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Dietary supplement

Blue Cohosh Ingredients & Drug Interactions

by Hawaii Pharm

Blue Cohosh label
See full label image
Liquid Category: Botanical
Most serious interaction: Moderate
Clinical methodology reviewed by · Updated Sep 16, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Blue Cohosh 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

Blue Cohosh is a dietary supplement by Hawaii Pharm with 1 active ingredient. Its ingredients are commonly taken for inducing labor or starting menstruation, menstrual cramps and irregular periods, symptoms of menopause.Based on those ingredients, 259 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are wildcrafted Blue Cohosh extract. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

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Check Your Meds Against Blue Cohosh by Hawaii Pharm

Ask about any prescription or over-the-counter medication and we check it for interactions with Blue Cohosh by Hawaii Pharm — and tell you which ingredient is responsible.

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HelloPharmacist Scorecard of Blue Cohosh by Hawaii Pharm

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 16, 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.

Blue Cohosh by Hawaii Pharm contains one active ingredient: wildcrafted blue cohosh extract in a liquid form. The extract is prepared with vegetable palm glycerin, pharmaceutical-grade alcohol, and artesian Hawaiian purified water as inactive ingredients.

Does it work?

Couldn't assess
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
Not assessable

This is a single-ingredient Blue Cohosh product and its label doesn't state a use — see Blue Cohosh's own graded uses on its monograph.

Why this rating?
  • We looked at the product name, claims, and label statements and couldn't find a stated purpose to grade.

We don't have effectiveness data on file for blue cohosh in this product. The safety concerns with this ingredient are significant enough that effectiveness information alone won't tell you whether it's right for you—that's a conversation for your doctor or pharmacist.

The evidence, ingredient by ingredient Blue 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.

Blue cohosh carries serious safety cautions. It contains compounds that affect the heart and has been linked to significant adverse events, including chest pain (angina), high blood pressure, increased heart rate, stomach upset, diarrhea, and cramping.

Most critically, it is not safe in pregnancy—it can stimulate the uterus and has been linked to severe harm to newborns, including heart attacks, heart failure, and shock. There isn't enough safety information to use it while breastfeeding either.

Side effects, ingredient by ingredient Blue 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 — Blue Cohosh.
  • The most serious interaction on file is rated Moderate.
  • Some involve high-stakes drug classes: diabetes medications.
  • For scale: 259 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 taking this product, double-check with your doctor or pharmacist if you take blood pressure medications (such as captopril, enalapril, losartan, or valsartan), diabetes medications (including insulin, glimepiride, or glyburide), or use any nicotine products. These represent Moderate-severity interactions that could affect how your medications work.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFully disclosed formula with no assessable stated purpose. Moderate medication interactions have been identified, and safety information is well characterized.

Blue cohosh is a product with real safety and interaction concerns—not one most people should use without very careful conversation with their doctor or pharmacist first. If you take blood pressure or diabetes medication, use any form of nicotine, are pregnant, breastfeeding, or planning pregnancy, this product requires your healthcare provider's input before you consider it.

Talk to your own doctor or pharmacist about whether it's appropriate for you.

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 Oct 23, 2020.

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 Blue Cohosh, straight from the product label.

Brand Hawaii Pharm
Barcode (UPC) 650905482281
Net contents 4 Fluid Ounce(s); 120 mL
Market status On market
Date entered into DSLD Oct 23, 2020
DSLD ID 237335
Product type Botanical
Supplement form Liquid
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Adult (18 - 50 Years), Gluten 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 Blue Cohosh by Hawaii Pharm, 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:
0.7 mL
Maximum serving Sizes:
1 mL
Servings per container
120
UPC/BARCODE
650905482281
IngredientAmount% DV
wildcrafted Blue Cohosh extract970 mg--

Other ingredients: Vegetable Palm Glycerin, pharmaceutical grade Alcohol, artesian Hawaiian purified Water

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.
General Statements

Hawaii Pharm Herbal Extract Highest quality since 2008

Made with Aloha!

Formulation

Contains no GMO, gluten, artificial colors, heavy metals, preservatives, pesticides, fertilizers.

Super concentrated liquid herbal extract. Dry herb/menstruum ratio: 1:3.

Manufactured in an FDA registered facility.

Non GMO Gluten free

Made in USA, Hawaii

Suggested/Recommended/Usage/Directions

Directions for use: Shake well before using. Take about 20-30 drops (0.7-1 ml, one full squeeze of the dropper bulb) to 2-4 oz of juice or water up to 4 times per day.

Precautions

Warning: Keep out of the reach of children.

May have contraindications. We recommend to seek expert medical advice before taking.

Do not use if you are allergic to any ingredients.

Consult a physician before using during pregnancy, if nursing or taking any medications.

Do not use if seal is broken or missing.

Storage

Store in a cool dry place.

Formula

(Caulophyllum thalictroides)

FDA Statement of Identity

Herbal Dietary Supplement

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.

Seals/Symbols

FDA Registered Facility Made in United States of America USA

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

See for yourself

Blue Cohosh by Hawaii Pharm label

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

Blue Cohosh 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 Blue Cohosh by Hawaii Pharm

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

Serving size0.7 mL Dosage formLiquid Servings per container120 Amounts shown are per serving.

Wildcrafted Blue Cohosh extract

Interacts with
259 drugs
970 mg per serving

Blue cohosh is a traditional herb historically used by Native Americans and midwives to bring on labor or menstruation, but it carries serious safety...

Wildcrafted Blue Cohosh extract monograph & interactions

Other (inactive) ingredients: Vegetable Palm Glycerin, Pharmaceutical grade Alcohol, Artesian Hawaiian purified Water. These complete the product’s ingredient list but are not active constituents.

Interaction report

Blue Cohosh by Hawaii Pharm Drug Interactions

Want to check YOUR meds against Blue Cohosh?

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
259Drugs
259 Moderate

Ingredients driving the most interactions

wildcrafted Blue Cohosh extract 259

Individual Drug Interactions

The ingredients in Blue Cohosh interact with 259 drugs. Click any drug to see the details.

1 of the 1 ingredient in Blue Cohosh interact with drugs. Each result below shows which ingredient is responsible. wildcrafted Blue Cohosh extract

Each ingredient & the kinds of drugs it affects

For each ingredient in Blue Cohosh 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.

wildcrafted Blue Cohosh extract3 drug types · 259 drugs

Antidiabetes Drugs

There is some concern that blue cohosh might increase blood glucose levels. Theoretically, it might decrease the effectiveness of medicines used for diabetes. Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.

Likelihood Possible Evidence D
Antihypertensive Drugs

Constituents in blue cohosh might increase blood pressure by causing coronary vasoconstriction. Theoretically, concomitant use might decrease the effectiveness of drugs used for angina and high blood pressure; use with caution. Some antihypertensive drugs include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), Amlodipine (Norvasc), hydrochlorothiazide (HydroDiuril), furosemide (Lasix), and many others.

Likelihood Possible Evidence D
Nicotine

Blue cohosh can increase the effects of nicotine.

Likelihood Possible Evidence D
wildcrafted Blue Cohosh extract full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Blue Cohosh, from the product label.

Hawaii Pharm

See all Hawaii Pharm products
Name
Hawaii Pharm LLC
City
Honolulu
State
HI
ZipCode
96815
Web Address
www.hawaiipharm.com
Pharmacist Counseling Corner

Blue Cohosh by Hawaii Pharm: Common Questions

Does Blue Cohosh by Hawaii Pharm interact with any medications?
Yes. Based on its ingredients, Blue Cohosh has a known interaction with 259 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Blue Cohosh 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.
Is blue cohosh safe to use during pregnancy?
No. Blue cohosh is rated unsafe in pregnancy because it may stimulate the uterus and has been linked to serious harm to newborns, including heart attacks, heart failure, and shock. Do not use it if you are pregnant or planning to become pregnant—talk to your doctor or midwife about safer options.
Can I take blue cohosh while breastfeeding?
No. There isn't enough safety information available, so it should be avoided while breastfeeding. Talk to your doctor or pharmacist about what's safe for you and your baby.
What are the most common side effects?
The most common side effects are stomach upset, including diarrhea, cramping, nausea, vomiting, and abdominal pain, as well as mouth and throat irritation. More serious effects can include chest pain, high blood pressure, and increased heart rate.
What is blue cohosh used for?
We don't have effectiveness data on file for blue cohosh in this product, so we can't tell you what it's meant to do based on our data alone. Talk to your pharmacist about what benefits are claimed and whether the evidence supports them.
Does this product contain any fillers or other inactive ingredients?
Yes. Besides the active blue cohosh extract, this liquid contains vegetable palm glycerin, pharmaceutical-grade alcohol, and artesian Hawaiian purified water.

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

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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.

Blue Cohosh label
Go deeper

The Full Monographs Behind Blue Cohosh’s Ingredients

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

Herb & supplement monograph

Blue Cohosh

Interacts with 259 drugs

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 d...

Read the full Blue Cohosh monograph →
Sources

Sources & How We Checked

Blue Cohosh'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 16 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.

Blue Cohosh 16 references
  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.
  16. 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

See these in context on the Blue Cohosh monograph →

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

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