This product is not intended to diagnose, treat, cure, or prevent any disease. These statements have not been evaluated by the Food and Drug Administration.
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider before using herbs, especially if you are pregnant, nursing, taking medications, or have a medical condition.
This herb is NOT recommended during pregnancy due to potential risks to the developing fetus.
This herb is NOT recommended while breastfeeding as effects on infants are unknown.
Consult your healthcare provider before use.
3 Known Drug Interactions — Some May Be Serious
3 Moderate
This herb may interact with medications you are taking. Review the interactions table below and consult your healthcare provider before use.
What is a herb–drug interaction?
A herb–drug interaction happens when a plant or supplement changes how a medication works in your body — making it stronger, weaker, or more likely to cause harm. Herbs contain active compounds that can speed up or slow down the enzymes and transporters your body uses to process drugs.
Why it matters
•St. John's Wort can make birth control, antidepressants, and blood thinners less effective.
•Garlic can increase bleeding risk with warfarin and other blood thinners (also ginkgo, ginger, and turmeric).
•Kava can amplify sedation when taken with anxiety or sleep medications (also valerian).
The risk is highest for older adults, anyone taking several medications, and people with chronic conditions.
Always tell your doctor and pharmacist about every herb and supplement you take — and check below before combining.
Rare cases of liver injury have been reported with black cohosh, and combining it with atorvastatin (which also carries hepatic risk) warrants liver function monitoring.
This list reflects a curated subset of documented interactions and is not exhaustive. The absence of a drug here is not proof that it is safe to combine. Always confirm with a pharmacist or healthcare provider.
How does black cohosh work to relieve menopause symptoms?
Black cohosh's exact mechanism remains under investigation, though it is believed to act on serotonin receptors rather than estrogen receptors. Research suggests compounds like triterpene glycosides may modulate neurotransmitters involved in thermoregulation. Unlike phytoestrogens, it does not appear to stimulate breast tissue, making it distinct from hormonal therapies (Evidence Level: B).
Can black cohosh interact with medications or hormone therapy?
Black cohosh may interact with hormone-sensitive conditions and medications metabolized by the liver. It is contraindicated for patients with hormone-sensitive cancers or those taking CYP450 substrates due to potential liver enzyme interactions. Patients on anticoagulants or hormone replacement therapy should consult a physician before use (Evidence Level: C/D).
What is the recommended dosage for black cohosh extract?
The standard adult dosage for black cohosh is 20 to 40 mg of a standardized extract (containing triterpene glycosides) taken twice daily. Clinical studies often utilize specific extracts like Remifemin. Users should not exceed recommended durations without medical supervision, typically limiting use to six months (Evidence Level: B).
Is black cohosh safe to take during pregnancy or breastfeeding?
Black cohosh is considered unsafe during pregnancy because it can stimulate uterine contractions and induce labor. While traditionally used for this purpose near term, it should be avoided earlier in pregnancy to prevent miscarriage. It is also not recommended during breastfeeding due to insufficient safety data and potential toxicity to the infant (Evidence Level: C/D).
Is black cohosh effective for treating hot flashes and night sweats?
Clinical studies suggest black cohosh may reduce the frequency and severity of hot flashes and night sweats associated with menopause (Evidence Level: B). While results have been mixed, meta-analyses often show modest benefits compared to placebo. It is considered one of the most researched herbs for menopausal symptom management, though individual responses vary significantly.
PubMed-compiled information sheet
This sheet was compiled from PubMed (NIH) abstracts using AI assistance. Every factual claim is cited to a real PubMed article (see the source list). It has not yet been human-reviewed — confirm with a healthcare provider before use.
Compiled from 25 PubMed articles · model: gemma4:31b
Summary
Black cohosh (Actaea racemosa) is a North American botanical supplement primarily used to manage menopausal symptoms [PMID:29261886, PMID:31643322].
Background
Black cohosh, also known as Cimicifuga racemosa, is a perennial dicot of the Buttercup (Ranunculaceae) family native to the Eastern United States and Canada [PMID:29261886, PMID:33861455]. It is also referred to as baneberry, black snakeroot, bug root, and bugbane [PMID:29261886].
Traditional uses
Historically, it has been used by indigenous populations for rheumatoid muscular pain, headache, inflammation, dysmenorrhea, premenstrual syndrome (PMS), and menstrual pain and cramping [PMID:33861455, PMID:22504147]. It has also been used to promote labor [PMID:30000840].
Active compounds
The rootstock contains triterpene glycosides (including actein, cimicifugoside, and 27-deoxyactein), isoferulic acid, and alkaloids such as n-methylcytisine [PMID:30000840, PMID:18592868].
Mechanism of action
While historically thought to have estrogenic activity, recent studies suggest it does not bind to estrogen receptors and lacks estrogenic effects on mammary cancer cells in vitro or uterine histology in rats [PMID:30000840, PMID:23459142]. Some research suggests it may act as an antinociceptive agent [PMID:22504147].
Clinical evidence
Evidence AMenopausal symptoms (neurovegetative and psychological)
Isopropanolic extract (iCR) was significantly superior to placebo and comparable in efficacy to low-dose transdermal estradiol or tibolone, with a better benefit-risk profile than tibolone [PMID:33021111].
Evidence BMenopausal symptoms (combined therapy)
A combination of Black Cohosh, Soy Isoflavones, and SDG Lignans showed significant improvements in somatic, psychological, and urogenital domains compared to placebo [PMID:40131516].
Evidence CClimacteric complaints
The extract CR BNO 1055 reduced major climacteric complaints as effectively as conjugated estrogens and significantly more than placebo [PMID:23459142].
Evidence AHot flashes in breast cancer patients
Research assessing efficacy for the treatment of hot flashes in women with breast cancer is inconclusive [PMID:17602247].
Safety & adverse effects
General adverse reactions are low in frequency but may include dizziness, nausea, headache, rash, vomiting, mastalgia, and weight gain [PMID:30000840, PMID:15898823]. Rare but severe reports of acute liver injury, hepatitis, and allergic reactions have occurred [PMID:30000840, PMID:31643322].
Pregnancy & lactation
Historically used by Native American women as a galactogogue, but there is no current data on safety and efficacy in nursing mothers or infants; some sources recommend against use during breastfeeding due to lack of safety data [PMID:30000840].
Drug interactions
Black cohosh is reported to have a low likelihood of drug interactions and can generally be safely taken with most medications [PMID:28762712].
Dosage & administration
One review notes a current recommended dosage of 40-80 mg/day for certain extracts [PMID:15898823]. No PubMed data available. Consult a healthcare provider.
Evidence summary
Evidence for the treatment of menopausal symptoms is supported by meta-analyses and RCTs, though some reviews describe findings as inconsistent or methodology as poor. Safety is generally high for short-term use, though rare hepatotoxicity is noted.
PubMed sources
1.PMID: 28762712 (2017) — Common Herbal Dietary Supplement-Drug Interactions. · American family physician
2.PMID: 39477563 (2024) — Complementary and Alternative Medicine for Menopause. · The Nursing clinics of North America
3.PMID: 30000840 (2006) — Exploring the Efficacy and Safety of Black Cohosh (Cimicifuga racemosa) in Menopausal Symptom Management. · Journal of mid-life health
4.PMID: 31643322 (2012) — Botanicals and Their Bioactive Phytochemicals for Women's Health. · CITED REFERENCES
5.PMID: 29261886 (2026) — Black cohosh. · American family physician
— A review of effective herbal medicines in controlling menopausal symptoms.
· Electronic physician
7.PMID: 33021111 (2021) — Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence. · Climacteric : the journal of the International Menopause Society
8.PMID: 30725649 (2026) — Gynecology: select topics. · Primary care
9.PMID: 40131516 (2025) — Assessing the combined effects of Black Cohosh, Soy Isoflavones, and SDG Lignans on menopausal symptoms: a randomized, double-blind, placebo-controlled clinical trial. · European journal of nutrition
10.PMID: 15500420 (2004) — The safety of black cohosh (Actaea racemosa, Cimicifuga racemosa). · Expert opinion on drug safety
11.PMID: 15898823 (2005) — Black cohosh (Actaea/Cimicifuga racemosa): review of the clinical data for safety and efficacy in menopausal symptoms. · Treatments in endocrinology
12.PMID: 33926292 (2022) — Systematic Review of Black Cohosh (Cimicifuga racemosa) for Management of Polycystic Ovary Syndrome-Related Infertility. · Journal of pharmacy practice
13.PMID: 35020295 (2002) — Is black cohosh estrogenic? · Nutrition reviews
14.PMID: 22972105 (2012) — Black cohosh (Cimicifuga spp.) for menopausal symptoms. · The Cochrane database of systematic reviews
15.PMID: 23459142 (2014) — The non-estrogenic alternative for the treatment of climacteric complaints: Black cohosh (Cimicifuga or Actaea racemosa). · The Journal of steroid biochemistry and molecular biology
16.PMID: 33861455 (2021) — Ethnobotany, Phytochemistry, Traditional and Modern Uses of Actaea racemosa L. (Black cohosh): A Review. · Advances in experimental medicine and biology
17.PMID: 35337076 (2022) — Benefits of Black Cohosh (Cimicifuga racemosa) for Women Health: An Up-Close and In-Depth Review. · Pharmaceuticals (Basel, Switzerland)
18.PMID: 18592868 (2008) — [Efficacy and safety of Black cohosh (Actaea/Cimicifuga racemosa) in the treatment of vasomotor symptoms--review of clinical trials]. · Ginekologia polska
19.PMID: 22504147 (2012) — Black cohosh: coming full circle? · Journal of ethnopharmacology
20.PMID: 17602247 (2007) — Black cohosh (Cimicifuga racemosa [L.] Nutt.): safety and efficacy for cancer patients. · Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
21.PMID: 18585461 (2008) — Black cohosh (Cimicifuga racemosa) for menopausal symptoms: a systematic review of its efficacy. · Pharmacological research