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Black Cohosh Side Effects, Interactions and Warnings

Black cohosh is one of the most popular herbal therapies for premenstrual discomfort, hot flushes and other climacteric and menopausal symptoms. Most often, it is tolerated well. However, there are some recent reports on serious adverse events, probably associated with this complementary and alternative herbal medicine. Here is a report of a case of coagulation activation, fluid retention and transient autoimmune hepatitis most likely triggered by the use of black cohosh. Diagnostic procedures aimed to explain lower leg edema are not uncommon in the age group of women suffering from climacteric and menopausal symptoms. Therefore, black cohosh-induced fluid retention and coagulation activation should be considered in differential diagnosis, especially if thrombosis has been excluded.
- Coagulation activation and fluid retention associated with the use of black cohosh: a case study. -- Zimmermann R, Witte A, Voll RE, Strobel J, Frieser M. -- Climacteric. 2010 Apr;13(2):187-91.

Adverse reactions such as nausea, vomiting, headaches, dizziness, mastalgia, and weight gain have been observed in clinical trials. The estrogenic effects of black cohosh are controversial, and the more recent data indicate that black cohosh extracts may have an anti-estrogenic activity. Owing to potential effects on sex hormones, however, black cohosh should not be administered to children or during pregnancy and lactation.
- Nutr Clin Care 2002 Nov-Dec;5(6):283-9 -- Black cohosh: an alternative therapy for menopause? -- Mahady GB, Fabricant D, Chadwick LR, Dietz B.

Overdoses may produce nausea, vomiting, and dizziness, and may slow the heart rate or cause sweating, tremors, hypotension or joint pains. Normal dose may cause mild, transient stomach upset.

An assessment of risks and benefits of use during pregnancy or labor should be undertaken seriously with the assistance of an informed health care provider.

Safety data, especially during pregnancy and lactation, are still largely lacking for many herbal medications, and recommendations for usage and dosage vary.
- Herbs of special interest to women. -- Hardy ML. -- J Am Pharm Assoc (Wash). 2000 Mar;40(2):234-42; quiz 327-9.

The safety profile of black cohosh is positive, with low toxicity, few and mild side effects, and good tolerability.
- Black cohosh: efficacy, safety, and use in clinical and preclinical applications. -- McKenna DJ, Jones K, Humphrey S, Hughes K. -- Altern Ther Health Med. 2001 May;7(3):93-100.

One patient required urgent liver transplantation for fulminant hepatic failure after the brief use of black cohosh.
- Med J Aust 2002 Oct 21;177(8):440-3 -- Black cohosh and other herbal remedies associated with acute hepatitis. -- Whiting PW, Clouston A, Kerlin P.

Adverse events (AEs) with black cohosh are rare, mild, and reversible. Gastrointestinal upsets and rashes are the most common AEs. The spontaneous reporting programs do contain a few serious AEs, including hepatic and circulatory conditions, but causality cannot be determined.
- Menopause 2003 Jan-Feb;10(1):58-64 -- A systematic review of the safety of black cohosh. -- Huntley A, Ernst E.

last update: March 2010

This information is not intended to be a substitute for professional medical advice. You should not use this material to diagnose or treat a health condition or disease without consulting with your healthcare provider.
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