International Regulations -
Canada: Approved as an over-the-counter drug, with the exception that it is not to be used during pregnancy.
USA: None.
UK: None.
France: None.
Germany: Commission E approved black cohosh as an over-the-counter drug. The BGA (the German equivalent to the FDA in the US) does not list any contraindications or limitations.
Identification Problems -
Do not confuse Black Cohosh with Blue Cohosh (Caulophyllum thalictroides). Both are used for similar conditions, but blue cohosh is more toxic. It has been less studied than black cohosh.
Blue cohosh contains chemicals that are toxic to the heart. (one published case report - heart failure in a baby born to a mother who used blue cohosh to induce labor.)
There is also a white cohosh - a different plant.
Also, there are other plants with the common name of snake root and bugbane. Example - Snake Root - Aristolochia serpentaria or Sanicula marilandica are DIFFERENT plants from Black Snake Root, a common name for Black Cohosh.
It is possible to confuse black cohosh with other similar species. White baneberry or doll's eyes (Actaea pachypoda)(toxic plant) is found in similar habitats as black cohosh and looks very much like
it.
Contraindications -
Do not take black cohosh during pregnancy unless under a doctor's advisement. The herb promotes menstruation and can cause problems especially in early pregnancy. Black cohosh is also a parturient (helps in childbirth). It stimulates contractions and is used to promote labor in the last 4 weeks of term.- another reason for not using it during first 8 months of pregnancy. as it may induce miscarriage.
Do not take black cohosh while breastfeeding.
Allergy to black cohosh.
Safety in young children or those with severe liver or kidney disease is not known.
Consult your health care provider before using black cohosh if you have seizures, liver dysfunction, excessive alcohol intake, cancer, or other medical problems.
Precautions and Side Effects -
Black cohosh has few side effects if taken in the proper doses. The main side effects are: nausea, occasional mild gastrointestinal distress, abdominal pain, and diarrhea. Take the herb with a meal to help reduce nausea.
A headache caused by black cohosh may be a warning you are taking too much of the herb.
Large doses (5 grams, 1 teaspoonful of the root; or 12 grams or about 2 teaspoonfuls of liquid extract) can cause vomiting, headache, flushed face, dizziness, limb pains, and low blood pressure, gastroentertis and diarrhea.
The half-life of the herb in the body is unknown, so toxic reactions may remain some time before there is relief.
As with most side effects of any drug or herb, they are related to the actual medicinal effects.
The lowering of heart rate and the blood pressure is due to that action of black cohosh on the heart and the blood vessels. Have your blood pressure regularly checked while using the herb.
Fresh plant juice containing Ranunculosides (chemicals common to the buttercup family) may produce blistering of skin.
Allergic Reactions -
Salicylic acid is found in black cohosh. This could cause an allergic reaction in those sensitive to aspirin (acetylsalicylic acid). But generally the amount is so low that it should not be a problem.
Precautions Related to the Hormonal Action of Black Cohosh -
Do not take black cohosh for longer than 6 consecutive months without supervision by your doctor. It is important to remember there have been no long term studies of black cohosh. Any possible problems or side effects from using black cohosh over a long period of time is unknown.
Black cohosh can cause vaginal bleeding thru endometrial (lining of the uterus) stimulation. It should not be taken during heavy menstrual flow.
If you have missed periods or have irregular periods, before using black cohosh, be checked for pregnancy.
Do continue having your regular exams, such as Pap smears, mammograms, pelvic examinations.
Black cohosh is not a substitute for hormone replacement therapy during menopause.
Cancer Precautions -
Black cohosh does not appear to stimulate breast cancer cells in vitro (outside the body). But it has not been thoroughly tested. It does not seem to increase breast cancer risk, but the safety or lack of safety of black cohosh in breast cancer is unknown.
It has not been studied in patients with hormone-dependent cancers (e.g., breast, endometrial, ovarian cancer).
Interaction with Drugs and Other Herbs.-
Black cohosh may interact with those drugs and herbs that lower blood pressure and blood sugar, increasing their effects. However, there has been no report of problems in humans.
Birth control medications - possible interaction either increasing or decreasing the BCP effects.
Hormone replacement therapy (HRT) - possible interaction either increasing or decreasing the effect of the hormones.
Anti-estrogens (tamoxifen) - tamoxifen may be potentuated by black cohosh. There have been several studies showing dose dependent prevention of the growth of estrogen dependent cancer cells in vitro (test tube). Tamoxifen and black cohosh may act synergistically to block estrogenic growth of breast cancer cells, because the combined inhibitory effect is greater than the sum of the effect of either the drug or the herb alone.
Disulfuram (Antabuse), metronidazole (Flagyl) - alcohol in extracts of black cohosh could interact with these drugs and cause major side effects.(flushing, throbbing headache, nausea, vomiting, chest pain, hypotension, cardiovascular collapse)
Results have been found in as little as four weeks of use of black cohosh but six to eight weeks is more common. Twelve weeks is the point when a woman might discontinue the herb if it hasn't worked by that time. While there is no documentation of adverse effects with long-term use, this practice has not been closely studied. Therefore, some have suggested a 6 month limit on the herb's usage. The German Commission E does not recommend use for longer than 6 months.
The recommended daily dose is 40 mg. If you are using black cohosh tincture, that equals 2 ml three times a day in water or tea. You may prefer capsules or tablets.
Other dosages -
Crude, dried root or rhizome - 300 to 2000mg/day, (2 to 4 capsules per day.)
Solid, dry, powdered extract - 250mg three times a day
Cimicifugin - 1 to 6 grains,
Cimicifugin - powdered extract, U.S.P. - 4 grains.
Solid (dry powdered) extract (4:1) - 250-500 mg
Standardized extracts - 20 to 40 mg twice a day.
Black Cohosh extract should be standardized to contain 1mg of 27-deoxyaceteine per 20 mg of extract and total 40 mg of root - to be taken twice daily.(this is equal to 20mg of extract twice a day)
Fluid extract (1:1) - 4 mL (a scant 1 teaspoonful)
Fluid extract (FE) (BP1898) - 0.3 - 2 ml. (5 to 30 drops)
Syrup preparations are preferred to fluid extract or 'resinoids' (made from the resins of the plant) as these are less likely to cause headaches and dizziness.
Tinctures - 2 to 4 ml three times/ day., or 10-60 drops. Liquid tinctures can be mixed in water.
Tincture ( BPC1934) 1:10/ 60%, 2 to 4 ml
Decoction - 2 to 3 tablespoonful 6 times a day, cold (dried powdered root. 1 or 2 grams, simmered in water to make a drink similar to tea)
Decoction - pour a cup of water onto one-half to one teaspoonful of the dried root and bring to boil. Let it simmer for l0-l5 minutes. This should be drunk three times a day.
Black cohosh drink - put 20 grams of dried root in 34 oz. of water. Bring to a boil, then simmer 20 to 30 minutes until the liquid is reduced by a third. Strain, cover, and store in the refrigerator or a cool, dry place. The liquid keeps up to 48 hours.
Black Cohosh (Cimicifuga racemosa) 40mg standardized extract, 2.5% Triterpene glycosides - Adults - One capsule, three times a day (with food), or as professionally prescribed.
Tablets or capsules - 2/day
2.5% Triterpene Glycosides - 1 tablet provides 40 mg of Black Cohosh, dried extract
Remifemin® - the most studied form of black cohosh
It may take two to four weeks to see improvement in symptoms.
Liquid - 40 drops, two times a day
Liquid extract (1:1 in 90% alcohol) — 0.3–2.0 ml twice a day to three times a day
Tincture (1:10 in 60% alcohol) - 2 to 4 ml twice a day to three times a day.
Tablets - 20 mg twice a day
Doses related to condition -
PMS symptoms - 1 capsule twice a day.
Menopause symptoms - Standardized for 1 mg of triterpenes - two capsules twice a day.
After menopausal change.- tablet/capsule standardized for 1mg triterpenes - 2 tablets/capsules daily.
Black Cohosh pg.1 - General information, Medicinal Uses
Black Cohosh pg.3 - Other Uses, Magickal Uses
