Black cohosh ( Cimicifuga racemosa ) has a long history of traditional use in North American Indian medicine and has been used widely in Western cultures since the early 1800s.
It is generally used for the relief of the symptoms of menopause.

Recently, reports have been received in Australia and overseas of serious hepatic reactions occurring in association with black cohosh use, and in four cases the patient experienced hepatic failure requiring liver transplantation.

Currently, ADRAC (Adverse Drug Reactions Advisory Committee ) is aware of 49 cases of hepatotoxicity with black cohosh worldwide, including 11 Australian reports.

The details of five cases have been published. One was an autoimmune hepatitis,5 but others have involved massive and sub-massive necrosis.Serious cases have occurred with use for less than a month.

Many of the reports are confounded by use of other medication and by the range of ingredients in the herbal formulation being used. However, the lack of other identifiable causal substance/s and exclusion of viral infection in the serious cases suggests that there may be a causal association between black cohosh and serious hepatitis.

There are currently about 200 listed medicines containing black cohosh available in Australia. Considering the widespread use of black cohosh in Australia and around the world, the number of known cases of hepatotoxicity with this substance is very low. Because of the perceived safety of herbal products, it is possible that there have been cases for which the causal link has not been suspected. The proportion of cases reported may be considerably less than would be expected for a conventional medicine.

Source: Australian Adverse Drug Reactions Bulletin , 2006


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