Fulminant hepatic failure associated with the use of black cohosh: A case report

Abstract

With data from the Women's Health Initiative indicating that estrogen plus progesterone are associated with an increased risk of cardiovascular events, many patients and practitioners are looking for alternative therapies to manage menopausal symptoms. One alternative is black cohosh, an herbal product used primarily to treat these symptoms. In recent years there have been several case reports associating this substance with hepatitis and fulminant hepatic failure. We present a case of a woman who developed hepatic failure requiring liver transplantation from the use of this herb. Liver Transpl 12:989-992, 2006.

United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity

“…Although the Committee is aware that the agencies such as the TGA and HMPC and the NIH workshop reviewed more than 30 reports concerning liver damage, all the reports were not available for our analysis. Duplicate reports (such as MedWatch reports 16335, 71405, 78642, and 78707, which were also published as case reports in journals 17,18,20 ) were removed during the analysis. USP's MEDMARX medication error reporting system received documentation about three medication error reports that involved prescribing black cohosh.…”

Herbal Products and the Liver: A Review of Adverse Effects and Mechanisms

“…are dwindling partly because their toxicities have been recognized, or they have been withdrawn, or commercial products are now preferred.Black cohosh (Cimifuga racemosa): Reports of liver injury from black cohosh(83)(84)(85) -used to relieve menopausal symptoms -prompted the U.S. Pharmacopoeia to publish a cautionary monograph (86). Concerns of DILI were, however, not corroborated by a later meta-analysis of five small, randomized trials (87).…”

Is Black Cohosh a Hepatotoxic Medicinal Herb?

“…The patient consumed 80 mg of an unknown extract daily and for an unknown period. (2) In another case report [2] (RUCAM score 3) the patient was a 54-year-old woman suffering from hypothyroidism, fibromyalgia, osteoarthritis and depression. She had taken 1,000 mg black cohosh (unclear, if a type of extract or crude drug) daily for several months.…”