Black Cohosh and Liver Toxicity: Is There a Relationship?

Abstract

Herbal supplements are commonly used by patients for various problems. It is a well-known fact that most patients do not tell their physicians about the use of herbal supplements unless they are specifically asked. As a result, sometimes important information regarding drug side effects is missed in history taking. During our literature search, we found several retrospective studies and other meta-analyses that claim a lacking or weak link between black cohosh use and hepatotoxicity. We present a case of a 44-year-old female who developed subacute liver injury demonstrated on a CT scan and liver biopsy within a month of using the drug to resolve her hot flashes and discuss a possible temporal and causal association between black cohosh use and liver disease. Since the patient was not taking any other drugs, we concluded that the acute liver injury was caused by the use of black cohosh. We agree with the United States Pharmacopeia recommendations that a cautionary warning about hepatotoxicity should be labeled on the drug package.

Modulation of steroidogenesis by Actaea racemosa and vitamin C combination, in letrozole induced polycystic ovarian syndrome rat model: Promising activity without the risk of hepatic adverse effect

“…The consumption of black cohosh was correlated with acute liver injury (28). Additionally, the analysis of the case reports from the Expert Committee of the US Pharmacopeia's Council of Experts and others led to recommendation of cautionary warning in regard of hepatotoxicity should be labeled for AR products (29,30). However, the Council made its analysis using the Naranjo scale, which has already then been considered not to be of use in the assessment of liver case reports.…”

Naturally Occurring Nrf2 Activators: Potential in Treatment of Liver Injury

“…For example, black cohosh used for menopausal symptoms can lead to liver failure. We refer the reader to recent articles [146–149]. Safety studies for most phytochemicals discussed here are lacking.…”

Black Cohosh: An Uncommon Culprit of Bradycardia in Postmenopausal Women

“…Actaea racemosa , also known as Cimicifuga racemosa , is a plant native to North America and belongs to the buttercup family. It is a natural source of a popular herbal remedy known as black cohosh (BC), often used to alleviate menopausal symptoms due to its estrogen-like properties [ 1 ]. Breast soreness, uterine bleeding, and musculoskeletal symptoms were among the adverse events noted.…”