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
ROUTE | ONSET | PEAK | DURATION |
---|---|---|---|
PO | unknown | unknown | unknown |
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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