Actaea racemosa

History

Native Americans used black cohosh in the belief it could treat gynecological and other disorders.^[3][8][12] The plant appeared in the U.S. Pharmacopoeia under the name "black snakeroot" during the year 1830.^[3] In the 19th century, the root was used to treat snakebite, inflamed lungs, and pain from childbirth.^[13]

Herbalism

Extracts from the underground parts of the plant — the rhizome (Cimicifugae racemosae rhizoma) and the root (Cimicifugae racemosae radix) — are used in herbal medicine.^[2] The rhizomes and roots contain various saponins (triterpene saponins and triterpene glycosides, such as actein) as well as cimifugic acids and other phenol carboxylic acids.^[3][4]

Black cohosh products have received regulatory approval as herbal medicines across much of Europe, as well as in China, Malaysia, Thailand, Argentina, and several other countries. These approvals ensure consistent pharmaceutical quality, safety, and effectiveness in treating common menopausal symptoms, including hot flushes and excessive sweating.^[4] In other countries such as the United States and India, black cohosh is used as a dietary supplement marketed mainly for treatment of menopausal symptoms and other gynecological problems.^[8][14] Meta-analyses of current evidence back these claims for menopausal symptoms only in products that hold an official marketing authorization for this indication.^[15]

For all other products, no high-quality scientific evidence exists to support such uses.^{[2][3][16][17]}

Safety concerns

There is a lack of long term safety information for black cohosh.^[17]

The Herbal Medicinal Product Committee (HMPC) at the European Medicines Agency (EMA) has summarized the adverse drug reactions of herbal medicines made from cimicifuga with mentioning allergic skin reactions (urticaria, itching, exanthema), facial oedema and peripheral oedema, and gastrointestinal symptoms (i.e. dyspeptic disorders, diarrhoea).^[4]

Black cohosh does not show harmful effects on endometrium^[18] or breast cancer survivors.^[19] In contrast, such studies have not been published for dietary supplements made from black cohosh.^[3][12][2] Most black cohosh materials are harvested from the wild. Lack of proper authentication and adulteration of commercial preparations by other plant species are risk factors in dietary supplements^[8][20] and a critical matter of quality control in herbal medicinal products holding a marketing authorization. Very high doses of black cohosh may cause nausea, dizziness, visual effects, a lower heart rate, and increased perspiration.^[12]

Worldwide, some 83 cases of liver damage, including hepatitis, liver failure, and elevated liver enzymes, have been associated with using black cohosh, although a cause-and-effect relationship remains undefined.^[3] The clinical picture is similar to an autoimmune hepatitis with centrilobular liver cell necrosis, which can be treated with corticosteroids.^[21] Package leaflets of phytomedicines made from black cohosh caution that people with liver problems should not take it,^[2][17]

In 2007, the Australian Government warned that black cohosh may cause liver damage, although rarely, and should not be used without medical supervision.^[22] Other studies concluded that liver damage from use of black cohosh is unlikely.^[23][24][25]

Millions of women have taken black cohosh without reporting adverse health effects,^[2] and a meta-analysis of clinical trials found no evidence that black cohosh preparations had adverse effects on liver function.^[26]

Phytochemicals

The rhizomes and roots of black cohosh (Cimicifuga racemosa rhizoma) contain diverse phytochemicals, particularly triterpene glycosides, such as actein and cimicifugoside, cimicifugin, caffeic acid, various saponins, and phenolic acids.^{[3][4][27][28]}