Overview

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.



Uses & Effectiveness

Possibly Effective for

  • Symptoms of menopause. Taking a specific black cohosh product (Remifemin, Phytopharmica/Enzymatic Therapy) seems to help reduce symptoms of menopause, such as hot flashes. But these benefits might not occur with all products that contain black cohosh.

There is interest in using black cohosh for a number of other purposes, but there isn't enough reliable information to say whether it might be helpful.

Side Effects

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, and a feeling of heaviness. 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 and Warnings

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, and a feeling of heaviness. 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.

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: There is some concern that black cohosh may worsen existing breast cancer. But this concern hasn't been confirmed in scientific research. People who have breast cancer, have had breast cancer in the past, or are at high-risk for breast cancer, should speak with a healthcare professional before using black cohosh.

Hormone-sensitive conditions, including endometriosis, fibroids, ovarian cancer, uterine cancer, and others: Black cohosh acts somewhat like estrogen in the body. There is some concern that it might worsen conditions that are sensitive to estrogen. If you have a condition that could be affected by estrogen, speak with a healthcare professional before using black cohosh.

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.

Interactions

    Moderate Interaction

    Be cautious with this combination

  • Atorvastatin (Lipitor) interacts with Black Cohosh

    There is concern that black cohosh might harm the liver. Taking black cohosh with atorvastatin might increase the chance of liver damage.

  • Cisplatin (Platinol-AQ) interacts with Black Cohosh

    Cisplatin is used to treat cancer. There is some concern that black cohosh might decrease how well cisplatin works for cancer.

  • Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates) interacts with Black Cohosh

    Some medications are changed and broken down by the liver. Black cohosh might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications.

  • Medications that can harm the liver (Hepatotoxic drugs) interacts with Black Cohosh

    Black cohosh might harm the liver. Some medications can also harm the liver. Taking black cohosh along with a medication that can harm the liver might increase the risk of liver damage.

  • Estrogens interacts with Black Cohosh

    Black cohosh might have some of the same effects as estrogen. Taking black cohosh along with estrogen pills might decrease the effects of estrogen pills.

  • Serotonergic drugs interacts with Black Cohosh

    Black cohosh might increase a brain chemical called serotonin. Some medications also have this effect. Taking black cohosh along with these medications might increase serotonin too much. This might cause serious side effects including heart problems, seizures, and vomiting.

    Minor Interaction

    Be watchful with this combination

  • Medications moved by pumps in cells (Organic anion-transporting polypeptide substrates) interacts with Black Cohosh

    Some medications are moved in and out of cells by pumps. Black cohosh might change how these pumps work and change how much medication stays in the body. In some cases, this might change the effects and side effects of a medication.

Dosing

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.
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CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

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