Written by Jianping Liu, Xun Li and the CAM-Cancer Consortium.
Updated March 9, 2017

Black cohosh (Actaea racemosa)

Is it safe?

Adverse events

The minor adverse effects observed in clinical studies include nausea, vomiting, headaches, dizziness, mastalgia, and weight gain 18-20.

The above mentioned systematic review by Walji et al. of black cohosh in cancer patients concluded that black cohosh seems to have a relatively good safety profile 14. Another systematic review of black cohosh’s safety in general (not only cancer patients) retrieved 13 clinical trials involving more than 2,800 patients 21. All trials indicate relative safety: 97% of all the reported adverse effects were minor, and the only severe ones were not deemed to be related causally to black cohosh. This is in line with the findings of an earlier review 22. Recent clinical trials in general populations confirm these findings 23-26.

In response of the "potential association" between black cohosh and hepatotoxicity, a systematic review published in 2008 by the Dietary Supplement Information Expert Committee of the US Pharmacopeia's Council of Experts on the hepatotoxicity found all the reports of liver damage were assigned possible causality, and none were of probable or certain causality 27. The clinical pharmacokinetic and animal toxicological information did not reveal unfavourable information about black cohosh.

Fritz et al did not systematically assess the impact of black cohosh on liver function but reported no impact on liver function or symptoms suggestive of impaired liver function among the studies the included in their review 13.

A systematic review published in 2011 including five randomized double-blind clinical trials involving 1,117 women who were treated daily with black cohosh extract for 3 to 6 months also found no evidence that it had any adverse effect on liver function 28. These confirms the findings of the 2007 systematic review by Walji including five RCTs and 21 pre-clinical studies of cancer patients 13.

The eight most recent papers reviewing published and spontaneous case reports (numbers ranging from 22 to 75) of initially alleged black cohosh hepatotoxicity were identified. All surveys found a lack of causality for the herbal medicine in all cases 29-36

Contraindications

Pre-existing liver damage is a contraindication.

Interactions

Black cohosh was found to alter the response to the agents commonly used to treat breast cancer in an experiment report using mouse breast cancer line 37. In this experiment, the black cohosh extracts increased the cytotoxicity of doxorubicin and docetaxel and decreased the cytotoxicity of cisplatin.

Warnings

Based on the safety review by the Dietary Supplement Information Expert Committee 27, it was determined that black cohosh products should be labelled to include a cautionary statement. This is a change from the Expert Committee's decision of 2002, which required no such statement

Citation

Jianping Liu, Xun Li, CAM-Cancer Consortium. Black cohosh (Actaea racemosa) [online document]. http://cam-cancer.org/The-Summaries/Herbal-products/Black-cohosh-Actaea-racemosa. March 9, 2017.

Document history

Most recent update in March 2017 by Barbara Wider.
Assessed as up to date in September 2013 by Barbara Wider.
Update and revision in June 2012 by Jianping Liu, Xun Li and Guoyan Yang.
Fully revised and updated in August 2009 by Jianping Liu and Xun Li.
Summary first published in March 2006, authored by Jianping Liu. 

References

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