Black cohosh (Actaea racemosa)
Abstract and key points
- Black cohosh (Actaea racemosa) is a medicinal herb.
- Current evidence does not support an association between black cohosh and increased risk of breast cancer.
- There is a lack of evidence supporting the efficacy of black cohosh for reduction of hot flashes in breast cancer patients.
- Black cohosh appears to be relatively safe; but pre-existing liver damage is a contraindication.
Black cohosh (Actaea racemosa, synonym: Cimicifuga racemosa) is a medicinal herb traditionally used by native American Indians for menstrual, menopausal, and other conditions. Extracts of black cohosh have been recommended as an alternative to hormone replacement therapy for the treatment of hot flushes in menopausal women.
The effects of black cohosh have been assessed in a systematic review including 14 randomized controlled trials, 7 uncontrolled trials and 5 observational studies. The evidence on efficacy forhot flushesis divided, with some benefits seen when compared with baseline, but not when compared with placebo. Two observational studies found no association between black cohosh and risk of breast cancer, whereas two studies reported significant reductions in risk of primary breast cancer among postmenopausal women and risk of recurrence, respectively. Seventeen trials showed no significant impact on circulating hormone levels or proliferation in oestrogen responsive tissues.
Reviews of preclinical and clinical studies suggest black cohosh to be safe but pre-existing liver damage is a contraindication.
|Citation||Jianping Liu, Xun Li, CAM-Cancer Consortium. Black cohosh (Actaea racemosa) [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Black-cohosh-Actaea-racemosa. March 9, 2017.|
- Piersen CE. Phytoestrogens in botanical dietary supplements: implications for cancer. Integr Cancer Ther 2003; 2(2): 120-38.
- Popp M, Schenk R, Abel G. Cultivation of Cimicifuga racemosa (L.) nuttal and quality of CR extract BNO 1055. Maturitas 2003; 44 (Suppl 1):S1-7.
- Mahady GB, Fabricant D, Chadwick LR, Dietz B. Black cohosh: an alternative therapy for menopause? Nutr Clin Care 2002;5(6):283-9
- Anonymous. Cimicifuga racemosa. Monograph. Alternative Medicine Review 2003; 8(2):186-9.
- Blumenthal M, ed. Herbal Medicine: Expanded Commission E Monograph. 1st ed. Newton, Mass: Integrative Medicine Communications; 2000.
- Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002;288(3):321-33.
- Schairer C, Lubin J, Troisi R, Sturgeon S, Brinton L, Hoover R. Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk. JAMA. 2000;283(4):485-91.
- Graf MC, Geller PA. Treating hot flushes in breast cancer survivors: a review of alternative treatments to hormone replacement therapy. Clin J Oncol Nurs 2003;7(6):637-40.
- Einer-Jensen N, Zhao J, Andersen KP, Kristoffersen K. Cimicifuga and Melbrosia lack oestrogenic effects in mice and rats. Maturitas 1996;25:149-53.
- Kruse SO, Lohning A, Pauli GF, Winterhoff H, Nahrstedt A. Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Planta Med 1999; 65(8):763-4.
- De Smet P. Herbal medicine in Europe – relaxing regulatory standards. N Engl J Med 2005;352:1176-8.
- Medicines and Healthcare products Regulatory Agency. Guidance: Herbal Medicines Granted a Traditional Herbal Registration (THR), updated 7th March 2017. Available at: https://www.gov.uk/government/publications/herbal-medicines-granted-a-traditional-herbal-registration-thr/herbal-medicines-granted-a-traditional-herbal-registration, accessed 9th March 2017.
- Fritz H, Seely D, McGowan J, Skidmore B, Fernandes R, Kennedy DA, Cooley K, Wong R, Sagar S, Balneaves LG, Fergusson D. Black cohosh and breast cancer: a systematic review. Integr Cancer Ther. 2014;13(1):12-29.
- Walji R, Boon H, Guns E, Oneschuk D, Younus J. Black cohosh (Cimicifuga racemosa [L.] Nutt.): safety and efficacy for cancer patients. Support Care Cancer. 2007;15(8):913-21.
- Tamaki H, Satoh H, Hori S, Ohtani H, Sawada Y. Inhibitory effects of herbal extracts on breast cancer resistance protein (BCRP) and structure-inhibitory potency relationship of isoflavonoids. Drug Metab Pharmacokinet. 2010;25(2):170-9.
- Einbond LS, Soffritti M, Esposti DD, Wu HA, Tibaldi E, Lauriola M, He K, Park T, Su T, Huggins L, Wang X, Roller M, Brennan R. Pharmacological mechanisms of black cohosh in Sprague-Dawley rats. Fitoterapia. 2012 Apr;83(3):461-8.
- Einbond LS, Soffritti M, Degli Esposti D, Tibaldi E, Lauriola M, Bua L, He K, Genovese G, Su T, Huggins L, Wang X, Roller M, Wu HA. Chemopreventive potential of black cohosh on breast cancer in Sprague-Dawley rats. Anticancer Res. 2012;32(1):21-30.
- Zava DT, Dollbaum CM, Blen M. Estrogen and progestin bioactivity of foods, herbs, and spices. Proc Soc Exp Biol Med 1998;217:369-78.
- Wu XS. Remifemin improve gynecological malignant tumor postoperative patients of menopause syndrome for the clinical research. Dissertation for Master Degree of Dalian Medical University 2011; 1-20.
- Huang XF. The clinical research of Black cohosh extract in breast cancer patients with climacteric complaints. Dissertation for Master Degree of Manjing University of Chinese Medicine 2011;10-21.
- Borrelli F. Ernst E. Black cohosh (Cimicifuga racemosa): a systematic review of adverse events. American Journal of Obstetrics & Gynecology 2008;199(5):455-66.
- Huntley A. The safety of black cohosh (Actaea racemosa, Cimicifuga racemosa). Expert Opin Drug Saf 2004; 3(6):615-23.
- Ross SM. Menopause: a standardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptoms. Holist Nurs Pract. 2012;26(1):58-61.
- Bai WP, Wang SY, Liu JL, Geng L, Hu LN, Zhang ZL, Chen SL, Zheng SR. Efficacy and safety of remifemin compared to tibolone for controlling of perimenopausal symptoms. Chinese Journal of Obstetrics and Gynecology 2009;44(8): 597-600.
- Li YL, Cui MH, Gao S. Efficacy of remifemin for control of climacteric symptoms. Progress in Obstetrics and Gynecology 2011;20(6): 462-65.
- Sun NX, Jin ZJ, Jia XF, Li W. Black cohosh improves vaginal atrophy in postmenopausal women. Academic Journal of Second Military Medical University 2012;33(3): 339-42.
- Mahady GB. Low Dog T. Barrett ML. Chavez ML. Gardiner P. Ko R. Marles RJ. Pellicore LS. Giancaspro GI. Sarma DN. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause 2008;15(4 Pt 1):628-38.
- Naser B, Schnitker J, Minkin MJ, de Arriba SG, Nolte KU, Osmers R. Schaper & Brümmer GmbH & Co. KG, Salzgitter, Germany. Suspected black cohosh hepatotoxicity: no evidence by meta-analysis of randomized controlled clinical trials for isopropanolic black cohosh extract. Menopause. 2011;18(4):366-75.
- Teschke R, Schwarzenboeck A, Schmidt-Taenzer W, Wolff A, Hennermann KH. Herb induced liver injury presumably caused by black cohosh: a survey of initially purported cases and herbal quality specifications. Ann Hepatol. 2011;10(3):249-59.
- Teschke R, Schmidt-Taenzer W, Wolff A. Spontaneous reports of assumed herbal hepatotoxicity by black cohosh: is the liver-unspecific Naranjo scale precise enough to ascertain causality? Pharmacoepidemiol Drug Saf. 2011;20(6):567-82.
- Firenzuoli F, Gori L, Roberti di Sarsina P. Black cohosh Hepatic Safety: Follow-Up of 107 Patients Consuming a Special Cimicifuga racemosa rhizome Herbal Extract and Review of Literature. Evid Based Complement Alternat Med. 2011;2011:821392.
- Huang Y, Jiang B, Nuntanakorn P, Kennelly EJ, Shord S, Lawal TO, Mahady GB. Fukinolic acid derivatives and triterpene glycosides from black cohosh inhibit CYP isozymes, but are not cytotoxic to Hep-G2 cells in vitro. Curr Drug Saf. 2010;5(2):118-24.
- Teschke R. Black cohosh and suspected hepatotoxicity: inconsistencies, confounding variables, and prospective use of a diagnostic causality algorithm. A critical review. Menopause. 2010;17(2):426-40.
- Teschke R, Bahre R, Fuchs J, Wolff A. Black cohosh hepatotoxicity: quantitative causality evaluation in nine suspected cases. Menopause. 2009;16(5):956-65.
- Teschke R, Bahre R, Genthner A, Fuchs J, Schmidt-Taenzer W, Wolff A. Suspected black cohosh hepatotoxicity--challenges and pitfalls of causality assessment. Maturitas. 2009;63(4):302-14.
- Teschke R, Schwarzenboeck A. Suspected hepatotoxicity by Cimicifugae racemosae rhizoma (black cohosh, root): critical analysis and structured causality assessment. Phytomedicine. 2009;16(1):72-84.
- Rockwell S, Liu Y, Higgins SA. Alteration of the effects of cancer therapy agents on breast cancer cells by the herbal medicine black cohosh. Breast Cancer Res Treat. 2005;90(3):233-9.
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