreatitis; however, it is uncertain if saw palmetto is the cause of these effects due to confounding factors. The supplement should be used cautiously in patients undergoing surgery due to a possible increased risk of perioperative bleeding (likely due to platelet dysfunction). Other popular herbal remedies associated with increased bleeding risk include ginkgo biloba, ginseng and garlic. (Choice A) Allergic reactions such as anaphylaxis are typically associated with the use of echinacea, an herbal supplement often used to prevent or treat the common cold. This reaction is most often observed in patients with environmental allergies. (Choice C) Myocardial infarction is associated with the use of ephedra, a supplement previously used to treat asthma/upper respiratory symptoms and improve weight loss/athletic performance. This agent has been banned by the US Food and Drug Administration. (Choice D) Nephrotoxicity (eg, fulminant tubulointerstitial renal disease) has been observed with the use of aristolochic acid, a compound included in many Chinese herbal weight loss regimens. The concurrent use of vasoconstrictive appetite suppressants (eg, fenfluramine, diethylpropion) may hasten the development of nephrotoxicity. (Choice E) The most common acute drug reactions to St. John's wort include gastrointestinal distress, dizziness, fatigue, photosensitivity, and dry mouth. Longer term studies have found an increase in anorgasmia, urinary frequency, and swelling. Educational objective: Saw palmetto is generally well tolerated but should be used cautiously in patients undergoing surgery due to a possible increased risk of perioperative bleeding. Other popular herbal remedies associated with increased bleeding risk include ginkgo biloba, ginseng and garlic. References: Serenoa repens (saw palmetto): a systematic review of adverse events. (http://www.ncbi.nlm.nih.gov/pubmed/19591529)

A 63-Year-Old Man Comes to the Clinic for a New