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Black cohosh (cimicifuga racemosa) and hepatotoxicity

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • Black cohosh (cimicifuga racemosa) is a herbal medicine that has traditionally been used to treat a variety of conditions including rheumatism, rheumatoid arthritis, intercostal myalgia, sciatica, chorea, tinnitus, dysmenorrhoea, and uterine colic
    • currently black cohosh is mainly used to treat menopausal symptoms and it may become more widely used as women seek an alternative to hormone replacement therapy
      • there is evidence concerning the use of a fixed combination of black cohosh and St John's wort in reducing perimenopausal (climacteric) and depressive symptoms (1)
      • however the long term safety of black cohosh is not clear
  • adverse effects of black cohosh include gastrointestinal irritation, headache, dizziness and vomiting
  • hepatotoxicity with black cohosh - there have been 10 reports of suspected adverse reactions associated with black cohosh, 7 of which have been reports of hepatotoxicity
    • mechanism for hepatotoxicity with black cohosh is not known. However, an immunological response has been suggested

NICE state (3):

  • there is some evidence that isoflavones or black cohosh may relieve vasomotor symptoms
    • however
      • multiple preparations are available and their safety is uncertain
      • different preparations may vary
      • interactions with other medicines have been reported
  • there is some evidence that St John's wort may be of benefit in the relief of vasomotor symptoms, but there is uncertainty about:
    • appropriate doses
    • persistence of effect
    • variation in the nature and potency of preparations
    • potential serious interactions with other drugs (including tamoxifen, anticoagulants and anticonvulsants).

Reference:

  1. Uebelhack R et al. Black cohosh and St John's wort for climacteric complaints: a randomized trial. Obstet Gynecol 2006;107:247-55.
  2. Current Problems in Pharmacovigilance (2004); 30:1-12.
  3. NICE (November 2015). Menopause: diagnosis and management

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