Black Cohosh

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• QHow should I take black cohosh?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  Take black cohosh according to package directions or as directed by your doctor or herbal practitioner. Look for standardized extracts, tinctures and pill forms of this herb. The recommended dose of black cohosh ranges from 40 - 80 mg. (milligram) per day. Tablets of black cohosh should be standardized to contain one mg. of 27-deoxyactein per 20 mg. tablet; these pills should be swallowed with a full glass of water. Liquid forms of this herb should be measured in a dose-measuring dropper, cup or spoon; take two to four milliliters (ml.) of black cohosh in water or tea three times a day.
  
  You can make a tea from 34 ounces of water mixed with 20 grams of dried black cohosh root. Bring this mixture to a boil and turn down to simmer until the liquid is reduced by a third (approximately 20 to 30 minutes). Strain the liquid, pour into a covered container and store in the refrigerator for up to 48 hours. Use a cup of this black cohosh tea three times per day.
  
  There is no recommended dosage of black cohosh for children. Do not take different forms of this herb at the same time unless directed to do so by your doctor.
  
  
• QShould I tell my doctor if I am taking black cohosh?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  Talk to your doctor about all medications, over-the-counter drugs, vitamins, supplements and herbs, including black cohosh, that you are taking. Report any side effects you experience to your doctor. Although black cohosh is generally well tolerated at recommended doses, it is possible to have adverse reactions to this herb.
  
  
• QHow should I store black cohosh supplements?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  The same storage rule applies to black cohosh supplements as to any other supplement: Keep them cool and dry. Black cohosh and other supplements may be degraded by heat and moisture, so don't store them in the medicine cabinet in your bathroom, where humidity can reach more than 98%, or a kitchen drawer near a hot oven.
  
• QHow does black cohosh work?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  Researchers believe the herb, black cohosh, may have estrogenic effects, but studies are not conclusive and more research is needed. One of the compounds found in black cohosh, fukinolic acid, has shown antiinflammatory action. There are several other active compounds in this herb and research is ongoing.
  
  
• QWhat should I know before using black cohosh supplements?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  Check with your doctor before taking black cohosh supplements, or any dietary or herbal supplement. Black cohosh supplements come from the dried stems and roots of the black cohosh plant, which is native to North America and related to the buttercup. It has been used for treating menstrual and menopausal symptoms including cramps, hot flashes and night sweats for hundreds of years, dating back to Native American medicine. But few large, controlled studies have found it to be effective and safe, and certain people absolutely should not take it. These include women who are pregnant or  nursing or who have a hormone-sensitive condition such as endometriosis, fibroid tumors or cancer of the breast, ovary or uterus, as well as anyone with a history of liver problems.
  
  Black cohosh supplements may cause side effects ranging from headaches, weight gain and stomach pain to changes in heart rate and dizziness. Talk to your doctor so you can weigh the potential benefits and risks of taking this supplement.
• QCan black cohosh supplements cause liver disease?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  Black cohosh, also known as black snakeroot, has been linked to liver inflammation (hepatitis) or liver failure. However, these kinds of problems have been reported only rarely, and it's not known whether black cohosh actually caused them. Even so, experts recommend that people who have a liver condition steer clear of the herb.
  
  Black cohosh is sometimes used to relieve arthritis, muscle pain and menopause symptoms (such as hot flashes). If you take it for these reasons or to treat any other ailment, be aware that it can have side effects. Call your doctor immediately if you develop signs of a liver problem, such as your skin turning yellow, abdominal pain and/or darkening urine.
  

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• QWhat drugs and foods interact with black cohosh supplements?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  Some drugs may interact with black cohosh, an herb that is sometimes taken in supplement form to treat hot flashes and other menopausal symptoms, although its effectiveness hasn't been proved. The herb is sometimes used to relieve side effects of breast cancer treatment, but some doctors recommend waiting until treatment is complete.
  
  Black cohosh also contains small amounts of salicylic acid, so anyone allergic to aspirin should avoid black cohosh. Pregnant women and those with liver problems should not take black cohosh. As with any supplement, consult your doctor before taking black cohosh.
• QIs it safe to take black cohosh along with labetalol and Norvasc?

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  A MediGuard answered

  Black cohosh is not tested or regulated by the FDA. Its safety and effectiveness are not clearly documented. As a result, the potential risks and/or advantages of black cohosh are not well known. Since the use of Black Cohosh and prescription drugs in combination is not well studied, it is still possible that you could experience side effects and or an interaction when Blach Cohosh is used with Labetalol and Norvasc. If you are still concerned about menopause symptoms, you should talk to your primary doctor, cardiologist, or gynecologist before taking this supplement.
• QWho should not take black cohosh?

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  A RealAge answered

  The following cautions should be considered before using black cohosh:
  
  Situations in which use of black cohosh is not advised:
  

  • Do not use black cohosh during pregnancy or while nursing.
  • Women with breast cancer and women with a family history of breast cancer should speak with their doctors regarding black cohosh use.

  Side effects: Black cohosh may cause gastrointestinal discomfort or upset stomach. It may also cause miscarriage.
  
  Drug interactions: There are no known interactions of black cohosh with any drugs.

• QWhat are side effects of black cohosh supplements?

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  A MediGuard answered

  Based on information from iGuard.org, a free medication monitoring service, 3% of patients experience side effects while taking Black Cohosh. Some of the side effects reported by iGuard members include: Abdominal Pain/Cramps. Please follow up with your doctor or other healthcare provider if you are experiencing any symptoms that worsen or do not go away.