Black Cohosh
Actaea racemosa
Other names: Black Cohosh
Photo credit: H. Zell
Safety information
Safety information
Toxicity: Generally tolerated up to ~1 year, BUT rare reports of serious liver damage (dark urine, fatigue, jaundice); LiverTox classes it a rare documented cause of idiosyncratic liver injury. Some products adulterated/mislabeled with other Actaea species. | Mild — larger doses can cause stomach upset and headache.
Contraindications: Uncertain safety in hormone-sensitive conditions (breast/uterine cancer). Possibly unsafe in pregnancy/breastfeeding. | Avoid in pregnancy and breastfeeding; caution with hormone-sensitive conditions (estrogenic action).
Interactions: Consult provider; caution with hepatotoxic drugs; possible mild interaction with some chemotherapy noted in preclinical work. | None specifically noted.
Pregnancy & breastfeeding: Possibly unsafe in pregnancy/breastfeeding. | Avoid in pregnancy and breastfeeding.
Evidence level
Supported by clinical trials in humans.
Preparations
decoction · root
Part used: root
Traditional use: painful periods, menopausal symptoms and hot flushes; rheumatic/arthritic pain, tinnitus, high blood pressure
Proposed mechanism: estrogenic action
tincture · root
Part used: root
Traditional use: menopausal symptoms
tablets · root
Part used: root
Traditional use: menopausal symptoms
standardized root/rhizome extract (capsule/tablet) / tincture · root/rhizome
Part used: root/rhizome
Traditional use: menopausal symptoms (hot flashes), PMS, menstrual cramps
Proposed mechanism: not estrogen-receptor agonism as once thought; proposed serotonergic, dopaminergic, opioidergic central effects (triterpene glycosides, e.g., actein) - preclinical and unresolved
Dosage note (descriptive only): trials commonly used standardized extracts equivalent to ~40 mg/day root/rhizome; trial regimen, descriptive only
Associated conditions
Nutritional notes
Not relevant. | Not a food.
Healing traditions
Sources (3)
- NCCIH Black Cohosh fact sheet
- NIH LiverTox Black Cohosh chapter
- Encyclopedia of Herbal Medicine (book, p.79) — Andrew Chevallier, English, 2016