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Blood Thinners With Saw Palmetto and Pomegranate: What to Ask
Memorial Sloan Kettering lists case reports of bleeding with saw palmetto, including with rivaroxaban and during surgery, and a case report of a pomegranate and warfarin interaction. Prostadine lists both herbs without amounts. If you take a blood thinner, ask a pharmacist before starting.
Written by the Prostadine label deskUpdated · 4 min read
The basics01
Which medicines are blood thinners?
Two groups matter: anticoagulants, which slow clotting, and antiplatelet drugs, which stop platelets sticking together.
Anticoagulants include warfarin, rivaroxaban, apixaban and dabigatran. Antiplatelet drugs include aspirin and clopidogrel. Millions of older men take one of these for the heart, for an irregular heartbeat or after a stroke, and that group overlaps with men who think about the prostate.
If you are unsure whether a tablet is one, the pharmacy label or a quick call to the pharmacist will tell you.
The evidence02
What are the saw palmetto reports?
Memorial Sloan Kettering lists case reports of bleeding problems with saw palmetto, including one with rivaroxaban and bleeding during surgery. It also notes that saw palmetto may increase bruising and bleeding risk with anticoagulants and antiplatelet drugs (MSK, Saw Palmetto).
These are case reports, which are single stories and not controlled trials. They cannot show how often it happens or whether saw palmetto caused it. They are, however, the kind of signal that pharmacists take seriously, since the harm of a bleed can be large.
The numbers03
What about pomegranate?
MSK notes a case report suggesting an interaction between pomegranate and warfarin, and it says the juice may raise levels of some drugs (MSK, Pomegranate). Again this is a signal, not a proof.
Warfarin is a drug with a narrow safe range, so even a small shift in how it is processed can change the blood test, known as the INR, that doctors use to adjust the dose. A change in diet or a new supplement is a common cause of a surprising INR.
The catch04
What to do, by medicine
| If you take | Do this before the drops |
|---|---|
| Warfarin | Ask your clinic; expect an extra INR check if you start |
| Rivaroxaban, apixaban, dabigatran | Ask your pharmacist about saw palmetto and bleeding |
| Aspirin or clopidogrel | Ask your pharmacist; watch for bruising and nosebleeds |
| No blood thinner | Tell your doctor before any planned surgery |
Safety05
What are the signs of a bleeding problem?
Unusual bruising, nosebleeds that do not stop, bleeding gums, blood in the urine or stool, black stools, heavy bleeding from cuts, severe headache or dizziness are all reasons to seek care. Blood in the urine in a man with prostate symptoms should always be checked, whatever the cause (NIDDK, Prostatitis).
Seek urgent care for heavy bleeding, a severe headache, vomiting blood or black tarry stools.
Stopping it can cause a clot or stroke. Only your prescriber should change it.
What to do06
Why does surgery matter?
Surgeons ask about supplements because some affect bleeding. With saw palmetto, a case of bleeding during surgery has been reported (MSK, Saw Palmetto). Tell the surgical team about the drops well before the date, and ask whether to pause them. The usual advice for many herbal products is to stop some time before a procedure, but only the team can set the timing for you.
On the label07
How to ask the question
Say: I take this blood thinner, and I am thinking of a liquid that contains saw palmetto and pomegranate and several seaweeds. Does anything on that list worry you? Bring the ingredient list from our ingredients page.
Write down the answer. If the pharmacist wants more information, the seller can supply it, and the contact page has the number.
FAQ08
Prostadine questions people ask
Does saw palmetto thin the blood?
It is not a classic blood thinner, but case reports describe bleeding, including with rivaroxaban and during surgery. MSK says it may raise bleeding risk with anticoagulants.
Can I take pomegranate with warfarin?
A case report suggests an interaction. Ask your clinic before using a concentrated pomegranate product, and expect a closer INR check if you start.
Should I stop supplements before surgery?
Tell the surgical team about every supplement well in advance. They will advise whether and when to pause each one. Do not stop prescribed medicines without their instruction.
What is an INR test?
A blood test that shows how quickly your blood clots, used to adjust warfarin. A new supplement can shift it, so tell your clinic when you start one.
Who wrote this09
Written and reviewed by
Pages built from the bottle photos, the info page and linked NIH, FDA, NCI, FTC and peer-reviewed sources.
Last updated . Read our editorial standards and how we check reviews. This website is run by a licensed U.S. retail desk for Prostadine, not by the manufacturer. We earn money when you buy through our order links.
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