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.
  
  
• QWhat are the potential risks of taking black cohosh?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  Individuals with high blood pressure, a seizure disorder or problems with blood clots should be very cautious in using black cohosh. Some cases of hepatitis necessitating a liver transplant have been reported by individuals taking products containing black cohosh, but the correlation between the herb and the liver disease is not clear. Individuals with liver problems should consult their doctor before using black cohosh. The U.S. Pharmacopeia, the organization that sets standards for foods and drugs in the United States, has advised the following warning on black cohosh packaging: "Discontinue use and consult a healthcare practitioner if you have a liver disorder or develop symptoms of liver trouble, such as abdominal pain, dark urine or jaundice."
  
  In a few reports, women using black cohosh have experienced a miscarriage or vaginal bleeding, but the correlation between the herb and such adverse events is not clear.
  
  
• QWhat are the other names for black cohosh supplements?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  Other names for black cohosh, which is available as a supplement, include black snakeroot, rattletop, rattleroot, rattleweed and macrotys. It’s also called bugbane and bugwort because insects tend to steer clear of this perennial plant (which has the scientific name Actaea racemosa).
  
  Black cohosh root is sometimes used to treat menopausal symptoms like hot flashes, night sweats and irritability, and it’s found in many menopause supplements. It’s the main ingredient in Remifemin, a popular over-the-counter herbal treatment. Experts believe that black cohosh may have a hormone-like effect in the body. Before taking the herb or a supplement containing it, speak with your health-care provider about any potential risks.
  
• 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.
  
  
• 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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• QDoes black cohosh help reduce hot flashes?

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  A Dr. Michael Roizen, MD , Internal Medicine, answered

  

  The herb black cohosh reduces hot flashes in 35 percent of cases—the same as a placebo. Because no harm is caused, and 35 percent is nothing to sneeze at, lots of women are plenty happy to keep using it.
  
  You might think that placebos are useless sugar pills for hot flashes or insomnia, but 35 percent of users get relief from them, which is an example of the power of positive thinking and your mind's control of your body.

  

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• 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.
  
• 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.
• 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.

• QCan black cohosh supplements help treat menopause symptoms?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  It's not clear whether black cohosh supplements are helpful for relieving menopause symptoms. Black cohosh has been touted as a treatment for hot flashes, night sweats and irritability due to menopause for hundreds of years, dating back to Native American medicine. In modern times, however, the results of clinical studies looking at the effects of black cohosh on menopausal symptoms have been mixed. In some, black cohosh supplements appear to help reduce hot flashes, but in others, it's been ineffective. If you have menopause symptoms, black cohosh supplements might be worth a try, but don't take it, or any herbal supplement, without consulting your doctor first.

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