Drug & supplement interaction

Blue Cohosh + Roxithromycin

Roxithromycin brand name: Roxithromycin.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 13, 2026
The bottom line No known interaction

We found no known interaction between Blue Cohosh and Roxithromycin 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.

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Interaction report

Blue Cohosh and Roxithromycin

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 Roxithromycin and Blue 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.

Blue Cohosh safety at a glance

Blue Cohosh overall Use caution Blue cohosh contains compounds that can affect the heart and has been linked to serious adverse events.
Pregnancy Likely Unsafe When used orally. Blue cohosh is a uterine stimulant and can induce labor. Several blue cohosh constituents, such as anagyrine and N-methylcytisine, are potenti... Read the full pregnancy detail
Breastfeeding Likely Unsafe When used orally. Blue cohosh is a uterine stimulant and can induce labor. Several blue cohosh constituents, such as anagyrine and N-methylcytisine, are potenti... 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 Roxithromycin and Blue Cohosh? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Roxithromycin

Interactions in our licensed database are recorded against drug classes, not just single drug names. Roxithromycin is filed under 2 classifications — cytochrome p450 3a4 (cyp3a4) inhibitors, oral drugs. Blue Cohosh has documented interactions with 3 drug classes — the most serious being antidiabetes drugs (moderate), antihypertensive drugs (moderate) and nicotine (moderate) — and none of Roxithromycin’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

Blue Cohosh Does Interact With Other Medications

Blue Cohosh has 259 moderate known drug interactions in our database — Roxithromycin isn’t one of them. If you take anything else, check it against the full list below.

Moderate 259 No known interaction 2,571 (incl. Roxithromycin)
Taking anything else?

Check Another of Your Medications Against Blue Cohosh

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

What to actually watch for

What Blue Cohosh Itself Has Been Linked To

This is not an interaction — nothing below involves Roxithromycin. It is the side-effect record for Blue Cohosh on its own, from the licensed Natural Medicines monograph. If something new turns up after you add Blue Cohosh, this list is the first place to look. 4 entries are worth acting on rather than waiting out — marked below.

  • A stroke or mini-stroke / Seizures Worth acting on Additional detail

    “Orally, blue cohosh can cause significant adverse effects including mucous membrane irritation, stomach upset including diarrhea and cramping, chest pain (angina), hypertension, and hyperglycemia.

    Neonatal acute myocardial infarction (MI), congestive heart failure (CHF), and shock has occurred following maternal use of a blue cohosh combination product one month before delivery.”

    Blue Cohosh · Natural Medicines adverse-effect record, reported in abortion.

    6 sources cited
    1. 6002. Fetrow CW, Avila JR. Professional's Handbook of Complementary & Alternative Medicines. 1st ed. Springhouse, PA: Springhouse Corp., 1999.
    2. 566. Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. J Pediatr 1998;132:550-2. PubMed
    3. 3383. Edmunds J. Blue cohosh and newborn myocardial infarction? Midwifery Today Int Midwife 1999;52:34-5.
    4. 94534. Dugoua JJ, Perri D, Seely D, et al. Safety and efficacy of blue cohosh (Caulophyllum thalictroides) during pregnancy and lactation. Can J Clin Pharmacol. 2008;15(1):e66-73.
    5. 1122. 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
    6. 9492. Gunn TR, Wright IM. The use of black and blue cohosh in labour. N Z Med J 1996;109:410-1.

    “In one case, a mother was advised to drink a blue cohosh tea to induce labor. The infant experienced a seizure during delivery and 2 days later it was discovered that the infant was experiencing an evolving ischemic stroke. There is also another case report of severe complications, including seizures, in an infant whose mother was given an unknown dose of black and blue cohosh at 42 weeks gestation to induce labor.”

    Blue Cohosh · Natural Medicines adverse-effect record, reported in epilepsy.

    5 sources cited
    1. 12047. Finkel RS, Zarlengo KM. Blue cohosh and perinatal stroke. N Engl J Med 2004;351:302-3. PubMed
    2. 94534. Dugoua JJ, Perri D, Seely D, et al. Safety and efficacy of blue cohosh (Caulophyllum thalictroides) during pregnancy and lactation. Can J Clin Pharmacol. 2008;15(1):e66-73.
    3. 1122. 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
    4. 9492. Gunn TR, Wright IM. The use of black and blue cohosh in labour. N Z Med J 1996;109:410-1.
    5. 94934. Sirtori CR, Triolo M, Bosisio R, et al. Hypocholesterolaemic effects of lupin protein and pea protein/fibre combinations in moderately hypercholesterolaemic individuals. Br J Nutr 2012;107:1176-83. PubMed
  • A heart attack / Heart failure / Chest pain / Raised blood pressure Worth acting on Additional detail

    “Orally, blue cohosh can cause tachycardia, hypertension, and chest pain (angina). Neonatal acute myocardial infarction (MI), congestive heart failure (CHF), myocardial toxicity, and shock has occurred following maternal use of a blue cohosh combination product one month before delivery.”

    Blue Cohosh · Natural Medicines adverse-effect record, reported in angina.

    6 sources cited
    1. 36720. Rao, R. B. and Hoffman, R. S. Nicotinic toxicity from tincture of blue cohosh (Caulophyllum thalictroides) used as an abortifacient. Vet.Hum.Toxicol. 2002;44(4):221-222.
    2. 36724. Scott, C. C. and Chen, K. K. The pharmacological action of N-methylcytisine. The Journal of Pharmacology and Experimental Therapuetics 1943;79:334-339. DOI
    3. 94934. Sirtori CR, Triolo M, Bosisio R, et al. Hypocholesterolaemic effects of lupin protein and pea protein/fibre combinations in moderately hypercholesterolaemic individuals. Br J Nutr 2012;107:1176-83. PubMed
    4. 566. Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. J Pediatr 1998;132:550-2. PubMed
    5. 3383. Edmunds J. Blue cohosh and newborn myocardial infarction? Midwifery Today Int Midwife 1999;52:34-5.
    6. 12047. Finkel RS, Zarlengo KM. Blue cohosh and perinatal stroke. N Engl J Med 2004;351:302-3. PubMed
  • High blood sugar / Shortness of breath Worth acting on Additional detail

    Recorded for Blue Cohosh in the same Natural Medicines adverse-effect record shown under A stroke or mini-stroke / Seizures above.

  • Kidney problems Worth acting on Additional detail

    “There is a case report of severe complications, including renal failure, in an infant whose mother was given an unknown dose of black and blue cohosh at 42 weeks gestation to induce labor.”

    Blue Cohosh · Natural Medicines adverse-effect record, reported in kidney failure.

    3 sources cited
    1. 1122. 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. 9492. Gunn TR, Wright IM. The use of black and blue cohosh in labour. N Z Med J 1996;109:410-1.
    3. 94934. Sirtori CR, Triolo M, Bosisio R, et al. Hypocholesterolaemic effects of lupin protein and pea protein/fibre combinations in moderately hypercholesterolaemic individuals. Br J Nutr 2012;107:1176-83. PubMed
  • Sweating Additional detail

    Recorded for Blue Cohosh in the same Natural Medicines adverse-effect record shown under A stroke or mini-stroke / Seizures above.

Showing the 10 most notable of 17 recorded effects — ranked by how unusual each one is across medicines generally, with serious effects weighted up.

Everything above comes from the Natural Medicines adverse-effect record for Blue Cohosh — expand a row for the licensed statement it rests on. We haven’t matched Roxithromycin to its FDA label in our system yet, so we can’t compare its own side-effect list here — the leaflet that comes with your prescription is the authoritative list for Roxithromycin.

Special populations

Blue Cohosh in Pregnancy & Breastfeeding

Pregnancy And Lactation Likely Unsafe

When used orally. Blue cohosh is a uterine stimulant and can induce labor. Several blue cohosh constituents, such as anagyrine and N-methylcytisine, are potentially teratogenic and might cause congenital malformations in newborns. Use of blue cohosh near term can cause life-threatening toxicity in the infant, as well as severe toxicity in the mother. Many midwives still use blue cohosh to facilitate delivery. This dangerous practice should be avoided.

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

Everything else you take

See Every Supplement That Interacts With Roxithromycin

This page covers Blue Cohosh only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Roxithromycin page lists 30 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Adrafinil (moderate), Cannabidiol (cbd) (moderate), Cannabinol (cbn) (moderate) and Cannabis (moderate).

By severity: 1 major · 19 moderate · 10 minor.

From our pharmacist’s overview on the Roxithromycin page

“If you take roxithromycin, an antibiotic prescribed for chest, throat, and skin infections, the entry to sort out first is activated charcoal, the only major-rated interaction among the 30 supplements on file. Charcoal binds medicines in the gut and can pull roxithromycin levels low enough to undercut treatment of the infection itself.”

Reviewed by 2 · Jul 18, 2026

Open the Roxithromycin interaction page

One more smart check

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

We hold 126 real supplement products containing Blue Cohosh, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Blue Cohosh. Even though Blue Cohosh itself has no known interaction with Roxithromycin, 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 Blue Cohosh and Roxithromycin 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 Blue Cohosh
Steady interest

#1,085 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Roxithromycin
Top 10%

#151 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 Blue Cohosh reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 13, 2026. The Blue Cohosh and Roxithromycin records this page draws on were last updated July 10, 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 Blue Cohosh

What is Blue Cohosh?

  • Inducing labor or starting menstruation
  • Menstrual cramps and irregular periods
  • Symptoms of menopause
  • Pelvic or uterine discomfort
  • Traditional Native American remedy

Blue cohosh is a traditional herb historically used by Native Americans and midwives to bring on labor or menstruation, but it carries serious safety concerns, especially for the heart and during pregnancy. There is very little reliable human evidence that it works, and reports of harm—including serious problems in newborns—make it an herb most people should avoid without close professional supervision.

Caulophyllum thalictroides · Berberidaceae · Root and rhizome · Capsules, tinctures, dried root, tea, liquid extracts

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

Blue Cohosh: dosing

There is no well-established, standardized safe dose for blue cohosh. Products vary widely in strength, and the herb's safety concerns make general dosing recommendations inappropriate.Because of the risk of serious side effects, we do not provide specific amounts.

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

Read the full Blue Cohosh monograph & all interactions
Keep checking

Other Drugs & Blue Cohosh

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

0Major
259Moderate
0Minor
2,570No known interaction
259 Moderate 2,570 No interaction
Moderate

259 interactions

Showing 60 of 259 moderate interactions — see all 259 on the Blue Cohosh page.

No interaction 2,570 drugs checked — show the list

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

Showing the 60 most looked-up of 2,570 medications checked with no known interaction — see the full Blue Cohosh list.

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

Blue Cohosh References

The 16 references that drive our Blue 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. Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. J Pediatr 1998;132:550-2. PubMed
  2. 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
  3. Wright IM. Neonatal effects of maternal consumption of blue cohosh. J Pediatr 1999;134:384-5. DOI
  4. Edmunds J. Blue cohosh and newborn myocardial infarction? Midwifery Today Int Midwife 1999;52:34-5.
  5. Fetrow CW, Avila JR. Professional's Handbook of Complementary & Alternative Medicines. 1st ed. Springhouse, PA: Springhouse Corp., 1999.
  6. Irikura B, Kennelly E. American Health Consultants. Blue Cohosh: a word of caution. 1999. Available at: http://www.ahcmedia.com/articles/50424-blue-cohosh-a-word-of-caution.
  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. Finkel RS, Zarlengo KM. Blue cohosh and perinatal stroke. N Engl J Med 2004;351:302-3. PubMed
  10. Kennelly, E. J., Flynn, T. J., Mazzola, E. P., Roach, J. A., McCloud, T. G., Danford, D. E., and Betz, J. M. Detecting potential teratogenic alkaloids from blue cohosh rhizomes using an in vitro rat embryo culture. J.Nat.Prod. 1999;62(10):1385-1389. PubMed
  11. Rao, R. B. and Hoffman, R. S. Nicotinic toxicity from tincture of blue cohosh (Caulophyllum thalictroides) used as an abortifacient. Vet.Hum.Toxicol. 2002;44(4):221-222.
  12. Gunn, T. R. and Wright, I. M. The use of black and blue cohosh in labour. N.Z Med J 10-25-1996;109(1032):410-411.
  13. Scott, C. C. and Chen, K. K. The pharmacological action of N-methylcytisine. The Journal of Pharmacology and Experimental Therapuetics 1943;79:334-339. DOI
  14. Low, D. T. Blue cohosh and neonatal myocardial toxicity. Journal of the American Herbalists Guild 2001;2(2):9-10.
  15. Dugoua JJ, Perri D, Seely D, et al. Safety and efficacy of blue cohosh (Caulophyllum thalictroides) during pregnancy and lactation. Can J Clin Pharmacol. 2008;15(1):e66-73.

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 Blue Cohosh and Roxithromycin Together: Common Questions

Is it safe to take Blue Cohosh with Roxithromycin?
We do not list a known interaction between Blue Cohosh and Roxithromycin. 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.
How was the Blue Cohosh and Roxithromycin combination checked?
Interactions in our licensed database are recorded against drug classes. Roxithromycin is filed under 2 classifications, and Blue Cohosh has documented interactions with 3 drug classes — none of Roxithromycin'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 Blue Cohosh interact with any other medications?
Yes. Blue Cohosh has 259 documented drug interactions in our database — Roxithromycin 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 Roxithromycin interact with any supplements?
Yes. Roxithromycin has documented interactions with 30 supplements in our database — Blue Cohosh is not one of them. The Roxithromycin 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

Blue Cohosh monograph Uses, safety profile, and every drug interaction in one place Roxithromycin supplement interactions Every supplement checked against Roxithromycin, 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 16 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Roxithromycin and Blue 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.