black cohosh

General

Complementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

Pronunciation:
blak coe-hosh


Trade Name(s)

  • Remifemin

Trade Name(s)

  • baneberry
  • black snakeroot
  • bugbane
  • phytoestrogen
  • rattle root
  • rattleweed
  • rattle top
  • squaw root

Ther. Class.

menopausal agents

Do not confuse black cohosh with blue or white cohosh

Common Uses

  • Management of menopausal symptoms
  • Premenstrual discomfort
  • Dysmenorrhea
  • Mild sedative
  • Rheumatism

Action

  • Therapeutic effects are produced by glycosides isolated from the fresh or dried rhizome with attached roots.
  • Mechanism of action is unclear.

Therapeutic Effect(s):

May decrease symptoms of menopause, including hot flashes, sweating, sleep disturbance, and anxiety. Has no effect on vaginal epithelium.

Pharmacokinetics

Absorption: Unknown.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: Unknown.

TIME/ACTION PROFILE

ROUTEONSETPEAKDURATION
POunknownunknownunknown

Contraindication/Precautions

Contraindicated in:

  • OB:  Pregnancy and lactation.

Use Cautiously in:

  • Breast cancer (may increase risk of metastasis);
  • Hormone-sensitive cancers;
  • Protein S deficiency (increased risk for thrombosis);
  • Liver disease.

Adverse Reactions/Side Effects

Neuro: dizziness, headache, SEIZURES (in combination with evening primrose and chasteberry)

GI: GI upset, hepatotoxicity

Derm: rash

Misc: breast tenderness, cramping, vaginal spotting/bleeding, weight gain

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Natural Drug Interaction

  • Unknown effects when combined with hormone replacement therapy and  antiestrogens  (e.g.,  tamoxifen ).
  • Concurrent use with  hepatotoxic drugs  may ↑ risk of liver damage.
  •  Alcohol-containing preparations  may interact with  disulfiram  and  metronidazole.
  • May ↓ cytotoxic effects of  cisplatin.
  • May precipitate hypotension when used in combination with  antihypertensives.

Natural-Natural:

May ↑ risk of hepatotoxicity when used with  chaparral,  comfrey,  kava-kava, and  niacin .

Route/Dosage

PO (Adults): Tablets (Remifemin): 20 mg twice daily.  Liquid extract: 0.3–2 mL 2–3 times daily.  Tincture: 2–4 mL 2–3 times daily.  Dried rhizome: 0.3–2 g 3 times daily. Do not use for more than 6 mo.

Availability

Alone or in combination with other herbal medicinals: OTC

Tablets (Remifemin 20 mg [best studied black cohosh product]): OTC

Liquid extract (1:1 in 90% alcohol): OTC

Tincture (1:10 in 60% alcohol): OTC

Dried rhizome

Assessment

  • Assess frequency and severity of menopausal symptoms.
  • Monitor BP for patients on antihypertensive drugs; may increase effects and cause hypotension.
  • Assess for history of seizures or liver disease.

Implementation

  • Administration with food may help to minimize nausea.

Patient/Family Teaching

  • Advise patients with seizures, liver dysfunction, excessive alcohol intake, cancer, or other medical problems to consult their health care professional prior to initiating self-therapy with this herb.
  • Advise patient to consult health care professional before taking with other estrogen replacements.
  • Advise patient to notify health care professional if pregnancy is planned or suspected. Avoid use during pregnancy; may induce a miscarriage.

Evaluation/Desired Outcomes

Resolution of menopausal vasomotor symptoms.

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