Black cohosh (Claudia Chiang, Purdue College of Pharmacy

BLACK COHOSH

CLAUDIA CHIANG, STUDENT PHARMACIST SPRING 2022

SCIENTIFIC AND COMMON NAMES

Actaea racemosa, Cimicifuga racemosa Black snakeroot, macrotys, bugbane, bugwort, rattleroot, rattleweed

BACKGROUND

Black cohosh is a plant, grown in North America, in which Native Americans have introduced to European colonists. It was originally used to treat musculoskeletal pain, fever, cough, pneumonia, labor, and menstrual irregularities. In traditional Chinese medicine, it was known for antiinflammatory, analgesic, and antipyretic uses. The root and rhizome of the plant are what is used in herbal preparations.

COMMON USES

Menopausal symptoms Hot flashes, night sweats, vaginal dryness, heart palpitations, tinnitus, vertigo, sleep disturbances, nervousness, irritability Arthritis Osteoporosis Breast cancer-related hot flashes Insect repellant

https://www.emedicinehealth.com/what_does_black_cohosh_do_for_your_body/article_em.htm

PHARMACOLOGY

The active ingredients of black cohosh include phytosterin, organic acids, sugars, tannins, long-chain fatty acids, and triterpene glycosides. There is not enough evidence to conclude a certain mechanism of action, but there are several hypotheses. Some properties that black cohosh is suspected to have are antihistamine, antiinflammatory, antilipemic, antineoplastic, antioxidant, antiviral, bone metabolism, estrogenic, and GI effects. It is said to have selective estrogen receptor modulating (SERM) effects, thus, having both estrogenic and antiestrogenic effects.

DOSAGE FORMS

Capsules Tablets Liquid extracts Dried root for tea

TYPICAL DOSING/SERVING

Recommended dose ranges from 20 to 80 mg/day Tea: 20g of dried root in 34 oz water; one cup 3 times/day

Based on clinically used commercial products, therapeutic effects usually begin after two weeks of treatment with maximum effects usually occurring within eight weeks Depending on formulations, results show variability in effectiveness

SAFETY AND TOXICITY

Possibly safe when taken orally and appropriately Concerns of possibility of causing liver damage/toxicity in patients Several case reports linking it, but evidence is inconclusive Avoid use during pregnancy May increase risk of miscarriage (theoretically) Avoid use when breast-feeding due to hormonal effects Theoretically may adversely affect a nursing child

ADVERSE EFFECTS

Common: Breast tenderness, dizziness, upset stomach, headache, irritability, rash, tiredness, weight gain Rare: Endometrial hyperplasia, hepatotoxicity

FOOD/DRUG INTERACTIONS

Atorvastatin, cisplatin, cytochrome P450 2D6 substrates, hepatotoxic drugs/herbs, organic aniontransporting polypeptide substrates (OATP)

https://www.gnc. com/blackcohosh/197012.h tml A double-blind, randomized, placebo-controlled crossover trial was performed to study the efficacy of black cohosh for the treatment of hot flashes in women. This trial occurred over two 4-week periods, and one 20mg capsule was taken by mouth twice daily. The toxicity effects were found to be minimal, and the average number of hot flashes decreased by 17% with black cohosh and 26% with the placebo. The study concluded that it failed to show any evidence of black cohosh reducing hot flashes more than the placebo.

PERSONAL OPINION

Based on my opinion and research, I would not recommend or use this product. This is due to the lack of support and evidence of its use and effectiveness. In addition, black cohosh being linked to possible liver damage leads me to believe that taking it would not be worth the risk when there are other alternative medications or supplements available. ~ C. Chiang

REFERENCES

1.

2.

3.

4.

5.

6. National Center for Complementary and Integrative Health. Black Cohosh. Accessed February 19, 2022. https://www.nccih.nih.gov/health/black-cohosh National Institutes of Health. Black Cohosh. Accessed February 19, 2022. https://ods.od.nih.gov/factsheets/BlackCohoshHealthProfessional/ Black Cohosh. Professional Monograph. Natural Medicines. Accessed February 19, 2022. https://naturalmedicinestherapeuticresearch-com.ezproxy.lib.purdue.edu/ Black Cohosh. Natural products database. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 19, 2022. http://online.lexi.com Mount Sinai. Black Cohosh. Accessed February 19, 2022. https://www.mountsinai.org/health-library/herb/blackcohosh Pockaj BA, Gallagher JG, Loprinzi CL, et al. Phase III Double-Blind, Randomized, Placebo-Controlled Crossover Trial of Black Cohosh in the Management of Hot Flashes. 2016; 24(18). doi: 10.1200/JCO.2005.05.4296