Actaea racemosa L.

Related Terms

5-HT(7) ligand, Actaea macrotys, Actaeapachypoda, Actaeapodocarpa, Actaea racemosa L., Actaearubra, actaealactone, act?e ? grappes (French), Amerikanisches Wanzenkraut (German), Appalachian bugbane, baneberry, BCE, black bugbane, black cohosh root extract Cr 99, black cohosh roots, black snakeroot, Botrophis serpentaria, bugbane, bugwort, caffeic acid, Cimicifuga, Cimicifuga racemosa, Cimicifugae racemosae rhizoma, Cimicifugawurzelstock (German), cimicifugic acid A, cimicifugic acid B, cimicifugic acid D, cimicifugic acid E, cimicifugic acid F, cimicifugic acid G, cohosh bugbane, CR, CR BNO 1055, CR extract, ferulic acid, fukinolic acid, herbe au punaise (French), ICR, isoferulic acid, isopropanolic black cohosh extract, isopropanolic extract, macrotys, Macrotys actaeoides, methyl caffeate, mountain bugbane, N-omega-methylserotonin, p-coumaric acid, phytoestrogen, protocatechualdehyde, protocatechuic acid, Ranunculaceae (family), rattle root, rattle snakeroot, rattle top, rattle weed, rattlesnake root, rattleweed, Remifemin?, rhizoma Actaeae, rich weed, richweed, schwarze Schlangenwurzel (German), snakeroot, solvlys, squaw root, squawroot, Thalictrodes racemosa, Traubensilberkerze (German), triterpene glycosides, Wanzenkraut, Ze 450.
Combination product examples: GYNO-Plus (black cohosh and St. John's wort), PNC (pennyroyal, red raspberry, lobelia, blue cohosh, black cohosh, blessed thistle), Phyto-Female Complex (standardized extracts of black cohosh, dong quai, milk thistle, red clover, American ginseng, chaste-tree berry), Reumalex? (contains 35mg of black cohosh, 100mg of white willow bark, 25mg of sarsaparilla (4:1), 17mg of poplar bark (7:1), and 40mg of guaiacum resin).
Note: Black cohosh (Cimicifuga racemosa) is not to be confused with blue cohosh (Caulophyllum thalictroides) , which contains potentially cardiotoxic or vasoconstrictive chemicals. Black cohosh (Cimicifuga racemosa) is also not to be confused with Cimicifuga foetida, bugbane, fairy candles, or sheng ma; these are species from the same family (Ranunculaceae) with different therapeutic effects.

Background

Black cohosh is popular as an alternative to hormonal therapy in the treatment of menopausal symptoms such as hot flashes, mood disturbances, excessive sweating, palpitations, and vaginal dryness. Several studies have reported black cohosh may improve menopausal symptoms for up to one year, although the evidence is mixed.
The mechanism of action of black cohosh remains unclear. Research suggests that there may be no direct effects on estrogen receptors, although this is an area of active controversy.
Safety and efficacy beyond one year have not been proven. Reports suggest the safety of short-term use, including in women with menopausal symptoms for whom estrogen replacement therapy is not suggested. Nonetheless, caution is advised until better-quality safety data are available. There have been reports of liver damage and higher lead levels in the blood from black cohosh. Use of black cohosh in high-risk populations (such as in women with a history of breast cancer) should be under the supervision of a licensed healthcare professional.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


A study using black cohosh and other herbs reduced pain. Due to limited research, the effect of black cohosh on arthritis is unclear. Additional studies are needed in this area.

 C


A study using black cohosh and other herbs reduced pain. Due to limited research, the effect of black cohosh on arthritis is unclear. Additional studies are needed in this area.

 C


Studies show that black cohosh has mixed effects on bone density. More research is needed in this area.

 C


Studies show that black cohosh has mixed effects on bone density. More research is needed in this area.

 C


Research suggests that black cohosh has mixed results on breast cancer, possibly due to product variability and dosage. Additional studies are needed in this area.

 C


Research suggests that black cohosh has mixed results on breast cancer, possibly due to product variability and dosage. Additional studies are needed in this area.

 C


Limited research shows mixed results regarding black cohosh on cholesterol and heart disease risk. More well-designed studies involving humans are needed in this area.

 C


Limited research shows mixed results regarding black cohosh on cholesterol and heart disease risk. More well-designed studies involving humans are needed in this area.

 C


Available research suggests that the effect of black cohosh on infertility is unclear. Additional research is needed in this area.

C


Available research suggests that the effect of black cohosh on infertility is unclear. Additional research is needed in this area.

C


Black cohosh is a popular alternative to prescription hormonal therapy for the treatment of menopausal symptoms. Initial human research suggests that black cohosh may improve some of these symptoms for up to one year. However, the current evidence is mixed, and additional research needed.
 C


Black cohosh is a popular alternative to prescription hormonal therapy for the treatment of menopausal symptoms. Initial human research suggests that black cohosh may improve some of these symptoms for up to one year. However, the current evidence is mixed, and additional research needed.
 C


Black cohosh has not been well studied for mental performance in postmenopausal women. More research is needed in this area.

 C


Black cohosh has not been well studied for mental performance in postmenopausal women. More research is needed in this area.

 C


Black cohosh may be a potential treatment for migraines associated with menstruation. Additional research on black cohosh alone is warranted.

 C


Black cohosh may be a potential treatment for migraines associated with menstruation. Additional research on black cohosh alone is warranted.

 C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

Adults (over 18 years old)
There is no proven effective dose for black cohosh. The British Herbal Compendium recommends 40-200 milligrams of dried black cohosh root daily in divided doses, although traditional doses have been as high as one gram three times daily. As a tincture or liquid, the British Herbal Compendium recommends 0.4-2 milliliters of a (1:10) 60% ethanol tincture daily. Powdered black cohosh root or tea (1-2 grams three times daily) also has been used.
For bone density in postmenopausal women, preparations containing 40 milligrams of black cohosh have been taken by mouth for up to three months.
For breast cancer treatment (menopausal symptoms), 1-4 tablets containing 2.5 milligrams of black cohosh extract have been taken by mouth for six months in addition to tamoxifen. In another study, 20 milligrams of black cohosh was taken by mouth daily for a year. A dose of 20 milligrams of black cohosh has also been given twice daily for 1-6 months.
For heart disease in postmenopausal women, 40 milligrams of black cohosh has been taken by mouth daily for three months, stopped for three months, then taken for three months again.
For infertility, 120 milligrams of black cohosh root has been taken by mouth daily for 12-13 days.
For menopausal symptoms, 6.5-160 milligrams of an alcoholic black cohosh extract, a black cohosh root extract, or other black cohosh formulations has been taken by mouth daily for up to one year in various studies. In some studies, 40 drops of a liquid extract have been taken by mouth once or twice daily for up to 24 weeks. An adjusted dose of black cohosh, starting at 64 milligrams for two weeks increased to 128 milligrams by the fourth week, has been studied.
For mental performance in postmenopausal women, 128 milligrams of ground black cohosh parts has been taken once daily by mouth for one year.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Interactions

Interactions with Drugs
Because black cohosh may contain estrogen-like chemicals, the effects of other agents believed to have estrogen-like properties may be altered. The potential estrogen-like effects of black cohosh remain debated, and the active chemical contents of black cohosh have not been clearly identified. Although recent studies suggest no significant effects of black cohosh on estrogen receptors in the body, caution is warranted in people taking both black cohosh and estrogens, due to unknown effects. The influence of black cohosh in combination with tamoxifen is not clear in studies, and it is not known if tamoxifen counteracts the effects of black cohosh. Drugs like raloxifene may also interact.
Black cohosh may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin?) or heparin, antiplatelet drugs such as clopidogrel (Plavix?), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin?, Advil?) or naproxen (Naprosyn?, Aleve?).
Black cohosh may lower blood pressure and therefore should be used cautiously with other hypotensive agents such as beta-blockers like metoprolol (Lopressor?, Toprol?) or propranolol (Inderal?) and calcium-channel blockers like diltiazem (Cardizem?, Tiazac?) or verapamil (Isoptin?, Calan?). Black cohosh may contain small amounts of salicylic acid and may increase the anti-platelet effects of other agents such as aspirin.
Black cohosh may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be altered in the blood and change the intended effects. People taking any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
Black cohosh may also interact with agents for arthritis, cancer, or osteoporosis; agents for depression or selective serotonin reuptake inhibitors (SSRIs); agents for inflammation, pain relief, or sensation loss; agents for the brain, intestines, or stomach; agents taken by mouth; agents that affect dopamine; agents that inhibit blood clots and platelet aggregation; agents that may lower seizure threshold; agents that widen blood vessels; agents toxic to the liver; alcohol; antihistamines; cholesterol-lowering agents; estrogens; hormonal agents; raloxifene; salicylate-containing agents (e.g., aspirin); and tamoxifen.
Many tinctures contain high levels of alcohol and may cause nausea or vomiting when taken with metronidazole (Flagyl?) or disulfiram (Antabuse?).

Attribution

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Bebenek, M., Kemmler, W., von, Stengel S., Engelke, K., and Kalender, W. A. Effect of exercise and Cimicifuga racemosa (CR BNO 1055) on bone mineral density, 10-year coronary heart disease risk, and menopausal complaints: the randomized controlled Training and Cimicifuga racemosa Erlangen (TRACE) study. Menopause. 2010;17(4):791-800.
Brasky, T. M., Lampe, J. W., Potter, J. D., Patterson, R. E., and White, E. Specialty supplements and breast cancer risk in the VITamins And Lifestyle (VITAL) Cohort. Cancer Epidemiol Biomarkers Prev. 2010;19(7):1696-1708.
Geller, S. E., Shulman, L. P., van Breemen, R. B., Banuvar, S., Zhou, Y., Epstein, G., Hedayat, S., Nikolic, D., Krause, E. C., Piersen, C. E., Bolton, J. L., Pauli, G. F., and Farnsworth, N. R. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause. 2009;16(6):1156-1166.
Kelley, K. W. and Carroll, D. G. Evaluating the evidence for over-the-counter alternatives for relief of hot flashes in menopausal women. J Am Pharm.Assoc.(2003.) 2010;50(5):e106-e115.
Lundstrom, E., Hirschberg, A. L., and Soderqvist, G. Digitized assessment of mammographic breast density--effects of continuous combined hormone therapy, tibolone and black cohosh compared to placebo. Maturitas 2011;70(4):361-364.
Maki, P. M., Rubin, L. H., Fornelli, D., Drogos, L., Banuvar, S., Shulman, L. P., and Geller, S. E. Effects of botanicals and combined hormone therapy on cognition in postmenopausal women. Menopause. 2009;16(6):1167-1177.
Molla, M. D., Hidalgo-Mora, J. J., and Soteras, M. G. Phytotherapy as alternative to hormone replacement therapy. Front Biosci (Schol.Ed) 2011;3:191-204.
Naser, B., Schnitker, J., Minkin, M. J., de Arriba, S. G., Nolte, K. U., and Osmers, R. Suspected black cohosh hepatotoxicity: no evidence by meta-analysis of randomized controlled clinical trials for isopropanolic black cohosh extract. Menopause. 2011;18(4):366-375.
Palacio, C., Masri, G., and Mooradian, A. D. Black cohosh for the management of menopausal symptoms : a systematic review of clinical trials. Drugs Aging 2009;26(1):23-36.
Rostock, M., Fischer, J., Mumm, A., Stammwitz, U., Saller, R., and Bartsch, H. H. Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints - a prospective observational study. Gynecol.Endocrinol. 2011;27(10):844-848.
Shams, T., Setia, M. S., Hemmings, R., McCusker, J., Sewitch, M., and Ciampi, A. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern.Ther Health Med 2010;16(1):36-44.
Shou, C., Li, J., and Liu, Z. Complementary and alternative medicine in the treatment of menopausal symptoms. Chin J Integr Med 2011;17(12):883-888.
Teschke, R., Schwarzenboeck, A., Schmidt-Taenzer, W., Wolff, A., and Hennermann, K. H. Herb induced liver injury presumably caused by black cohosh: a survey of initially purported cases and herbal quality specifications. Ann Hepatol. 2011;10(3):249-259.
Thacker, H. L. Assessing risks and benefits of nonhormonal treatments for vasomotor symptoms in perimenopausal and postmenopausal women. J Womens Health (Larchmt.) 2011;20(7):1007-1016.
van Breemen, R. B., Liang, W., Banuvar, S., Shulman, L. P., Pang, Y., Tao, Y., Nikolic, D., Krock, K. M., Fabricant, D. S., Chen, S. N., Hedayat, S., Bolton, J. L., Pauli, G. F., Piersen, C. E., Krause, E. C., Geller, S. E., and Farnsworth, N. R. Pharmacokinetics of 23-epi-26-deoxyactein in women after oral administration of a standardized extract of black cohosh. Clin Pharmacol.Ther 2010;87(2):219-225.