Black Cohosh

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What is it?

Black cohosh is a woodland herb. The root is used for medicinal purposes.

Black cohosh is commonly used for symptoms of menopause, premenstrual syndrome (PMS), painful menstruation, weak and brittle bones (osteoporosis), and many others. However, there is no good scientific evidence to support these uses.

Do not confuse black cohosh with blue cohosh or white cohosh. These are unrelated plants. The blue and white cohosh plants do not have the same effects as black cohosh, and may not be safe.

It is effective?
Natural Medicines rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

Possibly Effective for …

  • Symptoms of menopause. Research shows that some black cohosh extracts can reduce some symptoms of menopause when taken by mouth. Most of this research is for a specific commercial black cohosh product, Remifemin. Research shows that the effects of Remifemin on menopausal symptoms are comparable to hormone therapy. The benefits may not occur with all products that contain black cohosh. Some studies show that other black cohosh products do not work any better than a sugar pill (“placebo”).

Insufficient Evidence to Make a Determination for …

  • Breast cancer. One study has found that taking black cohosh supplements is linked to a deceased risk of breast cancer. But other research has found no link.
  • Hot flashes in people treated for breast cancer. Some early research shows that black cohosh might reduce hot flashes in breast cancer patients, but more recent and higher quality research does not show a benefit.
  • Heart disease. Early research shows that taking black cohosh extract does not reduce the risk of heart disease in postmenopausal women.
  • Memory and thinking skills (cognitive function). Early research shows that taking 128 mg of black cohosh daily for 12 months does not improve memory or attention in postmenopausal women.
  • Inability to become pregnant within a year of trying to conceive (infertility). Early research shows that taking black cohosh extract with clomiphene citrate can increase pregnancy rates more than clomiphene citrate alone.
  • Weak and brittle bones (osteoporosis). Some research shows that black cohosh might improve bone formation and reduce bone breakdown, but it does not seem to improve bone mineral density. It isn’t known if black cohosh reduces the risk of fractures.
  • Childbirth. Some people report that black cohosh can help start labor. Despite its use by many nurse-midwives, there is no reliable scientific evidence that black cohosh is safe or beneficial for this purpose.
  • Acne.
  • Anxiety.
  • Cough.
  • Insect repellent.
  • Menstrual cramps (dysmenorrhea).
  • Migraine.
  • Osteoarthritis.
  • Premenstrual syndrome (PMS).
  • Rheumatoid arthritis (RA).
  • Warts.
  • Others.

More evidence is needed to rate black cohosh for these uses.

How does it work?
The root of black cohosh is used for medicinal purposes. Black cohosh root contains several chemicals that might have effects in the body. Some of these chemicals work on the immune system and might affect the body’s defenses against diseases. Some might help the body to reduce inflammation. Other chemicals in black cohosh root might work in nerves and in the brain. These chemicals might work similarly to another chemical in the brain called serotonin.

Black cohosh root also seems to have some effects similar to the female hormone, estrogen. In some parts of the body, black cohosh might increase the effects of estrogen. In other parts of the body, black cohosh might decrease the effects of estrogen. Black cohosh should not be thought of as an “herbal estrogen” or a substitute for estrogen. It is more accurate to think of it as an herb that acts similarly to estrogen in some people.

Is there concern for the safety of its use?
When taken by mouth: Black cohosh is POSSIBLY SAFE when taken appropriately by adults for up to one year. It can cause some mild side effects such as stomach upset, cramping, headache, rash, a feeling of heaviness, vaginal spotting or bleeding, and weight gain.

There is also some concern that black cohosh may be associated with liver damage. It is not known for sure if black cohosh actually causes liver damage. Until more is known, people who take black cohosh should watch for symptoms of liver damage, such as yellowing of the skin and eyes (jaundice), unusual fatigue, or dark urine. If these symptoms develop, black cohosh should be stopped and a healthcare provider should be contacted.

Special Precautions & Warnings:

Pregnancy or breast-feeding: Black cohosh is POSSIBLY UNSAFE when pregnant or breast-feeding. It might increase the risk of miscarriage.

Breast cancer: There is some concern that black cohosh may worsen existing breast cancer. Women who have breast cancer or who have had breast cancer in the past, and women at high-risk for breast cancer, should avoid black cohosh.

Hormone-sensitive conditions, including endometriosis, fibroids, ovarian cancer, uterine cancer, and others: Black cohosh acts somewhat like the female hormone, estrogen, in the body. There is some concern that it could worsen conditions that are sensitive to female hormones. Do not take black cohosh if you have a condition that could be affected by female hormones.

Liver disease: Some reports suggest that black cohosh might cause liver damage. It is not known for sure if black cohosh is the cause of liver damage in these cases. Until more is known, people with liver disease should avoid taking black cohosh.

Protein S deficiency: People with a condition called protein S deficiency have an increased risk of blood clots. Due to the hormone-like effects of black cohosh, there is some concern that black cohosh might also increase this risk. Until more is known, people with protein S deficiency should avoid black cohosh.

Are there any drug interactions?

Atorvastatin (Lipitor)

Interaction Rating=Moderate Be cautious with this combination.

There is concern that black cohosh might harm the liver. Taking black cohosh with atorvastatin (Lipitor) might increase the chance of liver damage. However, there is not enough scientific information to know if this is an important concern. Before taking black cohosh talk to your healthcare provider if you take atorvastatin (Lipitor).

Cisplatin (Platinol-AQ)

Interaction Rating=Moderate Be cautious with this combination.

Cisplatin (Platinol-AQ) is used to treat cancer. There is some concern that black cohosh might decrease how well cisplatin (Platinol-AQ) works for cancer. Do not take black cohosh if you are taking cisplatin (Platinol-AQ).

Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates)

Interaction Rating=Moderate Be cautious with this combination.

Some medications are changed and broken down by the liver.
Black cohosh might decrease how quickly the liver breaks down some medications. Taking black cohosh along with some medications that are change by the liver can increase the effects and side effects of your medication. Before taking black cohosh talk to your healthcare provider if you take any medications that are changed by the liver.
Some medications that are changed by the liver include amitriptyline (Elavil), clozapine (Clozaril), codeine, desipramine (Norpramin), donepezil (Aricept), fentanyl (Duragesic), flecainide (Tambocor), fluoxetine (Prozac), meperidine (Demerol), methadone (Dolophine), metoprolol (Lopressor, Toprol XL), olanzapine (Zyprexa), ondansetron (Zofran), tramadol (Ultram), trazodone (Desyrel), and others.

Medications that can harm the liver (Hepatotoxic drugs)

Interaction Rating=Moderate Be cautious with this combination.

There is concern that black cohosh might harm the liver. Taking black cohosh along with medication that might also harm the liver can increase the risk of liver damage. Do not take black cohosh if you are taking a medication that can harm the liver.
Some medications that can harm the liver include acetaminophen (Tylenol and others), amiodarone (Cordarone), carbamazepine (Tegretol), isoniazid (INH), methotrexate (Rheumatrex), methyldopa (Aldomet), fluconazole (Diflucan), itraconazole (Sporanox), erythromycin (Erythrocin, Ilosone, others), phenytoin (Dilantin), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), and many others.

Are there any interactions with herbs and supplements?
Herbs and supplements that might harm the liver: Black cohosh might harm the liver. Taking black cohosh along with other herbs and supplements that might also harm the liver can increase the risk of liver damage. Do not take black cohosh if you are taking other herbs or supplements that can harm the liver.

Some of these products include androstenedione, chaparral, comfrey, DHEA, germander, kava, niacin, pennyroyal oil, red yeast, and others.

Are there any interactions with food?
There are no known interactions with foods.

What dose is used?
The following doses have been studied in scientific research:

BY MOUTH:

  • Symptoms of menopause: 40-128 mg of black cohosh extract daily for up to 12 months. Specific products used in research include CR BNO 1055 (Bionorica), Remifemin (Schaper & Brümmer GmbH & Co.), and Remixin (Mikro-Gen).

By what other names is the product known?
Actaea macrotys, Actaea racemosa, Actée à Grappes, Actée à Grappes Noires, Actée Noire, Aristolochiaceae Noire, Baie d’actée, Black Cohosh, Baneberry, Black Aristolochiaceae, Black Snakeroot, Bugbane, Bugwort, Cimicaire à Grappes, Cimicifuga, Cimicifuga Racemosa, Cimicifuge, Cohosh Negro, Cohosh Noir, Cytise, Herbe aux Punaises, Macrotys, Phytoestrogen, Phytoestrogène, Racine de Serpent, Racine de Squaw, Racine Noire de Serpents, Rattle Root, Rattle Top, Rattlesnake Root, Rattleweed, Rhizoma Cimicifugae, Sheng Ma, Snakeroot, Squaw Root.

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