Actaea racemosa, Cimicifuga racemosa, black cohosh (Remifemin, Estroven)
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Indications
- management of menopausal symptoms (hot flashes)[7]
- premenstrual syndrome
- dyspepsia
- rheumatism
- minor depression
Contraindications
- pregnancy
- lactation
- general anesthesia[9]
- discontinue 2 weeks prior to general anesthesia
- avoid in women with estrogen-positive breast cancer
Caution:
- patients of hormone replacement therapy (estrogen/progestin)
- patients on oral contraceptives
- use for > 6 months NOT recommended
- long term safety NOT tested
Dosage
- 0.3-2 g dry rhizome or root TID
- 0.32 mL of 1/1 extract with 90% ethanol
- 2.5 mg Remifemin BID (20 mg root stock BID)[7]
- 160 mg daily of 70% ethanol extract, 2.5% triterpene glycosides
- do NOT use for more than 6 months
* Remifemin is extract with isopropanol[7]
Adverse effects
- nausea/vomiting
- headache
- possible estrogen-like effect on breast[12]
- no increase in risk of breast cancer, but may result in more aggressive breast cancer[5]
- allegedly does NOT have adverse effects of estradiol of higher risk of ovarian cancer & endometrial cancer
- hepatotoxicity?[6][11][12]
Drug interactions
Mechanism of action
- proposed to work by binding estrogen receptors
- estriol-like activity
- affects vaginal lining
- may contain salicylate & thus have anti-rheumatic properties
- no effect on vaginal epithelium, endometrium or reproductive hormones (see HALT study)[10]
More general terms
Additional terms
Component of
References
- ↑ Blumenthal et al, Therapeutic Guide to Herbal Medicines, Trans S. Klein, MA, American Botanical Council, 1998
- ↑ Leiberman S. J Women's Health 7(5):525, 1998
- ↑ Shuster J. Hospital Pharmacy 31:1553, 1996
- ↑ Prescriber's Letter 9(9):52 2002
- ↑ 5.0 5.1 Prescriber's Letter 10(8):47 2003
- ↑ 6.0 6.1 Prescriber's Letter 11(7):41 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200714&pb=PRL (subscription needed) http://www.prescribersletter.com
Lontos S et al, Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust 2003, 179:390 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14503910 - ↑ 7.0 7.1 7.2 7.3 Journal Watch 25(12):94, 2005 Osmers R, Friede M, Liske E, Schnitker J, Freudenstein J, Henneicke-von Zepelin HH. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol. 2005 May;105(5 Pt 1):1074-83. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15863547
- ↑ 8.0 8.1 Newton KM et al, Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo. Ann Intern Med 2006, 145:869 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17179056
- ↑ 9.0 9.1 9.2 Dinman S Black cohash: a contraindication in general anesthesia. Plast Surg Nurs 2006, 26:42 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16543859
- ↑ 10.0 10.1 Reed SD et al, Vaginal, endometrial, and reproductive hormone findings: Randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: The Herbal Alternatives for Menopause (HALT) study. Menopause 2008, 15:51 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18257142
- ↑ 11.0 11.1 Mahady GB et al United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause 2008 Jul/Aug; 15:628. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18340277
Richardson MK. Black cohosh . . . a cautionary tale! Menopause 2008 Jul/Aug; 15:583. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18475214 - ↑ 12.0 12.1 12.2 12.3 Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19 American College of Physicians, Philadelphia 2015, 2018, 2022.