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Black Cohosh

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Black Cohosh, Cimicifuga racemosa, Actaea racemosa, Remifemin

  • See Also
  1. Herbal Medicine
  • Mechanism
  1. Native North American plant
  2. Plant root contains Estrogenic steroids
    1. Triterpene glycosides (acetin, cimicifugoside)
    2. Isoflavonoid formononetin
  3. Effects
    1. Weak Estrogenic effects
      1. Some studies suggest no effect on Uterus or vagina
    2. Anti-Estrogen effects
      1. Anti-proliferative effects on Breast Cancer cells
    3. Decreases leuteinizing Hormone (LH) levels
    4. Oxytocin-like effect in pregnancy (contractions)
  • Indications
  • Current Use
  1. Menopausal symptoms
    1. Post-menopausal Hot Flushes
    2. Insomnia
    3. Mood disturbance
  2. Dysmenorrhea
  • Contraindications
  1. Pregnancy (due to uterine contractions)
  2. Use caution if risk factors for Breast Cancer
    1. Black Cohosh has unclear effect on Breast Cancer risk
  • Efficacy
  1. No rigorous RCT studies to show efficacy to date
  • Adverse Effects
  1. Gastrointestinal intolerance (Nausea, discomfort)
  2. Headache
  3. Dizziness
  4. Weight gain
  • Drug Interactions
  1. No CYP enzyme or P-Glycoprotein interactions
  2. OATP2B1 Interactions that reduce efficacy of affected medications
    1. Amiodarone
    2. Fexofenadine
    3. Glyburide
    4. Statins
  • Cost
  1. Monthly: $12 to $30
  • Dosing
  1. Remifemin (Standardized 1 mg terpene per 20 mg tablet)
    1. Typical dose: Two 20 mg tablets bid
    2. Effects anticipated at 2-4 weeks after starting
  • References
  1. Jarry (1985) Planta Medica 4:316-9
  2. Rand (2001) CMEA Medicine Lecture, San Diego
  3. Asher (2017) Am Fam Physician 96(2): 101-7 [PubMed]
  4. Kligler (2003) Am Fam Physician 68(1):114-6 [PubMed]
  5. Morelli (2002) Am Fam Physician 66(1):129-34 [PubMed]