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black cohosh( blak coe-hosh) ,
black snakeroot(trade name),
rattle root(trade name),
rattle top(trade name),
Do not confuse black cohosh with blue or white cohoshManagement of menopausal symptomsPremenstrual discomfortDysmenorrheaMild sedativeRheumatism
ClassificationTherapeutic: none assigned
Therapeutic effects are produced by glycosides isolated from the fresh or dried rhizome with attached roots.
Mechanism of action is unclear.
May decrease symptoms of menopause, including hot flashes, sweating, sleep disturbance, and anxiety. Has no effect on vaginal epithelium.
Metabolism and Excretion: Unknown.
Contraindicated in: Obstetric: Pregnancy and lactation.
Use Cautiously in: Breast cancer (may increase risk of metastasis); Hormone-sensitive cancers ; Protein S deficiency (increased risk for thrombosis); Liver disease.
Adverse Reactions/Side Effects
- seizures (in combination with evening primrose and chasteberry) (life-threatening)
- GI upset
- weight gain
- breast tenderness
- vaginal spotting/bleeding
InteractionsUnknown effects when combined with hormone replacement therapy and antiestrogens (e.g., tamoxifen ).Concurrent use with hepatotoxic drugs may ↑ risk of liver damage.Alcohol-containing preparations may interact with disulfiram and metronidazole.May ↓ cytotoxic effects of cisplatin.May precipitate hypotension when used in combination with antihypertensives.May ↑ risk of hepatotoxicity when used with chaparral, comfrey, kava-kava, and niacin.
Oral (Adults) Tablets (Remifemin®)—20 mg bid. Liquid extract—0.3–2 mL bid-tid. Tincture—2–4 mL bid–tid. Dried rhizome—0.3–2 g tid. Do not use for more than 6 mo.
Alone or in combination with other herbal medicinals: OTC
Tablets (Remifemin® 20 mg [best studied black cohosh product]): OTC
Liquid extract (1:1 in 90% alcohol): OTC
Tincture (1:10 in 60% alcohol): OTC
- Assess frequency and severity of menopausal symptoms.
- Monitor BP for patients on antihypertensive drugs; may increase effects and cause hypotension.
- Assess for history of seizures or liver disease.
Potential Nursing DiagnosesSleep deprivation (Indications)
- Administration with food may help to minimize nausea.
- Advise patient to notify health care professional if pregnancy is planned or suspected. Avoid use during pregnancy; may induce a miscarriage.
- Patients with seizures, liver dysfunction, excessive alcohol intake, cancer, or other medical problems should be advised to consult their health care professional prior to initiating self-therapy with this herb.
- Advise patient to consult health care professional before taking with other estrogen replacements.
- Emphasize the importance of continued medical supervision for Pap smears, mammograms, pelvic examinations, and BP monitoring at the intervals indicated by health care professional.
- Resolution of menopausal vasomotor symptoms.
(1) Black cohosh, see there; Cimicifuga racemosa.
(2) Blue cohosh, see there; Caulophyllum thalictroides.
(3) Cynomorium coccineum, see there.