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Black Cohosh (Cimicifuga racemosa)Female Reproductive

Black Cohosh (Cimicifuga racemosa)

Overview

Black cohosh (Cimicifuga racemosa) is a tall herbaceous perennial, growing up to about 8 ft (2.5 m) with creamy-white flower spikes. Its thick, knobby root has a bitter, acrid taste and a distinctive odor. Traditionally, the root has been valued as a Native American remedy for women’s health issues, especially painful periods, menopausal problems (such as hot flashes), and uterine discomfort. It also has a history of use for rheumatic complaints, including rheumatoid arthritis, nerve conditions like tinnitus, and even venomous bites or stings. Modern research suggests black cohosh can help alleviate menopausal symptoms and may influence estrogenic activity within the body, although it does not contain estrogen itself.

Traditional uses & properties

Analgesic & Antispasmodic: Relieves pain and calms spasms, helpful for menstrual cramps and muscular aches. Antirheumatic & Anti-inflammatory: Beneficial for arthritis and inflammatory conditions, including rheumatic pain. Sedative & Hypotensive: Offers a mild sedative effect that may help reduce high blood pressure and improve dark, low-spirited moods. Possible Estrogenic Action: Appears to mimic or influence estrogen-related processes, potentially helping with symptoms of low estrogen, menopause, and certain menstrual imbalances.

Preparations & dosage

Tinnitus

Make a decoction and take 1/3 cup (75 ml) twice a day to help relieve symptoms of tinnitus.

Safety & precautions

Pregnancy & Uterine Contractions: Black cohosh can stimulate uterine contractions, making it contraindicated in early pregnancy. It is sometimes used in late pregnancy or labor under professional supervision. Side Effects in Large Doses: May cause headaches, dizziness, central nervous system irritation, nausea, and vomiting. Reducing or discontinuing use typically resolves these effects. Hormone-Sensitive Conditions: Not recommended for breastfeeding, existing hormone-sensitive conditions, or if you have a history of breast cancer without professional guidance. Duration of Use: Some sources recommend taking breaks after extended use (e.g., one year) to avoid unwanted effects.

Drug & food interactions

Black cohosh does not appear to interact with caffeine, chlorzoxazone, digoxin or midazolam. Limited data suggest that black cohosh may antagonise the activity of cisplatin.

Food

No interactions found.

Midazolam

Black cohosh does not affect the pharmacokinetics of midazolam. In a study in 19 healthy subjects given black cohosh extract (standardised to triterpene glycosides 2.5%) 40 mg twice daily for 28 days with a single 8-mg oral dose of midazolam on day 28, there was no change in the pharmacokinetics of midazolam. In addition, black cohosh had no effect on the duration of midazolam-induced sleep.1 Similarly, in another study in 12 non-smoking healthy subjects given black cohosh root extract (standardised to triterpene glycosides 0.2%) 1090 mg twice daily for 28 days, there was no significant change in the pharmacokinetics of a single 8-mg oral dose of midazolam.

Chlorzoxazone

Black cohosh does not significantly affect the pharmacokinetics of chlorzoxazone. In a study in 12 healthy subjects, black cohosh root extract 1.09 g twice daily (standardised to 0.2% triterpene glycosides) for 28 days, did not significantly affect the pharmacokinetics of chlorzoxazone 250 mg.

Oestrogens or oestrogen antagonists

Black cohosh contains oestrogenic compounds. This may result in additive effects with oestrogens or it may oppose the effects of oestrogens. Similarly, black cohosh may have additive effects with oestrogen antagonists or oppose the effects of oestrogen antagonists (e.g. tamoxifen).

Medicine

No interactions found.

Antineoplastics

The interaction between black cohosh and antineoplastics is based on experimental evidence only. No interactions found.

Digoxin

A standardised black cohosh extract did not alter the pharmacokinetics of digoxin in one study. cohosh extract 20 mg twice daily (standardised to 2.5% triterpene glycosides) for 14 days with a single 400-microgram oral dose of digoxin on day 14. There were no significant changes in the pharmacokinetics of digoxin, and no serious adverse effects were reported.

Habitat

Black cohosh is native to Canada and the eastern U.S. (as far south as Florida), favoring shady woodland areas and hedgerows. It also grows in parts of Europe, often self-seeding from cultivated plants. Typically, it is grown from seed and harvested in the autumn when the root is at its most potent.

Traditionally used for

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