Safety of Saw Palmetto with Oral Minoxidil

Evidence for Safety

• The American College of Cardiology recommends standard monitoring for oral minoxidil, including baseline and periodic blood pressure and heart rate measurements, when used with saw palmetto 1
• The Society for Perioperative Assessment and Quality Improvement (SPAQI) recommends holding saw palmetto for 2 weeks before surgery due to potential increased risk of hematuria and operative bleeding 2

Practical Management Algorithm

• The American College of Cardiology suggests ensuring standard monitoring for oral minoxidil, including assessing volume status since oral minoxidil causes sodium and water retention 1
• Monitoring for bleeding manifestations, such as hematuria, easy bruising, or prolonged bleeding from minor cuts, is recommended, particularly if the patient is on antiplatelet agents or anticoagulants 2

Special Circumstances

• If surgery is planned, discontinuing saw palmetto 2 weeks preoperatively is advised to minimize theoretical bleeding risk, while continuing oral minoxidil unless otherwise indicated by the surgical team 2, 4
• Avoiding abrupt discontinuation of oral minoxidil if beta-blockers are being used concurrently is recommended due to potential rebound hypertension 1