black cohosh

Black cohosh is a flowering plant, Actaea racemosa, belonging to the buttercup family, native to the eastern regions of North America.

Extracts made from the root and rhizome of black cohosh have been traditionally used as an herbal remedy to relieve menopausal symptoms, treat menstrual irregularities, induce labor, and to treat other conditions including cough, fever, rheumatoid arthritis, and musculoskeletal pain.

The therapeutic effects of black cohosh may derive from several biologically active substances present in black cohosh, including triterpene glycosides such as actein and cimifugoside, alkaloids, flavonoids and tannins. The precise mechanism of black cohosh is not clear and available studies have produced mixed results. Research indicates black cohosh may work in the following ways:

• Modulating the activity of estrogen, the female sex hormone
• Modulating the activity of serotonin, the chemical (neurotransmitter) involved in the regulation of mood, circadian rhythm and digestion
• Antioxidant activity
• Anti-inflammatory effects

Black cohosh is available over the counter (OTC) as dried, whole or powdered root, liquid extract, tincture, tablets and capsules. Research suggests black cohosh may have some efficacy for certain menstrual disorders and postmenopausal vasomotor symptoms such as flushing and night sweats, however, there is inadequate evidence for most of its other uses. Suggested uses of black cohosh include:

• Menopausal symptoms such as:
  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Sleep disturbances
  • Irritability
  • Mood swings
• Hot flashes related to breast cancer treatment
• Premenstrual syndrome
• Painful menstruation (dysmenorrhea) and menstrual cramps
• Induction of labor
• Nervous tension
• Osteoarthritis
• Rheumatoid arthritis
• Musculoskeletal pain
• Prevention of bone loss and osteoporosis
• Cough and sore throat
• Indigestion (dyspepsia)
• Fever

• Do not take black cohosh if you are hypersensitive to any of the components in the formulation.
• Do not take black cohosh in the following conditions:
  • Breast cancer
  • Endometrial cancer
  • Endometriosis
  • Ovarian cancer
  • Uterine fibroids
  • Any estrogen-sensitive condition
• Do not take black cohosh if you are pregnant or breastfeeding.
• Black cohosh may be associated with liver toxicity. Do not take black cohosh if you have liver function impairment or any liver disease. Discontinue immediately and see your physician if you develop any symptom of liver disease such as abdominal pain, dark urine or jaundice.

Common side effects of black cohosh include:

• Nausea
• Vomiting
• Gastrointestinal upset
• Weight gain
• Feeling of heaviness
• Abdominal pain
• Diarrhea
• Shortness of breath
• Slow heart rate (bradycardia)
• Central nervous system (CNS) disturbances
• Headache
• Dizziness
• Rash
• Sweating
• Cramping
• Joint pains
• Tremors
• Visual disturbances

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

• Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
• Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
• Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
• Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

There is not enough reliable information on what might be an appropriate dosage of black cohosh. Check the manufacturer’s label.

Suggested Dosing

• Dried root: 300-2000 mg PO TID
• Extract: 0.3-2 mL orally once daily; 1:1, 90% alcohol
• Tincture: 2-4 mL orally once daily; 1:10, 60% alcohol
• Tablet: 20-80 mg orally twice daily; standardized to 1 mg triterpene glycosides/20 mg tablet

Overdose

• There are no reports of serious adverse effects from black cohosh overdose. The most common overdose effects are mild gastrointestinal discomfort and rashes which should resolve with discontinuation of black cohosh. Very high doses may cause symptoms that include abdominal pain, diarrhea, dizziness, slow heart rate, and tremors.
• There are reports of liver damage from long-term use of black cohosh, however, evidence of a causal relationship has not been established.
• Black cohosh overdose treatment may be supportive and symptomatic care.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Black cohosh has no known severe interactions with other drugs.
• Serious interactions of black cohosh include:
  • iobenguane I 131
• Black cohosh has no known moderate interactions with other drugs.
• Mild interactions of black cohosh include:
  • nevirapine
  • tamoxifen
  • tenofovir DF
  • zidovudine

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

• Black cohosh may cause uterine contractions and lead to miscarriage or premature labor. Some homeopathic practitioners recommend taking black cohosh at term or near term to induce labor, but the safety of black cohosh use during pregnancy is not established. Avoid taking black cohosh if you are pregnant.
• There is no reliable information on the safety of black cohosh use in nursing mothers, avoid taking if you are breastfeeding.
• Never take any herbal supplement including black cohosh without first checking with your healthcare provider if you are pregnant or breastfeeding.

• Black cohosh supplements are possibly safe for most adults when taken orally in recommended doses for a short period.
• Take black cohosh exactly as per label instructions.
• Do not confuse black cohosh with blue cohosh which is a different herb.
• Check with your healthcare provider before taking any herbal supplement, including black cohosh products.
• Herbal products often contain many ingredients. Check labels for the components in the black cohosh product you choose.
• Black cohosh is marketed as an herbal supplement and is not regulated by the FDA. Products may differ in formulations and strengths, and labels may not always match contents; exercise caution in choosing your product.
• Store black cohosh safely out of reach of children.
• In case of overdose, seek medical help or contact Poison Control.