Black Cohosh
Common name
black snakeroot, macrotys, bugbane, bugwort, rattleroot, rattleweed
ID
HD0009
Scientific name of the plant
Actaea racemosa, Cimicifuga racemosa
Anatomical part for use
root, rhizome
Human use
Urinary tract and genital disorders
Summary
Actaea racemosa, the black cohosh, black bugbane, black snakeroot, or fairy candle (syn. Cimicifuga racemosa), is a species of flowering plant of the family Ranunculaceae. It is native to eastern North America from the extreme south of Ontario to central Georgia, and west to Missouri and Arkansas. It grows in a variety of woodland habitats, and is often found in small woodland openings. The roots and rhizomes were used in traditional medicine by Native Americans. Although its extracts are manufactured as herbal medicines and dietary supplements, black cohosh is not well-studied or recommended for safe and effective use in treating menopause symptoms or any disease. (Source: Wiki)
Evidence Level
Level 4 (Individual reports repeated observed over 5 years among different countries)
Hepatotoxicity reports in literature
- Black cohosh and other herbal remedies associated with acute hepatitis : (Source)
- Autoimmune hepatitis associated with the use of black cohosh: a case study : (Source)
- Fulminant liver failure associated with the use of black cohosh : (Source)
- Fulminant hepatic failure associated with the use of black cohosh: a case report : (Source)
- Black cohosh: a cause of abnormal postmenopausal liver function tests : (Source)
- Black cohosh-induced hepatitis : (Source)
- Liver failure associated with the use of black cohosh for menopausal symptoms : (Source)
- Severe hepatitis associated with the use of black cohosh: a report of two cases and an advice for caution : (Source)
- Liver Injury with Features Mimicking Autoimmune Hepatitis following the Use of Black Cohosh : (Source)
- Subacute liver failure secondary to black cohosh leading to liver transplantation : (Source)
- Black cohosh and liver toxicity: is there a relationship? : (Source)
- Black Cohosh Hepatotoxicity with Autoimmune Hepatitis Presentation : (Source)
Hepatotoxicity Description
In prospective clinical trials involving more than 1200 patients, black cohosh was not associated with serum enzyme elevations during treatment and no cases of clinically apparent liver injury were reported. However, products labeled as black cohosh have been linked to more than fifty instances of clinically apparent liver injury that have ranged in severity from symptomatic elevations in serum enzymes without jaundice, to acute self-limited hepatitis, prolonged hepatitis with cholestasis, autoimmune hepatitis, and acute liver failure requiring liver transplantation or with a fatal outcome. The latency to onset of liver injury ranged from 1 to 48 weeks, but was usually within 2 to 12 weeks. The clinical presentation was typically with jaundice and a markedly hepatocellular pattern of injury with liver biopsy histology resembling acute viral hepatitis. Some instances of an autoimmune hepatitis-like clinical syndrome have been described with high levels of autoantibodies, chronic hepatitis on liver biopsy and a clinical response to prednisone. In some cases, black cohosh appeared to have precipitated an autoimmune hepatitis that was self-sustained and relapsed when immunosuppression was withdrawn, while in other instances the hepatitis with autoimmune features resolved spontaneously after discontinuation of black cohosh or after a short course of prednisone. In several instances, the implicated product has been retrieved and found to contain Chinese Actaea species rather than black cohosh, and the role of Actaea racemosa in causing liver injury remains controversial. (Source: LiverTox)
Common name
black snakeroot, macrotys, bugbane, bugwort, rattleroot, rattleweed
ID
HD0009
Scientific name of the plant
Actaea racemosa, Cimicifuga racemosa
Anatomical part for use
root, rhizome
Human use
Urinary tract and genital disorders
Summary
Actaea racemosa, the black cohosh, black bugbane, black snakeroot, or fairy candle (syn. Cimicifuga racemosa), is a species of flowering plant of the family Ranunculaceae. It is native to eastern North America from the extreme south of Ontario to central Georgia, and west to Missouri and Arkansas. It grows in a variety of woodland habitats, and is often found in small woodland openings. The roots and rhizomes were used in traditional medicine by Native Americans. Although its extracts are manufactured as herbal medicines and dietary supplements, black cohosh is not well-studied or recommended for safe and effective use in treating menopause symptoms or any disease. (Source: Wiki)
Evidence Level
Level 4 (Individual reports repeated observed over 5 years among different countries)
Hepatotoxicity reports in literature
- Black cohosh and other herbal remedies associated with acute hepatitis : (Source)
- Autoimmune hepatitis associated with the use of black cohosh: a case study : (Source)
- Fulminant liver failure associated with the use of black cohosh : (Source)
- Fulminant hepatic failure associated with the use of black cohosh: a case report : (Source)
- Black cohosh: a cause of abnormal postmenopausal liver function tests : (Source)
- Black cohosh-induced hepatitis : (Source)
- Liver failure associated with the use of black cohosh for menopausal symptoms : (Source)
- Severe hepatitis associated with the use of black cohosh: a report of two cases and an advice for caution : (Source)
- Liver Injury with Features Mimicking Autoimmune Hepatitis following the Use of Black Cohosh : (Source)
- Subacute liver failure secondary to black cohosh leading to liver transplantation : (Source)
- Black cohosh and liver toxicity: is there a relationship? : (Source)
- Black Cohosh Hepatotoxicity with Autoimmune Hepatitis Presentation : (Source)
Hepatotoxicity Description
In prospective clinical trials involving more than 1200 patients, black cohosh was not associated with serum enzyme elevations during treatment and no cases of clinically apparent liver injury were reported. However, products labeled as black cohosh have been linked to more than fifty instances of clinically apparent liver injury that have ranged in severity from symptomatic elevations in serum enzymes without jaundice, to acute self-limited hepatitis, prolonged hepatitis with cholestasis, autoimmune hepatitis, and acute liver failure requiring liver transplantation or with a fatal outcome. The latency to onset of liver injury ranged from 1 to 48 weeks, but was usually within 2 to 12 weeks. The clinical presentation was typically with jaundice and a markedly hepatocellular pattern of injury with liver biopsy histology resembling acute viral hepatitis. Some instances of an autoimmune hepatitis-like clinical syndrome have been described with high levels of autoantibodies, chronic hepatitis on liver biopsy and a clinical response to prednisone. In some cases, black cohosh appeared to have precipitated an autoimmune hepatitis that was self-sustained and relapsed when immunosuppression was withdrawn, while in other instances the hepatitis with autoimmune features resolved spontaneously after discontinuation of black cohosh or after a short course of prednisone. In several instances, the implicated product has been retrieved and found to contain Chinese Actaea species rather than black cohosh, and the role of Actaea racemosa in causing liver injury remains controversial. (Source: LiverTox)