Interactions on record — worth a quick check against your medications. Check your meds →
Dietary supplement

Black Cohosh 540 mg Ingredients & Drug Interactions

by Solaray

Black Cohosh 540 mg label
See full label image
Capsule Category: Botanical
Most serious interaction: Moderate
Clinical methodology reviewed by · Updated Sep 9, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Black Cohosh 540 mg against your medications. The heart of this page is the interaction checker and the full interaction report — how this product’s ingredients may interact with prescription and over-the-counter medicines you may be taking.

Around that, we add a pharmacist’s high-level view of the product as a whole — what’s inside, the evidence for its stated use, how transparent the label is, and what safety data exists — so you can see the full picture in one place. It’s educational information from our licensed clinical databases and the clinical staff at HelloPharmacist — not medical advice — and we don’t sell or endorse products. Our editorial policy

The interaction bottom line Most serious interaction: Moderate

Black Cohosh 540 mg is a dietary supplement by Solaray with 1 active ingredient. Its ingredients are commonly taken for hot flashes and night sweats, other menopause symptoms, mood changes during menopause.Based on those ingredients, 652 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are Black Cohosh. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

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Check Your Meds Against Black Cohosh 540 mg by Solaray

Ask about any prescription or over-the-counter medication and we check it for interactions with Black Cohosh 540 mg by Solaray — and tell you which ingredient is responsible.

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HelloPharmacist Scorecard of Black Cohosh 540 mg by Solaray

Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.

From our pharmacy team — supplement deep dive

Generated from HelloPharmacist’s pharmacist-curated databases and editorial rules · Last generated Jul 12, 2026

What’s inside

Full disclosure
Ingredient Transparency · database check
Full

Every active ingredient lists its own amount on the label.

Why this rating?
  • The label discloses an exact amount for 1 of its 1 active ingredient.
  • No proprietary blends here — you can verify the dose of every single component.

This product contains one active ingredient: black cohosh 540 mg per capsule. Black cohosh is a plant extract traditionally used to address menopausal hot flashes and other symptoms tied to hormonal changes.

The capsule also contains cellulose as an inactive ingredient.

Does it work?

Moderate evidence
Evidence for Intended Use · database check
By FDA rules, dietary supplements can’t claim to treat, cure, or prevent disease — so labels speak in careful marketing language. We discern each product’s intended use from its name, label claims, and label statements, then grade the clinical evidence for that use. How these ratings are computed
Moderate

Some clinical evidence supports this product's ingredients for its stated purpose, but it isn't conclusive.

Why this rating?
  • The label markets this product for: midlife support for menopausal symptoms.
  • We looked for evidence on: Menopausal symptoms, Premenstrual syndrome (PMS), Dysmenorrhea, hot flashes, night sweats, mood changes.
  • The strongest evidence on file: Black Cohosh is rated "Possibly Effective" for Menopausal symptoms (Natural Medicines).
  • Also on file: Black Cohosh is rated "Insufficient Reliable Evidence To Rate" for Breast cancer-related hot flashes, Premenstrual syndrome (PMS), Dysmenorrhea.

Black cohosh is possibly effective for menopausal symptoms — that's the clearest evidence we have. For acne, sexual dysfunction, anxiety, and breast cancer-related hot flashes, the evidence isn't established in our data, meaning we don't have enough reliable research yet to rate how well it works for those uses.

The evidence, ingredient by ingredient Black Cohosh

How safe is it?

Well-documented data
Safety Information · database check
Well characterized

Adverse-effect, pregnancy, and general safety data are on file for most of these ingredients.

Why this rating?
  • We hold adverse-effect (side-effect) data for 1 of the 1 matched ingredient.
  • Pregnancy & breastfeeding safety ratings cover 1 of 1.
  • General safety write-ups exist for 1 of 1.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Black cohosh is generally well tolerated at typical doses in the short term, but there are some cautions. The most common side effects are minor — breast tenderness, dizziness, upset stomach, headache, irritability, rash, and tiredness.

Rare but serious concerns include liver damage (hepatotoxicity) and overgrowth of the uterine lining (endometrial hyperplasia), though the data conflict on both. There's also one case report of serotonin syndrome and another of seizures, though both involved multiple substances.

Black cohosh is rated possibly unsafe in pregnancy because of potential effects on the uterus and a lack of safety data — avoid it if you're pregnant. Safety while breastfeeding hasn't been established either, so it's best avoided then too.

Side effects, ingredient by ingredient Black Cohosh

Meds to double-check

Moderate interaction found
Known Interaction Concern · database check
Moderate identified

The most serious documented interaction for these ingredients is Moderate. Check your medications for a personalized result.

Why this rating?
  • 1 of the 1 matched ingredient can interact with medications — Black Cohosh.
  • The most serious interaction on file is rated Moderate.
  • For scale: 653 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.

Before you take this product, double-check it against any serotonergic drugs you're on — that's your biggest concern. Also flag any hepatotoxic medications, drugs metabolized by CYP2D6, atorvastatin (Lipitor), estrogen therapy, or cisplatin.

The interaction checker below will walk through your complete list.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFully disclosed formula with some supporting evidence for its stated purpose. Moderate medication interactions have been identified, and safety information is well characterized.

Black cohosh may help with menopausal hot flashes, but it comes with medication interactions and liver concerns you need to know about. If you take any antidepressants, liver-affecting drugs, or other prescription medications, check them against this product first.

Talk to your pharmacist before starting, especially if you're pregnant, breastfeeding, or have liver issues.

Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI

Assessment coverage: 1 of 1 active ingredient matched to our full ingredient reviews (monographs). Based on the product label dated Apr 23, 2024.

This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed

At a glance

General information

Key facts about Black Cohosh 540 mg, straight from the product label.

Brand Solaray
Barcode (UPC) 076280017038
Net contents 180 Veg Cap(s)
Market status On market
Date entered into DSLD Apr 23, 2024
DSLD ID 313487
Product type Botanical
Supplement form Capsule
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Vegan, Vegetarian, Adult (18 - 50 Years), Women (not pregnant or lactating), Dairy Free
From the label
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.

Supplement Facts

The label details for Black Cohosh 540 mg by Solaray, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
1 VegCap(s)
Maximum serving Sizes:
1 VegCap(s)
Servings per container
180
UPC/BARCODE
076280017038
IngredientAmount% DV
Black Cohosh540 mg--

Other ingredients: Cellulose

Tap any ingredient to jump to its full detail below.

Label statements
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
Brand IP Statement(s)

Solaray Est 1973

Formulation

True herbs +Midlife support

Vegan

Seals/Symbols

Lab Verified Vegan

FDA Statement of Identity

Dietary Supplement

General Statements

Since 1973, we've scoured the globe for the highest quality ingredients, connecting you with the most efficacious supplements that help you live brighter & embrace the moments that matter most.

A Brighter Way 1973

100% PCR bottles

Precautions

Warning: Do not use if safety seal is broken or missing. Keep your licensed health care practitioner informed when using this product.

Keep out of reach of children.

Do not use if you are pregnant or nursing.

California residents only Warning: Reproductive harm - www.P65Warnings.ca.gov

Suggested/Recommended/Usage/Directions

Directions: Use only as directed. Take 1 VegCap twice daily with a meal or glass of water.

Storage

Store in a cool, dry place.

Formula

Discussion: Originating in North America, black cohosh is a perennial herb in the buttercup family. Black cohosh is know for its phytoestrogen properties. Black cohosh may provide midlife support.

FDA Disclaimer Statement

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Is this label outdated? Report a formula or label change and our pharmacy team will review it.

See for yourself

Black Cohosh 540 mg by Solaray label

The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.

Black Cohosh 540 mg label

Label images are published by the NIH Dietary Supplement Label Database for the version of this product on file. Always read your actual product label.

View the full label (PDF)
What’s inside

The Ingredients in Black Cohosh 540 mg by Solaray

This is the 1 active ingredient this product is made of. Select it to open its full monograph.

Serving size1 VegCap(s) Dosage formCapsule Servings per container180 Amounts shown are per serving.

Black Cohosh

Interacts with
652 drugs
540 mg per serving Form: Cimicifuga racemosa

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...

Black Cohosh monograph & interactions

Other (inactive) ingredients: Cellulose. These complete the product’s ingredient list but are not active constituents.

Interaction report

Black Cohosh 540 mg by Solaray Drug Interactions

Want to check YOUR meds against Black Cohosh 540 mg?

Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.

 Go to the checker
652Drugs
636 Moderate 16 Minor

Ingredients driving the most interactions

Black Cohosh 652

Individual Drug Interactions

The ingredients in Black Cohosh 540 mg interact with 652 drugs. Click any drug to see the details.

1 of the 1 ingredient in Black Cohosh 540 mg interact with drugs. Each result below shows which ingredient is responsible. Black Cohosh

Each ingredient & the kinds of drugs it affects

For each ingredient in Black Cohosh 540 mg with known interactions, here are the types of medications it can affect. Open any type for the detail — or search your exact drug in the checker above.

Black Cohosh7 drug types · 652 drugs

Atorvastatin (Lipitor)

Taking black cohosh with atorvastatin might increase the risk for elevated liver function tests.
In one case report, a patient taking atorvastatin (Lipitor) developed significantly elevated liver function enzymes after starting black cohosh 100 mg four times daily. Liver enzymes returned to normal when black cohosh was discontinued. It is unclear whether the elevated liver enzymes were due to black cohosh itself or an interaction between atorvastatin and black cohosh.

Likelihood Possible Evidence D
Cisplatin (Platinol-Aq)

Theoretically, black cohosh may reduce the clinical effects of cisplatin.
Animal research suggests that black cohosh might decrease the cytotoxic effect of cisplatin on breast cancer cells.

Likelihood Possible Evidence D
Cytochrome P450 2D6 (Cyp2D6) Substrates

Some research suggests that black cohosh might inhibit CYP2D6, but there is conflicting evidence.
Some clinical research suggests that black cohosh might modestly inhibit CYP2D6 and increase levels of drugs metabolized by this enzyme. However, contradictory clinical research shows a specific black cohosh product (Remifemin, Enzymatic Therapy) 40 mg twice daily does not significantly inhibit metabolism of a CYP2D6 substrate in healthy study volunteers. Until more is known, use black cohosh cautiously in patients taking drugs metabolized by CYP2D6.

Likelihood Possible Evidence B
Estrogens

Theoretically, black cohosh may alter the effects of estrogen therapy.
Some research suggests that black cohosh has estrogenic effects. This may enhance or inhibit the effects of estrogen therapy.

Likelihood Possible Evidence D
Hepatotoxic Drugs

Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
There is concern that black cohosh might be linked to cases of liver failure and autoimmune hepatitis.

Likelihood Possible Evidence D
Serotonergic Drugs

Combining serotonergic drugs with black cohosh might cause additive serotonergic effects.
Black cohosh might increase the risk of serotonin syndrome when combined with other serotonergic drugs. Black cohosh acts as an agonist at several serotonin receptor subtypes and might interact with other serotonergic medications. In one case, a 55-year-old female who had been on stable treatment with sertraline 50 mg and duloxetine 60 mg daily developed serotonin syndrome after taking black cohosh extract 40 mg daily for 3 days.

Likelihood Possible Evidence D
Organic Anion-Transporting Polypeptide Substrates (Oatp)

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.

Likelihood Possible Evidence D
Black Cohosh full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Black Cohosh 540 mg, from the product label.

Solaray

See all Solaray products
Name
Nutraceutical Corp.
Web Address
www.nutraceutical.com
Pharmacist Counseling Corner

Black Cohosh 540 mg by Solaray: Common Questions

Does Black Cohosh 540 mg by Solaray interact with any medications?
Yes. Based on its ingredients, Black Cohosh 540 mg has a known interaction with 652 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Black Cohosh 540 mg contains a single active ingredient, and that one ingredient can interact with many different medications on its own. We check it against each medication and show the mechanism responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.
Does black cohosh really help with hot flashes?
Black cohosh is possibly effective for menopausal symptoms like hot flashes — that's the best evidence we have. For other uses like acne, anxiety, or sexual dysfunction, we don't have enough reliable research to say whether it works.
What are the most common side effects?
Most people tolerate black cohosh well at typical doses. The most common side effects are minor: breast tenderness, dizziness, stomach upset, headache, irritability, rash, and tiredness. Serious side effects are rare but can include liver damage.
Is it safe to take if I'm pregnant or breastfeeding?
No. Black cohosh is rated possibly unsafe in pregnancy because of potential effects on the uterus, and safety while breastfeeding hasn't been established. Talk to your doctor if you're pregnant or nursing.
Why does this product interact with so many medications?
Black cohosh affects how your body processes certain drugs through liver enzymes and other pathways. It may also act like estrogen and trigger serotonin effects, which can change how antidepressants and hormonal medications work.
What should I know about the liver concerns?
There's a rare concern that black cohosh might be linked to liver damage, and there's one case report of elevated liver enzymes when someone combined it with atorvastatin (Lipitor). If you take drugs that already stress your liver, that risk could be higher. Your pharmacist can help you figure out if it's safe for you.

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

Not sure if Black Cohosh 540 mg is safe with your meds?

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Label information is sourced from the NIH Dietary Supplement Label Database and reflects the product version on file; always read your actual product label. This page is for education only and is not a substitute for professional medical advice. Confirm with your pharmacist or doctor before combining supplements and medications.

Black Cohosh 540 mg label
Go deeper

The Full Monographs Behind Black Cohosh 540 mg’s Ingredients

Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.

Herb & supplement monograph

Black Cohosh

Interacts with 652 drugs

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-t...

Read the full Black Cohosh monograph →
Sources

Sources & How We Checked

Black Cohosh 540 mg's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.

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

The 68 references behind this product’s interaction data

Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.

Black Cohosh 68 references
  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.
  16. Seidlova-Wuttke D, Hesse O, Jarry H, et al. Evidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta. Eur J Endocrinol 2003;149:351-62. PubMed
  17. Rockwell S, Liu Y, Higgins SA. Alteration of the effects of cancer therapy agents on breast cancer cells by the herbal medicine black cohosh. Breast Cancer Res Treat 2005;90:233-9. PubMed
  18. Levitsky J, Alli TA, Wisecarver J, Sorrell MF. Fulminant liver failure associated with the use of black cohosh. Dig Dis Sci 2005;50:538-9. PubMed
  19. Cheong JL, Bucknall R. Retinal vein thrombosis associated with a herbal phytoestrogen preparation in a susceptible patient. Postgrad Med J 2005;81:266-7.. PubMed
  20. 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.
  21. Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes. Clin Pharmacol Ther 2005;77:415-26. PubMed
  22. Minciullo PL, Saija A, Patafi M, et al. Muscle damage induced by black cohosh (Cimicifuga racemosa). Phytomedicine 2006;13:115-8. PubMed
  23. Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Men PubMed
  24. MHRA. Black cohosh (Cimicifuga racemosa) - risk of liver problems. Herbal Safety News July 2006. Available at: http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary= true&ssDocName=CON2024131&ssTargetNodeId=663.
  25. Dugoua JJ, Seely D, Perri D, et al. Safety and efficacy of black cohosh (cimicifuga racemosa) during pregnancy and lactation. Can J Clin Pharmacol 2006;13:e257-61.
  26. Raus K, Brucker C, Gorkow C, Wuttke W. First-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055. Menopause 2006;13:678-91. PubMed
  27. Lynch CR, Folkers ME, Hutson WR. Fulminant hepatic failure associated with the use of black cohosh: a case report. Liver Transpl 2006;12:989-92. PubMed
  28. Bai W, Henneicke-von Zepelin HH, Wang S, et al. Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: A randomized, double blind, parallel-controlled study versus tibol
  29. Meyer S, Vogt T, Obermann EC, et al. Cutaneous pseudolymphoma induced by Cimicifuga racemosa. Dermatology 2007;214:94-6.
  30. Gori L, Firenzuoli F. Is black cohosh a hepatotoxic medicinal herb? Forsch Komplementarmed 2007;14:109-10. PubMed
  31. Assessment of case reports connected to herbal medicinal products containing cimicifugae racemosa rhizoma (black cohosh, root). Doc. Ref. EMEA/269259/2006. Available at: www.emea.eu.int/pdfs/human/hmpc/26925806en.pdf (Accessed 30 November 2007).
  32. Chung DJ, Kim HY, Park KH, et al. Black cohosh and St. John's wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J 2007;48:289-94. PubMed
  33. Chow ECY, Teo M, Ring JA, Chen JW. Liver failure associated with the use of black cohosh for menopausal symptoms. Med J Aust 2008;188:420-2. PubMed
  34. Mahady GB, Low Dog T, Barrett ML, et al. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause 2008;15:628-38. PubMed
  35. Hepatotoxicity with black cohosh. Australian Adv Drug Reactions Bull 2006;25:6. Available at: www.tga.gov.au/adr/aadrb/aadr0604.htm#a1.
  36. Dunbar K, Solga SF. Black cohosh, safety, and public awareness. Liver Int 2007;27:1017. PubMed
  37. Patel NM, Derkits RM. Possible increase in liver enzymes secondary to atorvastatin and black cohosh administration. J Pharm Pract 2007;20:341-6. DOI
  38. Joy D, Joy J, Duane P. Black cohosh: a cause of abnormal postmenopausal liver function tests. Climacteric 2008;11:84-8. PubMed
  39. Australian Adverse Drug Reactions Advisory Committee. Black cohosh and liver toxicity - an update. Aust Adv Drug Reactions Bull 2007;26:11.
  40. Gurley BJ, Swain A, Hubbard MA, et al. Clinical assessement of CYP2D6-mediated herb-drug interactions in humans: Effects of milk-thistle, black cohosh, goldenseal, kava kava, St. John's wort, and Echinacea. Mol Nutr Food Res 2008;52:755-63.
  41. Spangler L, Newton KM, Grothaus LC, et al. The effects of black cohosh therapies on lipids, fibrinogen, glucose and insulin. Maturitas 2007;57:195-204. PubMed
  42. Teschke R, Bahre R, Genthner A, et al. Suspected black cohosh hepatotoxicity - challenges and pitfalls of causality assessment. Maturitas 2009;63:302-14. PubMed
  43. Brasky TM, Lampe JW, Potter JD, et al. Specialty supplements and breast cancer risk in the VITamins And Lifestyle (VITAL) cohort. Cancer Epidemiol Biomarkers Prev 2010;19:1696-708. PubMed
  44. 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
  45. Vermes G, Bánhidy F, Acs N. The effects of remifemin on subjective symptoms of menopause. Adv Ther 2005;22:148-54. PubMed
  46. Nuntanakorn, P., Jiang, B., Einbond, L. S., Yang, H., Kronenberg, F., Weinstein, I. B., and Kennelly, E. J. Polyphenolic constituents of Actaea racemosa. J Nat Prod 2006;69(3):314-318.
  47. 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
  48. Briese V, Stammwitz U, Friede M, Henneicke-von Zepelin HH. Black cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational study. Maturitas 2007;57:405-14. PubMed
  49. Naser, B. and Liske, E. Liver failure associated with the use of black cohosh for menopausal symptoms. Med J Aust. 1-19-2009;190(2):99. PubMed
  50. van de Meerendonk, H. W., van Hunsel, F. P., and van der Wiel, H. E. [Autoimmune hepatitis induced by Actaea racemosa. Side affects of an herb extract]. Ned.Tijdschr.Geneeskd. 2-7-2009;153(6):246-249.
  51. 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
  52. Pierard, S., Coche, J. C., Lanthier, P., Dekoninck, X., Lanthier, N., Rahier, J., and Geubel, A. P. Severe hepatitis associated with the use of black cohosh: a report of two cases and an advice for caution. Eur J Gastroenterol Hepatol. 2009;21(8):941-945 PubMed
  53. Vannacci, A., Lapi, F., Gallo, E., Vietri, M., Toti, M., Menniti-Ippolito, F., Raschetti, R., Firenzuoli, F., and Mugelli, A. A case of hepatitis associated with long-term use of Cimicifuga racemosa. Altern.Ther Health Med 2009;15(3):62-63.
  54. Zimmermann, R., Witte, A., Voll, R. E., Strobel, J., and Frieser, M. Coagulation activation and fluid retention associated with the use of black cohosh: a case study. Climacteric. 2010;13(2):187-191. PubMed
  55. Amsterdam JD, Yao Y, Mao JJ, Soeller I, Rockwell K, Shults J. Randomized, double-blind, placebo-controlled trial of Cimicifuga racemosa (black cohosh) in women with anxiety disorder due to menopause. J Clin Psychopharmacol 2009;29:478-83. PubMed
  56. Bai WP, Wang SY, Liu JL, Geng L, Hu LN, Zhang ZL, Chen SL, Zheng SR. [Efficacy and safety of remifemin compared to tibolone for controlling of perimenopausal symptoms]. Zhonghua Fu Chan Ke Za Zhi 2009;44:597-600.
  57. McKenzie, S. C. and Rahman, A. Bradycardia in a patient taking black cohosh. Med J Aust. 10-18-2010;193(8):479-481. PubMed
  58. Stolze H. [An alternative to treat menopausal complaints]. Gynecologie 1982;1:14-16.
  59. Guzman G, Kallwitz ER, Wojewoda C, et al. Liver Injury with Features Mimicking Autoimmune Hepatitis following the Use of Black Cohosh. Case Rep Med. 2009;2009:918156. PubMed
  60. Enbom ET, Le MD, Oesterich L, Rutgers J, French SW. Mechanism of hepatotoxicity due to black cohosh (Cimicifuga racemosa): histological, immunohistochemical and electron microscopy analysis of two liver biopsies with clinical correlation. Exp Mol Pathol. PubMed
  61. Sen A. Orobuccolingual dyskinesia after long-term use of black cohosh and ginseng. J Neuropsychiatry Clin Neurosci 2013 Fall;25(4):E50. PubMed
  62. Hoban CL, Byard RW, Musgrave IF. Analysis of spontaneous adverse drug reactions to echinacea, valerian, black cohosh and ginkgo in Australia from 2000 to 2015. J Integr Med. 2019;17(5):338-343. PubMed
  63. Pkhaladze L, Davidova N, Khomasuridze A, Shengelia R, Panossian AG. Actaea racemosa L. is more effective in combination with Rhodiola rosea L. for relief of menopausal symptoms: a randomized, double-blind, placebo-controlled study. Pharmaceuticals (Basel) PubMed
  64. Yalçin M, Oguz A, Bestepe EE, Saglam NGU, Ergelen M. Black cohosh associated mania in a patient with unipolar depression. Int J Psychiatry Med 2020 Sep 21:91217420961185. doi: 10.1177/0091217420961185. PubMed
  65. Brar HS, Marathi R. Case of cholestatic drug-induced liver injury (DILI) associated with black cohosh. BMJ Case Rep 2021;14(5):e240408. PubMed
  66. Castelo-Branco C, Navarro C, Beltrán E, Losa F, Camacho M; on the behalf of the Natural Products Study Group of the Spanish Menopause Society. Black cohosh efficacy and safety for menopausal symptoms. The Spanish Menopause Society statement. Gynecol Endoc PubMed
  67. Trant AA, Chagpar A, Wei W, et al. The Effect of Black Cohosh on Ki67 expression and Tumor Volume: A Pilot Study of Ductal Carcinoma in Situ Patients. Integr Cancer Ther 2022;21:15347354221137290. PubMed
  68. 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

See these in context on the Black Cohosh monograph →

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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

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