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 Black Cohosh (Cimicifuga racemosa) Be aware that the U.S. Food and Drug Administration does not strictly regulate herbs and dietary supplements. There is no guarantee of strength, purity or safety of products containing or claiming to contain black cohosh. Decisions to use herbs or supplements should be carefully considered. Individuals using prescription drugs should discuss taking herbs or supplements with a pharmacist or health care professional before starting. Scientists have studied black cohosh for the following health problems:
Black cohosh has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially very serious and even life-threatening. You should consult a health care professional before taking black cohosh for unproven uses.
Allergies Patients with known allergies to black cohosh or other members of the Ranunculaceae plant family, such as buttercup, should avoid products that contain black cohosh. In nature, black cohosh contains small amounts of salicylic acid. It is not known how much is present in commercially available preparations. As a result, patients with known allergies to aspirin or aspirinlike products, such as nonsteroidal anti-inflammatory drugs, including ibuprofen (Advil), should avoid black cohosh. Side Effects Scientific studies and natural medicine textbooks report that black cohosh is well tolerated by most people for up to six months. The most common side effect are thought to be mild, such as stomach discomfort and rashes, which occur infrequently. Possible side effects include headaches, dizziness, seizures, nausea, vomiting, sweating, constipation, low blood pressure, slow heartbeats, weight gain, loss of bone mass (leading to osteoporosis) and liver damage. Because black cohosh is believed to have estrogen-like properties, it should be avoided by people with estrogen receptor-positive breast cancer, a family history of breast cancer, ovarian cancer or endometrial cancer. In theory, black cohosh may increase the risk of bleeding, or it may increase the risk of blood clots caused by estrogen-like effects. You may need to stop taking black cohosh before surgery; discuss this with a health care professional. Black cohosh should be used cautiously in patients with a history of blood clots or stroke, seizure disorder, known allergy to aspirin or salicylates, liver disease, or hormone-sensitive cancers or those taking medications for high blood pressure. Cases of liver damage and failure associated with black cohosh have been reported. Dysphoria and "heaviness in the legs" may occur. Pregnancy And Breast-Feeding Black cohosh is not recommended for pregnant women because its potential effects on the uterus may induce labor early. There is a report of damage to multiple organs in a child whose mother used black cohosh to induce labor. There is not enough safety evidence to use black cohosh while breast-feeding. Although used internationally, little safety and efficacy data are available for homeopathic preparations of blue and black cohosh. Interactions with drugs, supplements and other herbs have not been thoroughly studied. The interactions listed below have been reported in scientific publications. If you are taking prescription drugs, speak with a health care professional or pharmacist before using herbs or dietary supplements. Interactions With Drugs Because it is possible that salicylates may be present in black cohosh, the use of black cohosh with other salicylates such as aspirin or other blood-thinning medications theoretically may increase the risk of bleeding. Because of the possibility that black cohosh may lower blood pressure, it should be avoided by patients also taking drugs that lower blood pressure, such as metoprolol (Lopressor, Toprol). Because black cohosh is believed to have estrogen-like properties, it is possible that it may alter the effects of hormone therapies, such as birth control pills. Patients taking tamoxifen (Nolvadex) may experience increased side effects if taken with black cohosh. Other potential interactions include pain relievers, anesthetics, antidepressants, antihistamines, anti-inflammatories, cholesterol-lowering drugs, chemotherapy, antioxidants, drugs broken down by the liver, anti-seizure drugs, alcohol, and drugs used to treat osteoporosis. Interactions With Herbs And Dietary Supplements Because it is possible that salicylates may be present in black cohosh, its use with other salicylate-containing herbs, such as aspen bark, may increase the risk of bleeding. This is a theoretical risk and has not been reported in studies in humans. A risk may also exist when used with herbs such as Ginkgo biloba and garlic (Allium sativum). Black cohosh may lower blood pressure; caution is advised if also taking other herbs or supplements that may affect blood pressure, such as garlic (Allium sativum). Black cohosh may have estrogen-like properties and increase some effects of supplements such as soy or evening primrose oil (Oenothera biennis). Interactions with American pennyroyal, pain relievers, anesthetics, antihistamines, anti-inflammatories, cholesterol-lowering therapies, antioxidants, blue cohosh, and St. John's wort are possible. A case of seizure was reported in a patient using an herb combination of black cohosh, chasteberry (Vitex agnus-castus) and evening primrose oil (Oenothera biennis), as well as alcohol. It is not clear if black cohosh contributed to the cause of the seizure. Caution is advised if you are also taking SSRI or MAOI antidepressants. Check with your doctor and pharmacist before adding black cohosh. The doses listed below are based on scientific research, publications or traditional use. Because most herbs and supplements have not been thoroughly studied or monitored, safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients even within the same brand. Combination products often contain small amounts of each ingredient and may not be effective. The appropriate dosing should be discussed with a health care professional before starting therapy; always read the recommendations on a product's label. The dosing for unproven uses should be approached cautiously, because scientific information is limited in these areas. Doses of black cohosh are often based on the amount of the chemical 27-deoxyactein, which is believed to be its active ingredient. One commercially available product (Remifemin) contains one milligram of 27-deoxyactein in each 20-milligram tablet or in 20 drops of the liquid formulation. For Menopausal Symptoms Adults (Aged 18 Or Older) Tablets: A dose of one or two tablets per day (containing one to two milligrams of 27-deoxyactein) has been taken by mouth. Liquid: A dose of 20 to 40 liquid drops per day (containing one to two milligrams of 27-deoxyactein) has been taken by mouth. Cut and dried rhizome (fleshy horizontal underground stem): A dose of 40 to 200 milligrams per day, divided into several doses, has been taken by mouth. Powdered root or tea: A dose of one to two grams has been taken by mouth three times daily. Extract: A dose of four milliliters of fluid extract or 250 to 500 milliliters of dry powder extract has been taken three times daily by mouth. A dose of 39 milligrams was was shown to have a similar rate of effectiveness as a 127.3-milligram dose of extract in one study. A clinically tested standardized extract dose of 40 to 80 milligrams a day has also been reported. Tincture: A dose of four to six milliliters (1:5) has been taken daily by mouth. Many types of combination products with unique dosing regimens are available. Children (Younger Than 18) The dosage and safety of black cohosh have not been studied in children. Use of black cohosh in children is not recommended. Black cohosh has been suggested for the treatment of many conditions. However, scientific research provides only early support for the treatment of symptoms associated with menopause. More studies are needed before a strong recommendation can be made. Black cohosh should be avoided by pregnant or breast-feeding women and children. Black cohosh should be used cautiously by people with a known allergy to aspirin or nonsteroidal anti-inflammatory drugs, those taking drugs to treat high blood pressure, people with a seizure disorder or those with liver disease. There may be side effects or dangerous interactions because of the estrogenlike properties of black cohosh; however, several studies show that black cohosh has little or no estrogenic activity and even anti-estrogenic properties. This remains an area of controversy. This herb should be used only at recommended doses for less than six months. Consult a health care professional immediately if you experience side effects. The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.
Selected Scientific Studies: Black Cohosh Natural Standard has reviewed all of the currently available medical literature to prepare the professional monograph from which this version was created. Some of the more recent studies are listed below:
Last updated September 04, 2008 ©©1996-2000 InteliHealth Inc. All rights reserved. Source: Inteli-Health Inc. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a fitness regimen. Use of this online service is subject to InteliHealth's disclaimer and the terms and conditions .
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