black cohosh

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.

REMS

Management of menopausal symptoms
Premenstrual discomfort
Dysmenorrhea
Mild sedative
Rheumatism

Contraind./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.

Adv. 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

Interactions ⬆ ⬇

Natural-Drug Products:

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 Products:

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

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:

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.

US Brand Names ⬆ ⬇

Remifemin, baneberry, black snakeroot, bugbane, phytoestrogen, rattle root, rattleweed, rattle top, squaw root

Action ⬆ ⬇

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

Therapeutic effects:

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

Classifications ⬆ ⬇

Therapeutic Classification: menopausal agents

Pharmacokinetics ⬆ ⬇

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	unknown	unknown	unknown

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.

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Indications ⬇