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Blue Cohosh

Scientific Name(s): Caulophyllum thalictroides (L.) Michx.
Common Name(s): Radix caulophylli, Blue cohosh, Blue ginseng, Caulophyllum, Papoose root, Squaw root, Yellow ginseng

Medically reviewed by Last updated on Aug 22, 2022.

Clinical Overview


Blue cohosh has been used to induce uterine contractions in labor; however, there are no quality clinical trials to support any therapeutic application for blue cohosh, and concerns of toxicity outweigh any potential clinical benefit.


Despite widespread knowledge and use of blue cohosh, there are no clinical trials on which to base dosing recommendations.


Contraindications have not been identified.


Avoid use. Adverse effects have been documented.


None well documented.

Adverse Reactions

Information is limited; clinical trials are lacking. Potential for toxicity appears to outweigh any clinical benefit.


Blue cohosh root is potentially toxic to humans and to a developing fetus.

Scientific Family

  • Berberidaceae (barberry)


Blue cohosh is a perennial herb that grows up to 0.8 m in height, with yellowish-green flowers that bloom in early spring and mature into bitter, bright blue seeds. Blue cohosh is found throughout the woodlands of the eastern and midwestern United States, especially in the Allegheny Mountains. The matted, knotty rootstock, collected in the autumn, is used for medicinal purposes. Three species are recognized (C. thalictroides, Caulophyllum giganteum, and Caulophyllum robustum), all associated with the terms "blue cohosh" or "papoose root." Leung 2003, USDA 2019, Xia 2014


Blue cohosh was used by American Indians as a sedative, with the name "cohosh" deriving from the Algonquin name of the plant. It was used by Menomini, Meskawi, Ojibwe, and Potawatomi tribes for menstrual cramps, suppression of profuse menstruation, and induction of contractions in labor. In the 19th century Eclectic Medicine movement, blue cohosh was regarded as an emmenagogue, parturient, and antispasmodic. It continues to be used for regulating the menstrual cycle and inducing uterine contractions.Erichsen-Brown 1980, Leung 2003, Middleton 2017


Chemical constituents of the genus Caulophyllum (ie, C. thalictroides, C. giganteum, C. robustum) continue to be elucidated, and analytical techniques have been described. The underground parts of the plant contain triterpenoid saponins and glycosides, alkaloids, and other constituents, including resins. Identified compounds include caulophyllogenin and hederagenin arabinopyranosides, caulophyllines and caulophyllumines, lupanine, sparteine, taspine, and cauloside, among others. The alkaloids magnoflorine, baptifoline, anagyrine, and N-methylcytisine, as well as certain saponins, are constituents with toxicological relevance.Ali 2008, Avula 2011, Datta 2014, Leung 2003, Li 2010, Matsuo 2009, Rader 2013, Wang 2009, Wang 2011, Xia 2014

Uses and Pharmacology

Anti-inflammatory effects

Animal and in vitro data

Suppression of proinflammatory cytokines and other mediators of inflammation has been demonstrated in vitro with blue cohosh saponins.Lee 2012, Lu 2017, Qin 2018, Wang 2017 Studies of C. robustum extracts in mice with collagen-induced arthritis showed improvements in arthritis index, limb swelling, and histological findings by decreasing synovial membrane damage, the extent of inflammatory cell infiltration, and the expansion of capillaries.Wang 2017

Cardiovascular effects

Animal data

Pretreatment with the alkaloid caulophine from the roots of the related species C. robustum protected rats against induced cardiomyocyte injury, possibly via antioxidant activity and calcium antagonism.Si 2010, Si 2010, Wang 2009

Cytotoxic effects

A mechanism for cytotoxicity that involves formation of pH-dependent channels has been suggested for cauloside C isolated from C. robustum.Likhatskaya 1996

In vitro data

Caulophine and taspine have been shown to suppress epidermal growth factor in vitro.Hou 2011 Additionally, cytotoxic activity against HL-60 leukemia cells has been demonstrated by glycosides from C. thalictroides.Matsuo 2009 Piperidine alkaloids from C. robustum showed cytotoxicity against human palace cancer hela cell lines in an in vitro study.Yang 2019

Induction of labor

The 2 glycosides caulosaponin and caulophyllosaponin are thought to activate smooth muscle contractions and specifically stimulate uterine contractions.Kistin 2007, Rader 2013 Saponins of blue cohosh have uterine stimulant effects.Ferguson 1954

Animal and in vitro data

In studies of rats, extracts of Caulophyllum demonstrated inhibition of ovulation and effects on the uterus.Chandrasekhar 1974

Clinical data

There are no high-quality clinical trials regarding the use of blue cohosh for cervical ripening or induction of labor. A trial conducted in 1999 reported equivocal results for homoeopathic use of caulophyllum D4 versus placebo as an intervention to induce labor following premature rupture of membranes (N=40).Middleton 2017 A survey of US midwives published in 1999 reported widespread use of blue cohosh for the induction of labor; however, it is unclear if the preparations were of homeopathic potency or were more concentrated commercial extracts.Dugoua 2008 A 2005 Cochrane review found insufficient evidence to support the use of homeopathic caulophyllum for cervical ripening or induction of labor.Smith 2003 Concerns of toxicity in pregnancy and lactation exist.


Despite widespread knowledge and use of blue cohosh, there are no clinical trials on which to base dosing recommendations, and concerns regarding toxicity outweigh potential therapeutic benefit.Dugoua 2008

Composition of commercially available blue cohosh products varies, and adulteration has been described.Rader 2013

Pregnancy / Lactation

Avoid use; adverse effects have been documented.Brinker 1998, Ernst 2002 Blue cohosh has been used as an abortifacient.Rader 2013

Three case reports of adverse events in newborns related to maternal consumption of blue cohosh during pregnancy exist. Adverse reactions include acute MI with extensive congestive heart failure, infarct of the left middle cerebral artery with seizures, and multiorgan hypoxic injury. Causality has not been established.Dennehy 2010, Dugoua 2008, Finkel 2004, Kistin 2007, Rader 2013

Blue cohosh was identified as one of the most common herbs used by certified or licensed midwives for labor induction and/or dysfunctional labor according to state-wide surveys in California, Texas, and North Carolina.Dennehy 2010


Information regarding interactions with blue cohosh is limited because of a lack of clinical trials.

Adverse Reactions

Information is limited; clinical trials are lacking. Contact dermatitis has been described.Leung 2003 Nausea and elevated maternal blood pressure have been documented with use of blue cohosh during labor.Kistin 2007 Cardiovascular adverse reactions, including acute MI, infarct of the left middle cerebral artery, and tachycardia have been reported, particularly in infants born to women who consumed blue cohosh to induce labor; however, causality has not been established.Brown 2018, Dugoua 2008, Rader 2013


Blue cohosh root is potentially toxic to humans and to a developing fetus. Teratogens in extracts of C. thalictroides have been described, and mechanisms of action have been investigated.Datta 2014, Dugoua 2008, Keeler 1976, Kennelly 1999, Wu 2010 Case reports of poisoning in children from consumption of the raw seeds exist; however, the roasted seeds have been used as a coffee substitute.Leung 2003 Nicotine-like alkaloids with acetylcholine receptors activity have been described in C. thalictroides, with the potential for nicotinic poisoning.Schep 2009, Schmeller 1994

Reduced coronary flow was observed in rat heart preparations infused with N-methylcytisine, and a vasoconstrictive effect was found in hog and cattle carotid artery preparations exposed to the compound.Leung 2003, Scott 1943

Index Terms

  • Caulophyllum robustum Maxim.



This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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