Black cohosh: benefits, dosage, contraindications
Other name(s)
Actaea racemosa, Black cohosh, cimicifuga, cluster bugbane
Scientific name(s)
Cimicifuga racemosa, Actaea racemosa
Family or group:
Plants
Active ingredients:
Alkaloids
Salicylic acid
Indications
Scoring methodology
EFSA approval.
Menopause ✪✪✪✪✪
Several studies have shown that black cohosh is effective in reducing vasomotor symptoms (hot flashes, night sweats) associated with menopause. ESCOP states that black cohosh is used for symptoms associated with menopause such as hot flashes, excessive sweating, sleep disturbances and nervous irritability. More recent studies indicate that the magnitude of these effects is modest when focusing on high-quality studies.
Posologie
Oral administration: rhizome, root
5 mg
6 months
Women
dry extract
Black cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational study.
European Union herbal monograph on Cimicifuga racemosa (L.) Nutt., rhizoma
Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis.
Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect.
Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol
Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect.
European Union herbal monograph on Cimicifuga racemosa (L.) Nutt., rhizoma
Morning/evening menopausal formula relieves menopausal symptoms: a pilot study.
The preparation of Cimicifuga BNO 1055 versus conjugated estrogens in a double-blind, placebo-controlled study: effects on menopausal symptoms and bone markers.
Effect of exercise and Cimicifuga racemosa (CR BNO 1055) on bone mineral density, 10-year coronary heart disease risk, and menopausal complaints: the randomized controlled Training and Cimicifuga racemosa Erlangen (TRACE) study.
Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial.
A randomized placebo-controlled trial on the effectiveness of an herbal formula to alleviate menopausal vasomotor symptoms.
Premenstrual syndrome ✪✪✪✪✪
A study suggests that the combination of dong quai (100 mg), soy isoflavones (60 mg), and black cohosh (50 mg) may reduce the frequency of sudden migraines associated with premenstrual syndrome. nn
Posologie
Oral: rhizome, root
50 mg
24 - weeks
dry extract
Synergies
Dysmenorrhea ✪✪✪✪✪
Black cohosh is also used to relieve painful or irregular periods, as well as premenstrual syndrome. nn
Posologie
Oral use: rhizome, root
5 mg
dry extract
Properties
Estrogenic activity
Black cohosh has effects similar to those of estrogen that are exerted by an unknown mechanism. Indeed, animal research suggests that black cohosh extracts do not bind to estrogen receptors, do not upregulate estrogen-dependent genes, and do not stimulate the growth of estrogen-dependent tumors. nnHowever, animal studies have shown that black cohosh may suppress pituitary secretion of luteinizing hormone (LH). Black cohosh is thought to have selective effects on estrogen receptors and therefore estrogenic effects on some tissues and anti-estrogenic effects on others.nn
Usages associés
Anti-inflammatory
Fukinolic acid present in black cohosh is a potent inhibitor of neutrophil elastase involved in inflammatory reactions. Black cohosh has an anti-inflammatory effect throughout the reproductive system, whether at the level of the ovaries or the uterus: menstrual cramps, pain and inflammation associated with endometriosis, inflammation of the ovaries or the fallopian tubes…nnIn vitro, cimiracémate A, a component of black cohosh, inhibits lipopolysaccharide (LPS)-induced production of tumor necrosis factor (TNF-alpha) in primary blood macrophages. Similarly, isoferrulic acid, a component of black cohosh, has been shown to reduce the release of pro-inflammatory cytokines interleukin (IL)-6, TNF-alpha and interferon (IFN)-gamma.nn
Usages associés
Antioxidant
The high antioxidant content of black cohosh extracts allows them to neutralize free radicals and protect DNA from oxidative damage. nn
Usages associés
Neurological
Preliminary research suggests that black cohosh may act as a partial agonist of serotonin receptors. This effect may play a potential role in reducing menopausal symptoms. Other in vitro research suggests that black cohosh extracts may act as agonists of the mu-opioid receptor (a neurotransmitter receptor widely distributed in the brain). The mu-opioid receptor is essential for temperature and hormonal homeostasis, which may explain black cohosh's effects on alleviating menopausal symptoms, such as hot flashes.
Usages associés
Safe dosage
Adults 18 years and older: 40 mg - 140 mg (dry extract)
Black cohosh has been used safely in some studies for periods of up to one year.nnHowever, black cohosh can cause liver problems in some patients. Several case reports have linked black cohosh to liver failure or autoimmune hepatitis. nnMedical advice is recommended before any prolonged use of black cohosh.nn
Interactions
Médicaments
Atorvastatin: moderate interaction
A case has been reported of a patient taking black cohosh who developed elevated liver enzymes after coadministration with atorvastatin. It is unknown whether the liver enzyme elevation was due to black cohosh itself or to an interaction between atorvastatin and black cohosh. Until more is known, patients are advised to use black cohosh with caution if they are taking atorvastatin.
Cisplatin: moderate interaction
An animal study suggests that black cohosh may reduce the cytotoxic effect of cisplatin on breast cancer cells.
Substrate of cytochrome P450 enzymes: moderate interaction
Some clinical research suggests that black cohosh may inhibit cytochrome P450 2D6 (CYP2D6) and increase the levels of drugs metabolized by this enzyme. nnAmong the drugs metabolized by CYP2D6 are amitriptyline (Elavil), codeine, desipramine (Norpramin), flecainide (Tambocor), haloperidol (Haldol), imipramine (Tofranil), metoprolol (Lopressor, Toprol XL), ondansetron (Zofran), risperidone (Risperdal), tramadol (Ultram), venlafaxine (Effexor) and others.
Precautions
Breastfeeding: avoid
Black cohosh may have hormonal effects. Theoretically, ingestion of black cohosh by a breastfeeding mother could have an adverse effect on the child. nn
Breast cancer: avoid
Research in animal models suggests that black cohosh could increase the risk of metastasis in the presence of existing breast cancer. However, other clinical studies suggest that black cohosh does not significantly increase the risk of breast cancer. nnUntil more is known, women with a history of breast cancer or at risk of breast cancer should avoid using black cohosh.nn
Hormone-sensitive conditions: avoid
Black cohosh does not appear to affect estrogen receptors, but it has not been studied for more than 2 months in women with hormone-sensitive conditions. Until more is known, women with hormone-sensitive conditions should avoid black cohosh. These conditions include uterine cancer, ovarian cancer, endometriosis, and uterine fibroids. nn
Liver disorders: avoid
Black cohosh is suspected to be associated with cases of liver failure and autoimmune hepatitis. Until more is known, patients with liver disease are advised to avoid using black cohosh.
Protein S deficiency: avoid
Black cohosh is feared to increase the risk of thrombosis in patients with Protein S deficiency because of its estrogenic activity. A case of retinal venous thrombosis was reported in a patient with Protein S deficiency and systemic lupus erythematosus, three days after taking a combination product containing black cohosh.
Contraindications
Pregnancy: contraindicated
Black cohosh may have hormonal effects and may stimulate uterine contractions. Theoretically, this could increase the risk of miscarriage.
