Black Cohosh Interactions Overview

Additional Details

Is Black Cohosh Safe? Are There Any Warnings?

Black cohosh is considered to be possibly safe when used orally and appropriately. It has been safely used in some studies lasting up to a year, although most studies have only lasted up to 6 months. There is some concern that black cohosh may cause liver damage in some patients, although the evidence is not conclusive.

How Is Black Cohosh Thought To Work? What Is the Mechanism of Action?

Black cohosh contains various active constituents, including triterpene glycosides, organic acids, sugars, and tannins. It is believed to have estrogen-like effects, acting as a selective estrogen receptor modulator (SERM).

This means that it can have estrogenic effects in some tissues and antiestrogenic effects in others. Black cohosh has been shown to inhibit histamine release, possess anti-inflammatory properties, and have antioxidant effects. It may also have antiviral, antilipemic, and bone metabolism effects. However, more research is needed to fully understand its mechanism of action.

Pharmacokinetics

The active constituents of black cohosh are absorbed and distributed throughout the body. One constituent, 23-epi-26-deoxyactein, has a half-life of approximately two hours.

The excretion of black cohosh constituents occurs through various pathways. The distribution and metabolism of black cohosh in the body have been studied primarily in menopausal adults.

Interaction Overview (Full List Below)

Black cohosh may interact with certain drugs, such as atorvastatin and cisplatin, potentially increasing the risk of adverse effects. It may also interact with drugs metabolized by cytochrome P450 enzymes, as well as supplements and herbs with hepatotoxic effects.

Additionally, black cohosh may interact with certain health conditions, including breast cancer, hormone-sensitive cancers/conditions, and liver disease. It is important to consult with a healthcare professional before starting black cohosh to ensure safety and to avoid any potential interactions.

Common Side Effects to Watch For

Common side effects of black cohosh, when taken orally, may include breast tenderness, dizziness, gastrointestinal upset, headache, irritability, rash, and tiredness.

These side effects are generally well tolerated when used in typical doses. Serious adverse effects, such as endometrial hyperplasia and hepatotoxicity, are rare but have been reported. It is important to monitor for any unexpected or severe side effects and seek medical attention if necessary.

Are Supplements Standardized?

Black cohosh supplements are often standardized to triterpene glycoside content. One specific black cohosh extract, Remifemin, has been commonly used and studied, containing 1 mg triterpene glycosides per 20 mg tablet.

However, it is important to note that the amount of active constituents and standardization may vary among different black cohosh products. Some products labeled as black cohosh may contain other Actaea species or significant variability in active constituents. There have also been concerns about the presence of heavy metals in some black cohosh products.

What Is Black Cohosh Typically Used For?

Black cohosh has been studied primarily for its potential effectiveness in reducing menopausal symptoms, such as hot flashes. Some clinical trials have shown a modest reduction in symptoms when using a specific black cohosh product called Remifemin.

However, research on other conditions, such as acne, anxiety, breast cancer, cardiovascular disease, cognitive function, cough, dysmenorrhea, infertility, migraines, osteoarthritis, osteoporosis, labor induction, polycystic ovary syndrome, and premenstrual syndrome, has been limited or inconclusive. More research is needed to determine the effectiveness of black cohosh for these uses.

Drugs that interact with Black Cohosh