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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
Drug class: Herbal products

Medically reviewed by Last updated on Aug 23, 2021.

Clinical Overview


Blue cohosh has been used to induce uterine contractions; 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 or use of blue cohosh, there are no clinical trials on which to base dosage recommendations.


Contraindications have not yet 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 medical benefit.


Blue cohosh root is potentially toxic to humans and fetuses.

Scientific Family

  • Berberidaceae (barberry)


Blue cohosh is a perennial herb with yellowish-green flowers that bloom in early spring and mature into bitter, bright blue seeds. It 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. The root of an Asian species, Caulophyllum robustum Maxim., has also been used medicinally.Leung 2003, USDA 2014


Blue cohosh was used by American Indians as a sedative; the name "cohosh" comes 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 19th century Eclectic medical 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


Chemical constituents of blue cohosh continue to be elucidated. 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, magnoflurine, baptifoline, anagyrine, lupanine, sparteine, taspine, and cauloside, among others.

Analytical techniques have been described. The saponins of the related species C. robustum have also been characterized.Ali 1980, Avula 2011, Datta 2014, Leung 2003, Li 2010, Matsuo 2009, Wang 2011, Wang 2009

Uses and Pharmacology

Cardiovascular effects

Animal data

Pretreatment with the alkaloid caulophine from the roots of the related species C. robustum protected rats against induced cardiomycete injury, possibly via antioxidant activity, and calcium antagonism.Si 2010, Si 2010, Wang 2009 Coronary and carotid artery constriction has been described in animal studies.Scott 1943 Magnoflorine decreased arterial blood pressure in rabbits and induced hypothermia in mice.El Tahir 1991

Clinical data

There are no clinical data regarding the use of blue cohosh for the treatment of cardiovascular conditions.

Induction of labor

Animal data

The blue cohosh saponins have uterine stimulant effects.Ferguson 1954 Extracts of Caulophyllum given to rats were found to inhibit ovulation and affect the uterus.Chandrasekhar 1974 Both caulosaponin and caulophyllosaponin have been shown to stimulate uterine contractions in animals.Kistin 2007, Rader 2013

Clinical data

There are no high-quality clinical data regarding the use of blue cohosh for cervical ripening or induction of labor. 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 are of homeopathic potency or are 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

Other uses

A mechanism for cytotoxicity that involves formation of pH-dependent channels has been suggested for cauloside C.Likhatskaya 1996 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 Caulophyllum thalictroides.Matsuo 2009

Suppression of proinflammatory cytokines and other mediators of inflammation has been demonstrated in vitro with blue cohosh saponins.Lee 2012


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

The composition of commercially available blue cohosh products is known to vary, 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 exist regarding adverse events in newborns related to maternal consumption of blue cohosh during pregnancy. Adverse reactions include acute myocardial infarction with extensive congestive heart failure, infarct of the left middle cerebral artery with seizures, and multiorgan hypoxic injury. Causality has not been established.Dugoua 2008, Finkel 2004, Kistin 2007, Rader 2013


Information on interactions with this product is limited because of the 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


Blue cohosh root is potentially toxic to humans and fetuses. 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 Blue cohosh berries are poisonous to children when consumed raw; 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

Index Terms

  • Caulophyllum robustum Maxim.


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Si KW, Liu JT, He LC, et al. Effects of caulophine on caffeine-induced cellular injury and calcium homeostasis in rat cardiomyocytes. Basic Clin Pharmacol Toxicol. 2010;107(6):976-981.20649558
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