People Use This For: Black Cohosh is used for symptoms of
menopause, inducing labor in pregnant women, premenstrual
syndrome (PMS), painful periods, nervous tension, indigestion,
rheumatism, and as a mild sedative.
Safety: Possibly safe when used orally and appropriately. Black
cohosh has been safely used in some studies lasting up to a year;
1,2,3 There is concern that black cohosh might cause liver damage
in some patients. Several case reports link black cohosh to liver
failure or autoimmune hepatitis;
4,5,6,7,8,9,10,11,12,13,14,15,16,17 however, there is no
conclusive evidence that black cohosh is the cause of liver
damage in these patients.18 Until more is known, monitor liver
function in patients who take black cohosh for more than three
months. Analysis of 9 Cases of Suspected association between
Black Cohosh and Hepatitis concluded that there is little if any
hepatotoxic risk by the use of Black Cohosh in these cases.
Menopause 2009 Sep-Oct: 16(5):956-65 Teschke R, Bahre R, Fuchs J,
Wolff A. It is concluded that the use of BC may not exert an
overt toxicity risk, but quality problems in a few BC products
were evident that require additional regulatory quality
specifications. Ann Hepatology. 2011 Jul-Sep;10(3):249-59
Pregnancy and Lactation: Refer to Medical Herbalist
Effectiveness: POSSIBLY EFFECTIVE
Menopausal symptoms. Some black cohosh extracts seem to modestly
reduce symptoms of menopause, such as hot flashes. However, there
is considerable variability in the preparations used in clinical
trials, and in the results obtained.19
INSUFFICIENT RELIABLE EVIDENCE to RATE
Osteoporosis: Preliminary clinical research suggests that
postmenopausal women who take a specific black cohosh extract CR
BNO 1055 (Klimadynon/Menofem, Bionorica AG) 40 mg/day have
increased levels of bone-specific alkaline phosphatase (bALP),
which is a marker of bone formation, after 12 weeks of treatment.
20 However, it is not known if this black cohosh extract can
increase bone mineral density or decrease the risk of fracture.
More evidence is needed to rate black cohosh for these uses.
Mechanism of Action: The applicable parts of black cohosh are the
rhizome and root. The active constituents of black cohosh include
phytosterin; isoferulic acid; fukinolic acid; caffeic acid;
salicylic acid; sugars; tannins; long-chain fatty acids; and
triterpene glycosides, including acetein, cimicifugoside, and
27-deoxyactein.21,22 Black cohosh has estrogen-like effects (not
estrogenic effects) that are exerted by an unknown
Adverse Reactions: Black cohosh can commonly cause
gastrointestinal upset.4,24,25 Black cohosh has associated with
weakness and muscle damage in one case. In another case, a single
patient developed symptoms of cutaneous pseudolymphoma 6 months
after starting a specific black cohosh extract (Remifemin).
Symptoms resolved within 12 weeks of discontinuing black
cohosh.26 There are two case reports of cutaneous vasculitis in
menopausal women who took black cohosh-containing products. In
these cases, both women were taking a combination product
containing black cohosh 40 mg (Estroven, Amerifit Brands).
Symptoms resolved within 3 months of discontinuing the product.27
Interactions with Herbs & Supplements: Refer to a Medical
Herbalist. Interactions with Drugs: Atorvastatin (Lipitor) One
report of significant interaction. Chemotherapy: Refer to a
Medical Herbalist. Hepatotoxic Drugs: Refer to a Medical
Herbalist. Interactions with Foods: None known.
Interactions with Lab Tests: Liver Function Tests: Elevated liver
function tests have not been documented in clinical trials.20
Theoretically, some patients taking black cohosh might experience
elevated liver function tests.
Interactions with Diseases or Conditions: Breast Cancer: Refer to
Hormone-Sensitive Cancers/Conditions: Black cohosh doesn't seem
to affect estrogen receptors. Refer to Medical Herbalist.
Kidney Transplant: Refer to Medical Herbalist.
Liver Disease: Refer to Medical Herbalist.
Dosage/Administration: Dr Clare’s Blend: 1gm/day Oral:
Specific References: BLACK COHOSH 1. Raus K, Brucker C, Gorkow C,
Wuttke W. First-time proof of endometrial safety of the special
black cohosh extract (Actaea or Cimicifuga racemosa extract) CR
BNO 1055. Menopause 2006;13:678-91. Newton KM, Reed SD, LaCroix
AZ, et al. Treatment of vasomotor symptoms of menopause
2. with black cohosh, mulitbotanicals, soy, hormone therapy, or
placebo. Ann Intern Med 2006;145:869-79. Available at:
3. Geller SE, Shulman LP, van Breemen RB, et al. Safety and
efficacy of black cohosh and red clover for the management of
vasomotor symptoms: a randomized controlled trial. Menopause
4. Whiting PW, Clouston A, Kerlin P. Black cohosh and other
herbal remedies associated with acute hepatitis. Med J Aust
5. Lontos S, Jones RM, Angus PW, Gow PJ. Acute liver failure
associated with the use of herbal preparations containing black
cohosh. Med J Aust 2003;179:390-1.
6. Cohen B, Schardt D. Center for Science in the Public Interest.
Letter to Food and Drug Administration. Commissioner Mark
McClellan, MD, PhD. March 4, 2004. Cohen SM, O'Connor AM, Hart J,
et al. Autoimmune hepatitis associated with the use of
7. black cohosh: a case study. Menopause 2004;11:575-7.
8. Levitsky J, Alli TA, Wisecarver J, Sorrell MF. Fulminant liver
failure associated with the use of black cohosh. Dig Dis Sci
9. MHRA. Black cohosh (Cimicifuga racemosa) - risk of liver
problems. Herbal Safety News
10. Lynch CR, Folkers ME, Hutson WR. Fulminant hepatic failure
associated with the use of black cohosh: a case report. Liver
11. Chow ECY, Teo M, Ring JA, Chen JW. Liver failure associated
with the use of black cohosh for menopausal symptoms. Med J Aust
12. Mahady GB, Low Dog T, Barrett ML, et al. United States
Pharmacopeia review of the black cohosh case reports of
hepatotoxicity. Menopause 2008;15:628-38.
13. Hepatotoxicity with black cohosh. Australian Adv Drug
Reactions Bull 2006;25:6. Available at:
14. Dunbar K, Solga SF. Black cohosh, safety, and public
awareness. Liver Int 2007;27:1017.
15. Patel NM, Derkits RM. Possible increase in liver enzymes
secondary to atorvastatin and black cohosh administration. J
Pharm Pract 2007;20:341-6.
16. Joy D, Joy J, Duane P. Black cohosh: a cause of abnormal
postmenopausal liver function tests. Climacteric 2008;11:84-8.
17. Australian Adverse Drug Reactions Advisory Committee. Black
cohosh and liver toxicity - an update. Aust Adv Drug Reactions
18. Teschke R, Bahre R, Genthner A, et al. Suspected black cohosh
hepatotoxicity - challenges July 2006.
Available at: http://www.mhra.gov.uk/home/idcplg? and pitfalls of
causality assessment. Maturitas 2009;63:302-14.
19. Shams T, Setia MS, Hemmings R, et al. Efficacy of black
cohosh-containing preparations on menopausal symptoms: a
meta-analysis. Altern Ther Health Med 2010;16:36-44.
20. Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black
cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa,
and various blood parameters in postmenopausal women: a
double-blind, placebo-controlled, and conjugated
estrogens-controlled study. Menopause 2006;13:185-96.
21. Kruse SO, Lohning A, Pauli GF, et al. Fukiic and piscidic
acid esters from the rhizome of Cimicifuga racemosa and the in
vitro estrogenic activity of fukinolic acid. Planta Med
22. Loser B, Kruse SO, Melzig MF, Nahrstedt A. Inhibition of
neutrophil elastase activity by cinnamic acid derivatives from
Cimicifuga racemosa. Planta Med 2000;66:751-3. Einer-Jensen N,
Zhao J, Andersen KP, Kristoffersen K. Cimicifuga and Melbrosia
23. oestrogenic effects in mice and rats. Maturitas
24. Pepping J. Black cohosh: Cimicifuga racemosa. Am J Health
Syst Pharm 1999;56:1400-2.
25. Liske E. Therapeutic efficacy and safety of Cimicifuga
racemosa for gynecologic disorders. Adv Ther 1998;15:45-53.
26. Meyer S, Vogt T, Obermann EC, et al. Cutaneous pseudolymphoma
induced by Cimicifuga racemosa. Dermatology 2007;214:94-6.
27. Ingraffea A, Donohue K, Wilkel C, Falanga V. Cutaneous
vasculitis in two patients taking an herbal supplement containing
black cohosh. J Am Acad Dermatol 2007;56:S124-6.