Black Cohosh

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• 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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• 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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• 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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• 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.

• 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.
  
  
• 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.
  
  
• QWho should take black cohosh?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  The primary use of black cohosh is to treat menopausal symptoms including hot flashes, night sweats, and vaginal dryness. This herb has been used to induce labor, treat PMS (premenstrual syndrome), and treat irregularities of the menstrual cycle. Historically, black cohosh has been used to treat rheumatism. Many studies are being conducted on the uses and safety of black cohosh.
  
  
• 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.
  
  
• QHow should I take black cohosh?

  1 Answer

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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.