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Black cohosh (Actaea racemose) is a woodland herb native to North America. The root is used as medicine and is often used for estrogen-related conditions.
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.
People commonly use black cohosh for symptoms of menopause, premenstrual syndrome (PMS), painful menstruation, weak and brittle bones, and many other conditions, there is no good scientific evidence to support most of these uses.
Don't confuse black cohosh with blue cohosh or white cohosh. These are unrelated plants.
- Menopausal symptoms. Several clinical trials using a specific black cohosh product (Remifemin, Phytopharmica/Enzymatic Therapy) have shown a modest reduction in menopausal symptoms. Research on other formulations shows considerable variability in results.
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- Acne. Login for details
- Anxiety. Black cohosh does not appear to be effective for treating anxiety in postmenopausal patients.
Login for details - Breast cancer. It is unclear if oral black cohosh is beneficial for breast cancer treatment or prevention.
Login for details - Breast cancer-related hot flashes. Evidence for the use of oral black cohosh for hot flashes associated with breast cancer is conflicting.
Login for details - Cardiovascular disease (CVD). It is unclear if oral black cohosh reduces the risk of CVD.
Login for details - Cognitive function. It is unclear if oral black cohosh is beneficial for improving cognitive function in postmenopausal patients.
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- Dysmenorrhea. Login for details
- Infertility. It is unclear if oral black cohosh is beneficial for female infertility.
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- Migraine headache. Oral black cohosh has only been evaluated in combination with other ingredients; its effect when used alone is unclear.
Login for details - Osteoarthritis. Oral black cohosh has only been evaluated in combination with other ingredients; its effect when used alone is unclear.
Login for details - Osteoporosis. There is contradictory evidence on the benefit of black cohosh for osteoporosis treatment or prevention.
Login for details - Parturition. It is unclear whether oral black cohosh is beneficial or safe for labor induction.
Login for details - Premenstrual syndrome (PMS). Login for details
- Rheumatoid arthritis (RA). Oral black cohosh has only been evaluated in combination with other ingredients; its effect when used alone is unclear.
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When taken by mouth: Black cohosh is possibly safe when taken appropriately for up to one year. It can cause some mild side effects such as stomach upset, headache, rash, a feeling of heaviness, and weight gain. There is also some concern that black cohosh might cause liver damage in some people. People who take black cohosh should watch for symptoms of liver damage such as dark urine and fatigue.
Special Precautions & Warnings:
Pregnancy and breast-feeding: Black cohosh is possibly unsafe to use when pregnant or breast-feeding. It might increase the risk of miscarriage or affect a nursing infant.Breast cancer: Black cohosh may worsen existing breast cancer. People who have breast cancer or who have had breast cancer in the past, and those 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 estrogen in the body. It might worsen conditions that are sensitive to estrogen. Don't take black cohosh if you have a condition that could be affected by female hormones.
Liver disease: Black cohosh might cause liver damage in some people. But it isn't clear how often this occurs. Until more is known, people with liver disease should avoid taking black cohosh.
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.
Herbs and supplements that might harm the liver: Black cohosh might harm the liver. Taking it with other supplements that can also harm the liver might increase the risk of liver damage. Examples of supplements with this effect include garcinia, greater celandine, green tea extract, kava, and kratom.
There are no known interactions with foods.
Black cohosh has most often been used by adults in doses of 40-128 mg by mouth daily for up to one year. Speak with a healthcare provider to find out what dose might be best for a specific condition.
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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