Drug & supplement interaction

Black Cohosh + Levofloxacin (ophthalmic)

Levofloxacin (ophthalmic) brand name: Levofloxacin.

Minor Interaction
Medically reviewed by · Updated September 2026
The bottom line Minor

Black Cohosh has a minor interaction with Levofloxacin (ophthalmic). Black cohosh may inhibit one form of OATP, OATP2B1, which could reduce the bioavailability and clinical effects of OATP2B1 substrates.

Read the full interaction report
SeverityMinor
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Black Cohosh and Levofloxacin (ophthalmic)

Here is the interaction we found between these two, with the evidence behind it.

Minor

ORGANIC ANION-TRANSPORTING POLYPEPTIDE SUBSTRATES (OATP)

Why this applies to Levofloxacin (ophthalmic)

Levofloxacin (ophthalmic) falls under ORGANIC ANION-TRANSPORTING POLYPEPTIDE SUBSTRATES (OATP) — the group Black Cohosh interacts with.

Black cohosh may inhibit one form of OATP, OATP2B1, which could reduce the bioavailability and clinical effects of OATP2B1 substrates.
In vitro research shows that black cohosh modestly inhibits OATP2B1. OATPs are expressed in the small intestine and liver and are responsible for the uptake of drugs and other compounds into the body. Inhibition of OATP may reduce the bioavailability of oral drugs that are substrates of OATP.
Severity Minor Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the good news: you asked about the eye drop form of levofloxacin. The interaction on file is about black cohosh possibly blocking a gut transporter (OATP2B1) that helps absorb certain swallowed medicines. Since eye drops go straight onto the surface of your eye and barely enter your bloodstream, this absorption issue really doesn't apply here.

On top of that, the concern itself is weak, based only on lab (test tube) research, not on real people. So for your levofloxacin eye drops, I wouldn't worry about black cohosh interfering with them. If you're ever prescribed levofloxacin pills instead, it's worth a quick chat with your pharmacist, but for the drops, you're fine.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Fuchikami H, Satoh H, Tsujimoto M, Ohdo S, Ohtani H, Sawada Y. Effects of herbal extracts on the function of human organic anion-transporting polypeptide OATP-B. Drug Metab Dispos 2006;34:577-82. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Black Cohosh Also Interacts With Other Medications

Black Cohosh has 636 moderate, 15 minor known drug interactions in our database — the Levofloxacin (ophthalmic) one above is one of them. If you take anything else, check it against the full list below.

Moderate 636 Minor 15 No known interaction 2,179 (incl. Levofloxacin (ophthalmic))
Taking anything else?

Check Another of Your Medications Against Black Cohosh

Covers the 2,830 medications we’ve checked against Black Cohosh. Pick one to open its full report.

From our Q&A

Questions About Black Cohosh or Levofloxacin (ophthalmic)

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Black Cohosh or Levofloxacin (ophthalmic), not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Levofloxacin (ophthalmic)

This page covers Black Cohosh only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Levofloxacin (ophthalmic) page lists 64 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Apple (major), Grapefruit (major), Sweet Orange (major), Bacillus Coagulans (moderate) and Bacillus Subtilis (moderate).

By severity: 3 major · 49 moderate · 12 minor.

Open the Levofloxacin (ophthalmic) interaction page

One more smart check

Taking Black Cohosh as Part of a Dietary Supplement Product? Check It for Interactions

We hold 1,472 real supplement products containing Black Cohosh, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Black Cohosh. Your product may carry other ingredients that interact with Levofloxacin (ophthalmic) too, on top of Black Cohosh — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Black Cohosh and Levofloxacin (ophthalmic) Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Black Cohosh
Top 25%

#148 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Levofloxacin (ophthalmic)
Steady interest

#2,296 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Black Cohosh

What is Black Cohosh?

Black Cohosh
  • Hot flashes and night sweats
  • Other menopause symptoms
  • Mood changes during menopause
  • Premenstrual syndrome (PMS)
  • Menstrual cramps

Black cohosh is a North American plant most often used to ease menopause symptoms like hot flashes, but the research is mixed and far from settled. It is generally well tolerated for short-term use, though rare reports of liver problems mean you should talk with your pharmacist or doctor before trying it, especially if you have liver disease.

Read the full Black Cohosh monograph & all interactions
Medication

About Levofloxacin

What Is Levofloxacin Used For?

Brand name: Levofloxacin

Levofloxacin treats bacterial infections in adults, including pneumonia (both community-acquired and hospital-acquired), skin infections, urinary tract infections, kidney infections, chronic bacterial prostatitis, and sinus infections. It is also used after exposure to inhalational anthrax and for plague.

Because levofloxacin carries significant risks, it should only be used for uncomplicated urinary tract infections, acute bacterial worsening of chronic bronchitis, and acute bacterial sinusitis when no other treatment option is available. Always use it only for infections confirmed or strongly suspected to be bacterial.

See full Levofloxacin drug information
Keep checking

Other Drugs & Black Cohosh

Browse every other medication we’ve checked against Black Cohosh — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
636Moderate
15Minor
2,178No known interaction
636 Moderate 15 Minor 2,178 No interaction
Moderate

636 interactions

Showing 60 of 636 moderate interactions — see all 636 on the Black Cohosh page.

Minor

15 interactions

No interaction 2,178 drugs checked — show the list

We also checked Black Cohosh against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,178 medications checked with no known interaction — see the full Black Cohosh list.

See the full Black Cohosh interactions page
See every supplement checked against Levofloxacin (ophthalmic), ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Black Cohosh monograph › Uses, safety, and every drug interaction in one place Levofloxacin (ophthalmic) supplement interactions › Every supplement checked against Levofloxacin (ophthalmic), ranked by severity Levofloxacin drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Black Cohosh and Levofloxacin (ophthalmic) Together: Common Questions

Can you take Black Cohosh with Levofloxacin (ophthalmic)?
There is only a minor interaction, which is usually not serious. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Black Cohosh and Levofloxacin (ophthalmic) interaction?
We rate it Minor. This interaction is generally not clinically significant, but it remains worth noting and discussing with your pharmacist.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Levofloxacin (ophthalmic) and Black Cohosh?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.