Health Guide

Black cohosh

What is it?

Black cohosh is an herbal medicine used to treat menopause symptoms.

Other names for black cohosh include: Chimicifuga racemosa, Squaw root, Rattlesnake root, Black root, and Black snakeroot.

Ask your doctor, nurse, or pharmacist if you need more information about this medicine or if any information in this leaflet concerns you.

Before Using:

Tell your doctor if you

  • are taking medicine or are allergic to any medicine (prescription or over-the-counter (OTC) or dietary supplement)
  • are pregnant or plan to become pregnant while using this medicine
  • are breastfeeding
  • have a history of breast cancer or another estrogen-responsive tumor (ask your caregiver if you are unsure)
  • have any other health problems, such as high blood pressure or heart or blood vessel disease


Talk with your caregiver about how much black cohosh you should take. The amount depends on the strength of the medicine and the reason you are taking black cohosh. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more black cohosh or take it more often than what is written on the directions.

To store this medicine:

Keep all medicine locked up and away from children. Store medicine away from heat and direct light. Do not store your medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down and not work the way it should work. Throw away medicine that is out of date or that you do not need. Never share your medicine with others.

Drug and Food Interactions:

Do not take black cohosh without talking to your doctor first if you are taking:

  • Medicines that slow the immune system (examples: azathioprine (Imuran(R)), cyclosporine (Neoral(R), Sandimmune(R)), SangCya(R))) (5)
  • Blood thinning medicines (example: warfarin (Coumadin(R)) (11)
  • Cholesterol-lowering medicines (example: atorvastatin (Lipitor(R)) (12)


  • Before taking black cohosh, tell your doctor if you are pregnant or breastfeeding
  • Do not take black cohosh if you have a history of breast cancer or another estrogen-responsive tumor (ask your caregiver if you are unsure)

Side Effects:

Stop taking your medicine right away and talk to your doctor if you have any of the following side effects.

  • Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing, or rash.

Other Side Effects:

You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine.

  • Taking too much black cohosh may cause nausea (upset stomach), vomiting (throwing up), headache, dizziness, shaking, and feeling giddy or "hyper."
  • Yellowing of skin and/or eyes, dark urine, pain in your right side near the bottom of your rib cage. (13)


1. Blumenthal M, Busse WR, Goldberg A et al: The Complete German Commission E Monographs. American Botanical Council, Austin, TX; 1998:214-215.

2. Brinker F: Herb Contraindications and Drug Interactions. Eclectic Medical Publications, Sandy, OR; 1998.

3. Duker E-M, Kopanski L, Jarry H et al: Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. Planta Med 1991; 57(5):420-424.

4. Lepik K: Safety of herbal medications in pregnancy. CPJ/RPC 1997; 130:29-33.

5. Light TD & Light JA: Acute renal transplant rejection possibly related to herbal medications. Am J Transplantation 2003; 3:1608-1609.

6. Liske E: Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Adv Ther 1998; 15(1):45-53.

7. Liske E & Wustenberg P: Efficacy and safety of phytomedicines with particular references to Cimicifuga racemosa. J Med Assoc Thai 1998; Jan:S108.

8. Liske E, Hanggi W, Henneicke-Von Zepelin HH et al: Physiological investigation of a unique extract of black cohosh (Cimicifuga racemosae rhizome): A 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gen Based Med 2002; 11(2):163-174.

9. McGuffin M, Hobbs C, Upton R et al: Botanical Safety Handbook. CRC Press, Boca Raton, FL; 1997.

10. Stolze H: Der andere Weg, klimakterische Beschwerden zu behandeln. Gyne 1982; 3:314-316.

11. Product Information: COUMADIN(R) oral tablets, IV injection, warfarin sodium oral tablets, IV injection. Bristol-Myers Squibb Company, Princeton, NJ, 2007.

12. Product Information: LIPITOR(R) oral tablets, atorvastatin calcium oral tablets. Parke-Davis, New York, NY, 2007a.

13. Cohen SM, O'Connor AM, Hart J et al: Autoimmune hepatitis associated with the use of black cohosh: a case study. Menopause 2004; 11(5):575-577.

Last Updated: 7/4/2018
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