Drug & supplement interaction

Black Cohosh + Rifabutin

Rifabutin brand name: Mycobutin.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 20, 2026
The bottom line No known interaction

We found no known interaction between Black Cohosh and Rifabutin in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the label for Rifabutin states a food rule worth keeping to, and the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

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Interaction report

Black Cohosh and Rifabutin

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Rifabutin and Black Cohosh in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Black Cohosh safety at a glance

Black Cohosh overall Use caution Generally well tolerated short-term, but rare liver concerns mean medical guidance is wise.
Pregnancy Possibly Unsafe When used orally in pregnant patients who are not at term. Black cohosh might have hormonal effects and menstrual and uterine stimulant effects. Theoretically,... Read the full pregnancy detail
Breastfeeding Possibly Unsafe When used orally. Black cohosh might have hormonal effects. Theoretically, maternal intake of black cohosh might adversely affect a nursing child. Until more is... Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center) — the full detail is in the Special populations card below. Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Rifabutin and Black Cohosh? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Rifabutin

Interactions in our licensed database are recorded against drug classes, not just single drug names. Rifabutin is filed under 4 classifications — including cytochrome p450 3a4 (cyp3a4) inducers, antibiotic drugs, cytochrome p450 3a4 (cyp3a4) substrates. Black Cohosh has documented interactions with 7 drug classes — the most serious being atorvastatin (lipitor) (moderate), cisplatin (platinol-aq) (moderate) and cytochrome p450 2d6 (cyp2d6) substrates (moderate) — and none of Rifabutin’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Black Cohosh Does Interact With Other Medications

Black Cohosh has 636 moderate, 16 minor known drug interactions in our database — Rifabutin isn’t one of them. If you take anything else, check it against the full list below.

Moderate 636 Minor 16 No known interaction 2,178 (incl. Rifabutin)
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.

What to actually watch for

No Interaction Found — But Data Suggests Black Cohosh and Rifabutin May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do.

  • Stomach upset Additional detail

    Black Cohosh

    “Orally, black cohosh can commonly cause gastrointestinal upset. Constipation and indigestion have also been reported.”

    Black Cohosh · Natural Medicines adverse-effect record, reported in constipation.

    6 sources cited
    1. 4383. Whiting PW, Clouston A, Kerlin P. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2002;177:440-3. PubMed
    2. 4615. Pepping J. Black cohosh: Cimicifuga racemosa. Am J Health Syst Pharm 1999;56:1400-2. PubMed
    3. 4616. Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Adv Ther 1998;15:45-53.
    4. 10988. Huntley A, Ernst E. A systematic review of the safety of black cohosh. Menopause 2003;10:58-64.. DOI
    5. 13184. Nappi RE, Malavasi B, Brundu B, Facchinetti F. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol 2005;20:30-5.
    6. 35824. Vermes G, Bánhidy F, Acs N. The effects of remifemin on subjective symptoms of menopause. Adv Ther 2005;22:148-54. PubMed

    Rifabutin

    Listed in the ADVERSE REACTIONS section of the FDA label for Rifabutin. Read the label on DailyMed ›

  • Tiredness / Headache Additional detail

    Black Cohosh

    “Orally, black cohosh may cause headache, dizziness, or tiredness. There is one case report of seizures in a female who used black cohosh, evening primrose oil, and chasteberry. A separate case report describes a 55-year-old female who experienced serotonin syndrome after the addition of black cohosh extract 40 mg daily to longstanding treatment with duloxetine 60 mg and sertraline 50 mg daily.

    In one case, an infant…”

    Black Cohosh · Natural Medicines adverse-effect record, reported in acute respiratory distress syndrome (ards).

    6 sources cited
    1. 35852. Oktem M, Eroglu D, Karahan HB, Taskintuna N, Kuscu E, Zeyneloglu HB. Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized trial. Adv Ther 2007;24:448-61. PubMed
    2. 35886. Wong, V. C., Lim, C. E., Luo, X., and Wong, W. S. Current alternative and complementary therapies used in menopause. Gynecol.Endocrinol. 2009;25(3):166-174. PubMed
    3. 10988. Huntley A, Ernst E. A systematic review of the safety of black cohosh. Menopause 2003;10:58-64.. DOI
    4. 116172. Dernbach MR, Carpenter JE, Shah N, Carter GB. Black Cohosh Interactions with Prescription Medications Associated with Serotonin Toxicity and Rhabdomyolysis: A Case Report. J Emerg Med 2024;66(5):e592-e596. PubMed
    5. 9492. Gunn TR, Wright IM. The use of black and blue cohosh in labour. N Z Med J 1996;109:410-1.
    6. 9493. Baillie N, Rasmussen P. Black and blue cohosh in labour. N Z Med J 1997;110:20-1.

    Rifabutin

    Listed in the ADVERSE REACTIONS section of the FDA label for Rifabutin. Read the label on DailyMed ›

  • A skin rash Additional detail

    Black Cohosh

    Recorded for Black Cohosh in the same Natural Medicines adverse-effect record shown under Stomach upset above.

    Rifabutin

    Listed in the ADVERSE REACTIONS section of the FDA label for Rifabutin. Read the label on DailyMed ›

Reported for Black Cohosh but not commonly for Rifabutin: liver problems, shortness of breath, kidney problems and serotonin syndrome.

Effects for Rifabutin come from the ADVERSE REACTIONS section of its FDA label; effects for Black Cohosh come from the Natural Medicines adverse-effect record, quoted above. Where a percentage is shown, it is the share of 2,836 voluntary FDA FAERS reports for Rifabutin that mention that effect — a reporting proportion, not an incidence rate and not evidence the drug caused it. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

Special populations

Black Cohosh in Pregnancy & Breastfeeding

Pregnancy Possibly Unsafe

When used orally in pregnant patients who are not at term. Black cohosh might have hormonal effects and menstrual and uterine stimulant effects. Theoretically, this might increase the risk of miscarriage; avoid using during pregnancy. There is insufficient reliable information available about the safety of black cohosh when used to induce labor.

Lactation Possibly Unsafe

When used orally. Black cohosh might have hormonal effects. Theoretically, maternal intake of black cohosh might adversely affect a nursing child. Until more is known, nursing patients should avoid taking black cohosh.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.© 2026 Therapeutic Research Center

How to take them

Some Rifabutin Products Have a Food Rule — Black Cohosh Should Not Break It

At least one FDA label for a product containing Rifabutin says to take it with food. If you take Black Cohosh on an empty stomach out of habit, keep them separate — and take Rifabutin with a meal where the label says to.

This may not be true of your version. Food instructions belong to the product, not the ingredient: two Rifabutin products can carry different directions, and extended-release forms often differ from immediate-release ones. The label we read is quoted below — check the directions on your own box or bottle, or ask your pharmacist, for how to take the exact product you were given.

For those patients with propensity to nausea, vomiting, or other gastrointestinal upset, administration of rifabutin at doses of 150 mg twice daily taken with food may be useful.

From the Dosage and Administration section of the FDA label we read for Rifabutin — where that label names a specific product, the instruction is that product's. Read the label on DailyMed ›

A food rule is not an interaction — it is about how much of the medicine you absorb. The directions that came with your own product, and your pharmacist, outrank anything on this page.

From our Q&A

Questions About Black Cohosh or Rifabutin

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 Rifabutin, 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 Rifabutin

This page covers Black Cohosh only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Rifabutin page lists 180 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Grapefruit (major), St. John's Wort (major), Acacia Rigidula (moderate) and Adrafinil (moderate).

By severity: 3 major · 136 moderate · 41 minor.

From our pharmacist’s overview on the Rifabutin page

“Most people on rifabutin (Mycobutin) are treating or preventing serious mycobacterial infections like MAC or tuberculosis, often for months at a time, and this list deserves a careful read before adding a single capsule. Of the 180 supplements with an interaction on file, three carry a major rating, and all three can shift rifabutin's…”

Reviewed by 2 · Jul 18, 2026

Open the Rifabutin 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. Even though Black Cohosh itself has no known interaction with Rifabutin, another ingredient on your label might. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Black Cohosh and Rifabutin 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%

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

29 days ago today
Medication Rifabutin
Top 25%

#656 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.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Black Cohosh reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 20, 2026. The Black Cohosh and Rifabutin records this page draws on were last updated July 11, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
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.

Actaea racemosa · Ranunculaceae · Roots and rhizomes (underground stems) · Capsules, tablets, liquid extracts (tinctures), dried root for tea

An interaction check asks whether these two react with each other — it does not ask whether Black Cohosh is a good idea for someone in your situation. Here is what our Black Cohosh record says about it on its own.

Black Cohosh: dosing

There is no official standard dose of black cohosh. Many supplements are standardized to their triterpene glycoside content, and studies have used a range of amounts, so products can differ a lot from one another.The safest approach is to follow the directions on the product label and not exceed the recommended amount.

From our Black Cohosh monograph — the full record covers uses, side effects and every documented interaction.

Read the full Black Cohosh monograph & all interactions
Medication

About Rifabutin

What Is Rifabutin Used For?

Brand name: Mycobutin

Rifabutin capsules are used to prevent disseminated MAC (Mycobacterium avium complex) disease — a serious bacterial infection that can spread throughout the body — in patients with advanced HIV infection.

It is not approved to treat active tuberculosis (TB), and it must not be used alone in patients who have active TB, as this can lead to antibiotic resistance.

See full Rifabutin 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
16Minor
2,177No known interaction
636 Moderate 16 Minor 2,177 No interaction
Moderate

636 interactions

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

Minor

16 interactions

No interaction 2,177 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 2,177 medications checked with no known interaction — see the full Black Cohosh list.

See the full Black Cohosh interactions page
See every supplement checked against Rifabutin, ranked by severity
Evidence & sources

Black Cohosh References

The 68 references that drive our Black Cohosh monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. McFarlin BL, Gibson MH, O'Rear J, Harman P. A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice. J Nurse Midwifery 1999;44:205-16. PubMed
  2. Whiting PW, Clouston A, Kerlin P. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2002;177:440-3. PubMed
  3. Pepping J. Black cohosh: Cimicifuga racemosa. Am J Health Syst Pharm 1999;56:1400-2. PubMed
  4. Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Adv Ther 1998;15:45-53.
  5. Kruse SO, Lohning A, Pauli GF, et al. Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Planta Med 1999;65:763-4.
  6. Jacobson JS, Troxel AB, Evans J, et al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol 2001;19:2739-45. PubMed
  7. Gunn TR, Wright IM. The use of black and blue cohosh in labour. N Z Med J 1996;109:410-1.
  8. Baillie N, Rasmussen P. Black and blue cohosh in labour. N Z Med J 1997;110:20-1.
  9. Lontos S, Jones RM, Angus PW, Gow PJ. Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust 2003;179:390-1.. DOI
  10. Wuttke W, Seidlova-Wuttke D, Gorkow C. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas 2003;44:S67-77. PubMed
  11. Huntley A, Ernst E. A systematic review of the safety of black cohosh. Menopause 2003;10:58-64.. DOI
  12. Cohen SM, O'Connor AM, Hart J, et al. Autoimmune hepatitis associated with the use of black cohosh: a case study. Menopause 2004;11:575-7. PubMed
  13. Vitetta L, Thomsen M, Sali A. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2003;178:411-2.. PubMed
  14. Thomsen M, Vitetta L, Schmidt M, Sali A. Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust 2004;180:598-600.. DOI
  15. Cohen B, Schardt D. Center for Science in the Public Interest. Letter to Food and Drug Administration. Commissioner Mark McClellan, MD, PhD. March 4, 2004.

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking Black Cohosh and Rifabutin Together: Common Questions

Is it safe to take Black Cohosh with Rifabutin?
We do not list a known interaction between Black Cohosh and Rifabutin. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
Do Black Cohosh and Rifabutin have any of the same side effects?
Yes — our sources link each of them separately to 4 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.
Should I take Black Cohosh and Rifabutin at the same time of day?
At least one FDA label for a product containing Rifabutin says to take it with food. If you take Black Cohosh on an empty stomach out of habit, keep them separate and take Rifabutin with a meal where the label says to. Food instructions belong to the product rather than the ingredient — two Rifabutin products can differ — so check the directions on your own box. This is about absorption, not an interaction.
How was the Black Cohosh and Rifabutin combination checked?
Interactions in our licensed database are recorded against drug classes. Rifabutin is filed under 4 classifications, and Black Cohosh has documented interactions with 7 drug classes — none of Rifabutin's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does Black Cohosh interact with any other medications?
Yes. Black Cohosh has 652 documented drug interactions in our database — Rifabutin is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Rifabutin interact with any supplements?
Yes. Rifabutin has documented interactions with 180 supplements in our database — Black Cohosh is not one of them. The Rifabutin interaction page linked on this page lists every one, ranked by severity.

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

Where next

Keep Exploring

Black Cohosh monograph Uses, safety profile, and every drug interaction in one place Rifabutin drug information The full plain-English guide to this medication Rifabutin supplement interactions Every supplement checked against Rifabutin, ranked by severity Supplement interaction checker Check any supplement or product against your medications Browse medications A–Z Every drug we’ve checked against herbs & supplements References The 68 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Rifabutin 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.