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

Menopausal symptoms.
Premenstrual discomfort.
Dysmenorrhea.
Mild sedative.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to plants in the Ranunculaceae family;
Estrogen-dependent cancer;
OB: Pregnancy.

Use Cautiously in:

Breast cancer (may ↑ risk of metastasis);
Hormone-sensitive cancers;
Protein S deficiency (↑ risk for thrombosis);
Liver disease;
Surgery (discontinue ≥2 wk before procedure);
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

GI: GI upset, HEPATOTOXICITY

Derm: rash

GU: breast tenderness, cramping, vaginal spotting/bleeding

Metab: weight gain

Neuro: dizziness, headache, SEIZURES (IN COMBINATION WITH EVENING PRIMROSE AND CHASTEBERRY)

Interactions ⬆ ⬇

Natural-Drug Products:

Unknown effects when combined with hormone replacement therapy and antiestrogens (e.g., tamoxifen).
May ↑ risk of hepatotoxicity when used with other hepatotoxic drugs.
Alcohol-containing preparations may interact with disulfiram and metronidazole.
May ↓ effectiveness of cisplatin.
May ↑ risk of hypotension 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: ^OTC

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 >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:

Decreased symptoms of menopause, including hot flashes, sweating, sleep disturbance, and anxiety.

Classifications ⬆ ⬇

Therapeutic Classification: menopausal agents

Pharmacokinetics ⬆ ⬇

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	2–4 wk	8–12 wk	unknown

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of herb to patient.
Advise patient to consult with health care provider before using any herbal supplement, especially when taken concurrently with Rx or OTC medications or vitamins.
Advise patient with seizures, liver impairment, excessive alcohol intake, cancer, or other medical problems to consult health care provider before initiating self-therapy with this herb.
Advise patient to consult health care provider if used >6 mo and before taking with other estrogen replacements.
Advise patient to notify health care provider if unusual vaginal bleeding or breast changes occur.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or breastfeeding before using this herb. May cause miscarriage or preterm labor.

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Indications ⬇