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black cohosh

Generic name: black cohosh [ BLACK-KOE-hawsh ]
Brand name: Menopause Support
Drug class: Herbal products

What is black cohosh?

Black cohosh is an herb also known as Actaea racemosa, Actée à Grappes Noires, Actée Noire, Aristolochiaceae Noire, Baie d'actée, Baneberry, Black Snakeroot, Bugwort, Cimicaire à Grappes, Cimicifuga, Cytise, Herbe aux Punaises, Macrotys, Phytoestrogen, Racine de Serpent, Rattlesnake Root, Rhizoma Cimicifugae, Sheng Ma, Squaw Root, and many other names.

Black cohosh should not be confused with blue cohosh or white cohosh. Blue cohosh can have harmful effects on the heart.

Black cohosh has been used in alternative medicine in a specific preparation called Remifemin as a possibly effective aid in REDUCING the frequency of hot flashes caused by menopause.

Other uses not proven with research have included premenstrual syndrome (PMS), infertility, breast cancer, heart disease, osteoporosis, arthritis, rheumatism, migraine headaches, mental function, and many other conditions.

It is not certain whether black cohosh is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. Black cohosh should not be used in place of medication prescribed for you by your doctor.

Black cohosh is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Black cohosh may also be used for purposes not listed in this product guide.

What is the most important information I should know about black cohosh?

Follow all directions on the product label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

What should I discuss with my health care provider before taking black cohosh?

Before using black cohosh, talk to your healthcare provider. You may not be able to use black cohosh if you have certain medical conditions, especially.

  • liver disease;

  • past or present cancer of the breast, ovary, or uterus;

  • a history of endometriosis or uterine fibroids;

  • a genetic blood-clotting disorder; or

  • if you have ever had a kidney transplant.

It is not known whether black cohosh will harm an unborn baby. However, this product may increase your risk of having a miscarriage. Do not use this product without medical advice if you are pregnant.

It is not known whether black cohosh passes into breast milk or if it could harm a nursing baby. Do not use this product without medical advice if you are breast-feeding a baby.

Do not give any herbal/health supplement to a child without medical advice.

How should I take black cohosh?

When considering the use of herbal supplements, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.

If you choose to use black cohosh, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label.

Do not use different forms (tablets, liquid, tincture, teas, etc) of black cohosh at the same time without medical advice. Using different formulations together increases the risk of an overdose.

Call your doctor if the condition you are treating with black cohosh does not improve, or if it gets worse while using this product.

Store black cohosh as directed on the package. In general, black cohosh should be protected from light and moisture.

What happens if I miss a dose?

Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra black cohosh to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking black cohosh?

Avoid using black cohosh together with other herbal/health supplements that can harm your liver. This includes androstenedione, chaparral, comfrey, DHEA, germander, kava, niacin (vitamin B3), pennyroyal oil, or red yeast.

Black cohosh side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Although not all side effects are known, black cohosh is thought to be possibly safe when taken for a short period of time (up to 1 year).

Black cohosh can harm your liver. Stop using this product and call your doctor at once if you have signs of liver problems, such as:

  • nausea, loss of appetite, upper stomach pain;

  • itching, tired feeling;

  • dark urine, clay-colored stools; or

  • jaundice (yellowing of the skin or eyes).

Common side effects may include:

  • stomach pain or upset;

  • heavy feeling;

  • vaginal bleeding or spotting;

  • headache;

  • rash; or

  • weight gain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect black cohosh?

Do not take black cohosh without medical advice if you are using any of the following medications:

  • acetaminophen (Tylenol);

  • cisplatin;

  • donepezil;

  • erythromycin;

  • isoniazid;

  • methotrexate;

  • ondansetron;

  • an antidepressant or antipsychotic medicine--amitriptyline, clozapine, desipramine, fluoxetine, olanzapine, trazodone;

  • antifungal medicine--fluconazole, itraconazole;

  • cholesterol medication--atorvastatin (Lipitor), simvastatin (Zocor, Vytorin), and others;

  • heart or blood pressure medicine--amiodarone, flecainide, methyldopa, metoprolol;

  • narcotic medicine--codeine, fentanyl, meperidine, methadone, tramadol; or

  • seizure medicine--carbamazepine, phenytoin.

This list is not complete. Other drugs may interact with black cohosh, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this product guide.

Popular FAQ

There is concern that black cohosh might be toxic to the liver and may rarely increase liver toxicity with certain medications, including atorvastatin (Lipitor), acetaminophen (Tylenol), or alcohol. Continue reading

Further information

  • Consult with a licensed healthcare professional before using any herbal/health supplement. Whether you are treated by a medical doctor or a practitioner trained in the use of natural medicines/supplements, make sure all your healthcare providers know about all of your medical conditions and treatments.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.