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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

Clinical Overview

See also: Orencia

Use

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.

Dosing

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

Contraindications

Contraindications have not yet been identified.

Pregnancy/Lactation

Avoid use; adverse effects have been documented.

Interactions

None well documented.

Adverse Reactions

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

Toxicology

Blue cohosh root is potentially toxic to humans and fetuses.

Botany

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

History

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

Chemistry

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

Dosing

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

Interactions

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

Toxicology

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

References

Ali Z, Khan IA. Alkaloids and saponins from blue cohosh. Phytochemistry. 2008;69(4):1037-1042.18048069
Avula B, Wang YH, Rumalla CS, Ali Z, Smillie TJ, Khan IA. Analytical methods for determination of magnoflorine and saponins from roots of Caulophyllum thalictroides (L.) Michx. using UPLC, HPLC and HPTLC. J Pharm Biomed Anal. 2011;56(5):895-903.21872415
Brinker FJ. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications; 1998.
Caulophyllum thalictroides (L.) Michx. USDA, NRCS. 2014. The PLANTS Database (http://plants.usda.gov, 15 April 2014). National Plant Data Team, Greensboro, NC 27401-4901 USA.
Chandrasekhar K, Sarma GH. Proceedings: observation on the effect of low and high doses of Caulophyllum on the ovaries and the consequential changes in the uterus and thyroid in rats. J Reprod Fertil. 1974;38(1):236-237.4842315
Datta S, Mahdi F, Ali Z, et al. Toxins in botanical dietary supplements: blue cohosh components disrupt cellular respiration and mitochondrial membrane potential. J Nat Prod. 2014;77(1):111-117.24328138
Dugoua JJ, Perri D, Seely D, Mills E, Koren G. Safety and efficacy of blue cohosh (Caulophyllum thalictroides) during pregnancy and lactation. Can J Clin Pharmacol. 2008;15(1):e66-e73.18204101
El Tahir KE. Pharmacological actions of magnoflorine and aristolochic acid-1 isolated from the seeds of Aristolochia bracteata. Int J Pharmacogn. 1991;29(2):101-110.
Erichsen-Brown C. Medicinal and Other Uses of North American Plants: A Historical Survey with Special Reference to the Eastern Indian Tribes. Mineola, NY: Dover Publications; 1980;355.
Ernst E. Herbal medicinal products during pregnancy: are they safe? BJOG. 2002;109(3):227-235.11950176
Ferguson HC, Edwards LD. A pharmacological study of a crystalline glycoside of Caulophyllum thalictroides. J Am Pharm Assoc Am Pharm Assoc (Baltim). 1954;43(1):16-21.13129097
Finkel RS, Zarlengo KM. Blue cohosh and perinatal stroke. N Engl J Med. 2004;351(3):302-303.15254294
Hou X, Wang S, Hou J, He L. Establishment of A431 cell membrane chromatography-RPLC method for screening target components from Radix Caulophylli. J Sep Sci. 2011;34(5):508-513.21259434
Keeler RF. Lupin alkaloids from teratogenic and nonteratogenic lupins. III. Identification of anagyrine as the probable teratogen by feeding trials. J Toxicol Environ Health. 1976;1(6):887-898.966318
Kennelly EJ, Flynn TJ, Mazzola EP, et al. Detecting potential teratogenic alkaloids from blue cohosh rhizomes using an in vitro rat embryo culture. J Nat Prod. 1999;62(10):1385-1389.10543898
Kistin SJ, Newman AD. Induction of labor with homeopathy: a case report. J Midwifery Womens Health. 2007;52(3):303-307.17467597
Lee Y, Jung JC, Ali Z, Khan IA, Oh S. Anti-Inflammatory effect of triterpene saponins isolated from blue cohosh (Caulophyllum thalictroides). Evid Based Complement Alternat Med. 2012;2012:798192.22988475
Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics. 2nd ed. Hoboken, NJ: Wiley-Interscience; 2003.
Li G, Zhang Y, Yang B, et al. Leiyemudanosides A-C, three new bidesmosidic triterpenoid saponins from the roots of Caulophyllum robustum. Fitoterapia. 2010;81(3):200-204.19720119
Likhatskaya GN, Aminin DL, Agafonova IG, et al. The pH-dependent channels formed by cauloside C. Adv Exp Med Biol. 1996;404:239-249.8957300
Matsuo Y, Watanabe K, Mimaki Y. Triterpene glycosides from the underground parts of Caulophyllum thalictroides. J Nat Prod. 2009;72(6):1155-1160.19449879
Rader JI, Pawar RS. Primary constituents of blue cohosh: quantification in dietary supplements and potential for toxicity. Anal Bioanal Chem. 2013;405(13):4409-4417.23420136
Schep LJ, Slaughter RJ, Beasley DM. Nicotinic plant poisoning. Clin Toxicol (Phila). 2009;47(8):771-781.19778187
Schmeller T, Sauerwein M, Sporer F, Wink M, Müller WE. Binding of quinolizidine alkaloids to nicotinic and muscarinic acetylcholine receptors. J Nat Prod. 1994;57(9):1316-1319.7798968
Scott CC, Chen KK. The pharmacological action of N-methylcytisine. J Pharmacol Exp Ther. 1943;79(4):334-339.
Si K, Liu J, He L, et al. Caulophine protects cardiomyocytes from oxidative and ischemic injury. J Pharmacol Sci. 2010;113(4):368-377.20724803
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
Smith CA. Homoeopathy for induction of labour. Cochrane Database Syst Rev. 2003;(4):CD003399.14583972
Wang S, Wen B, Wang N, Liu J, He L. Fluorenone alkaloid from Caulophyllum robustum Maxim. with anti-myocardial ischemia activity. Arch Pharm Res. 2009;32(4):521-526.19407969
Wang XL, Liu BR, Chen CK, Wang JR, Lee SS. Four new fluorenone alkaloids and one new dihydroazafluoranthene alkaloid from Caulophyllum robustum Maxim. Fitoterapia. 2011;82(6):793-797.21596111
Wu M, Hu Y, Ali Z, Khan IA, Verlangeiri AJ, Dasmahapatra AK. Teratogenic effects of blue cohosh (Caulophyllum thalictroides) in Japanese medaka (Oryzias latipes) are probably mediated through GATA2/EDN1 signaling pathway. Chem Res Toxicol. 2010;23(8):1405-1416.20707411

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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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