Actaea macrotys, Actaea racemosa, Actée à Grappes, Actée à Grappes Noires, Actée Noire, Aristolochiaceae Noire, Baie d'actée, Black Cohosh, Baneberry, Black Aristolochiaceae, Black Snakeroot, Bugbane, Bugwort, Cimicaire à Grappes, Cimicifuga, Cimicifuga Racemosa, Cimicifuge, Cohosh Negro, Cohosh Noir, Cytise, Herbe aux Punaises, Macrotys, Phytoestrogen, Phytoestrogène, Racine de Serpent, Racine de Squaw, Racine Noire de Serpents, Rattle Root, Rattle Top, Rattlesnake Root, Rattleweed, Rhizoma Cimicifugae, Sheng Ma, Snakeroot, Squaw Root.
Black cohosh is an herb. The root of this herb is used for medicinal purposes. Black cohosh was first used for medicinal purposes by Native American Indians, who introduced it to European colonists. Black cohosh became a popular treatment for women's health issues in Europe in the mid-1950s.
Since that time, black cohosh has commonly been used to treat symptoms of menopause, premenstrual syndrome (PMS), painful menstruation, weakened bones (osteoporosis), and for starting labor in pregnant women. It is also used to promote sleep, for breast cancer, heart disease, to improve mental function, for infertility, arthritis, and indigestion.
Some people also apply black cohosh directly on the skin. This is because there was some thought that black cohosh would improve the skin's appearance. Similarly, people used black cohosh for other skin conditions such as acne, wart removal, and even the removal of moles, but this is seldom done anymore.
Black cohosh also goes by the name "bugbane" because it was once used as an insect repellent. It is no longer used for this purpose. Frontiersmen had said that black cohosh was useful for rattlesnake bites, but no modern researchers have tested this.
Do not confuse black cohosh with blue cohosh or white cohosh. These are unrelated plants. The blue and white cohosh plants do not have the same effects as black cohosh, and may not be safe.
How does it work?
The root of black cohosh is used for medicinal purposes. Black cohosh root contains several chemicals that might have effects in the body. Some of these chemicals work on the immune system and might affect the body's defenses against diseases. Some might help the body to reduce inflammation. Other chemicals in black cohosh root might work in nerves and in the brain. These chemicals might work similar to another chemical in the brain called serotonin. Scientists call this type of chemical a neurotransmitter because it helps the brain send messages to other parts of the body.
Black cohosh root also seems to have some effects similar to the female hormone, estrogen. In some parts of the body, black cohosh might increase the effects of estrogen. In other parts of the body, black cohosh might decrease the effects of estrogen. Estrogen itself has various effects in different parts of the body. Estrogen also has different effects in people at different stages of life. Black cohosh should not be thought of as an "herbal estrogen" or a substitute for estrogen. It is more accurate to think of it as an herb that acts similar to estrogen in some people.
Possibly Effective for...
- Menopausal symptoms. Research shows that some black cohosh extracts can reduce some symptoms of menopause when taken by mouth. Most of this research is for a specific commercial black cohosh product, Remifemin. Research shows that the effects of Remifemin on menopausal symptoms are comparable to hormone therapy. The benefits may not occur with all products that contain black cohosh.
Research using black cohosh products other than Remifemin has not always shown benefits for menopausal symptoms. Some studies show that other black cohosh products do not reduce hot flashes or menopausal symptoms any better than a sugar pill ("placebo").
In some studies, products containing black cohosh and other ingredients have been investigated. Products containing black cohosh plus St. John's wort seem to reduce menopausal symptoms. Similar results have been observed for products containing black cohosh, Panax ginseng, soy, and green tea extract or black cohosh, kava, hops, and valerian extract. However, a homeopathic product containing black cohosh doesn't seem to be effective at reducing overall menopausal symptoms, although it may reduce hot flashes.
Some women take black cohosh for hot flashes related to breast cancer treatment. Women with breast cancer should not use black cohosh without talking to their cancer specialist or other health provider. Some early research suggested that black cohosh might reduce hot flashes in breast cancer patients, but more recent and higher quality research shows that black cohosh does not reduce hot flashes in women with breast cancer. There is some question as to whether black cohosh is safe for women with breast cancer. It is important for a woman with breast cancer to discuss any use of black cohosh with her health provider before using it.
Insufficient Evidence to Rate Effectiveness for...
- Breast cancer. One study suggests that taking black cohosh supplements is linked to a deceased risk of breast cancer. However, other research has found no link. Results from one study shows that taking black cohosh might increase survival in women already diagnosed with breast cancer.
- Heart disease. Early research shows that taking 40 mg per day of a specific black cohosh extract (CR BNO 1055) does not reduce the risk of heart disease in postmenopausal women.
- Mental function. Early research suggests that taking 128 mg of black cohosh daily for 12 months does not improve memory or attention in postmenopausal women.
- Infertility. Early research suggests that taking 120 mg per day of black cohosh extract plus 150 mg of clomiphene citrate can increase pregnancy rates in infertile women compared to clomiphene citrate alone. Other research shows that taking 120 mg of black cohosh with 150 mg of clomiphene citrate results in pregnancy rates that are similar to those found when clomiphene citrate is taken with another fertility drug.
- Induction of labor. Some people report that black cohosh can help start labor. As many as 45% of nurse-midwives use black cohosh to start labor in pregnant women at term. Despite its common use, there is no reliable scientific evidence that black cohosh works for this purpose.
- Migraine headache. Early research shows that taking 25 mg of black cohosh extract plus 75 mg of soy extract and 50 mg of dong quai two times per day for 24 weeks reduces the occurrence of menstrual migraines.
- Osteoarthritis. Early research suggests that taking a specific product containing black cohosh and other ingredients (Reumalex) daily for 2 months improves pain, but not joint function, in people with osteoarthritis.
- Weak bones (Osteoporosis). Evidence regarding the benefit of black cohosh for treating or preventing osteoporosis is conflicting. One study shows that taking a product containing 40 mg of black cohosh (Remifemin, Schaper & Brümmer) for 3 months improves bone formation and reduces the breakdown of bone. Another study shows that taking a different product containing 40 mg of black cohosh extract (CR BNO 1055, Klimadynon/Menofem, Bionorica AG) for 3 months increases markers of bone formation in postmenopausal women. However, other research shows that taking this black cohosh product does not improve bone mineral density. It is not known if black cohosh reduces the risk of bone fractures.
- Rheumatoid arthritis. Early research suggests that taking a specific product containing black cohosh (Reumalex, Gerard House Ltd.) twice daily for 2 months improves pain, but not joint function, in people with rheumatoid arthritis.
- Bug bites.
- Mole removal.
- Painful menstruation.
- Premenstrual syndrome (PMS).
- Snake bite.
- Sore throat.
- Wart removal.
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).
Black cohosh is POSSIBLY SAFE when taken by mouth appropriately by adults for up to one year.
There is also some concern that black cohosh may be associated with liver damage. It is not known for sure if black cohosh actually causes liver damage. Researchers are studying this. Until more is known, people who take black cohosh should watch for symptoms of liver damage. Some symptoms that may suggest liver damage are yellowing of the skin and eyes (jaundice), unusual fatigue, or dark urine. If these symptoms develop, black cohosh should be stopped and a health provider should be contacted. People who take black cohosh should talk with their health provider about getting tests to make sure their liver is working well.
Breast cancer: There is some concern that black cohosh may worsen existing breast cancer. Women who have breast cancer or who have had breast cancer in the past, and women at high-risk for breast cancer, should avoid black cohosh.
Hormone-sensitive conditions, including endometriosis, fibroids, ovarian cancer, uterine cancer, and others: Black cohosh acts somewhat like the female hormone, estrogen, in the body. There is some concern that it could worsen conditions that are sensitive to female hormones. Do not take black cohosh if you have a condition that could be affected by female hormones. These conditions include ovarian cancer, uterine cancer, endometriosis, fibroids, and other conditions.
Kidney transplant: Taking a product containing black cohosh plus alfalfa has been linked to a report of kidney transplant rejection. It is not known if black cohosh is the cause of this rejection. Until more is known, people who have received a transplant should avoid black cohosh.
Liver disease: Some reports suggest that black cohosh might cause liver damage. It is not known for sure if black cohosh is the cause of liver damage in these cases. Until more is known, people with liver disease should avoid taking black cohosh.
Protein S deficiency: People with a condition called protein S deficiency have an increased risk of blood clots. Due to the hormone-like effects of black cohosh, there is some concern that black cohosh might also increase the risk of blood clots. There is a report linking blood clots in someone with protein S deficiency after taking black cohosh along with several other herbal products. Until more is known, people with protein S deficiency should avoid black cohosh.
Atorvastatin (Lipitor)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
There is concern that black cohosh might harm the liver. Taking black cohosh with atorvastatin (Lipitor) might increase the chance of liver damage. However, there is not enough scientific information to know if this is an important concern. Before taking black cohosh talk to your healthcare provider if you take atorvastatin (Lipitor).
Cisplatin (Platinol-AQ)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Cisplatin (Platinol-AQ) is used to treat cancer. There is some concern that black cohosh might decrease how well cisplatin (Platinol-AQ) works for cancer. Do not take black cohosh if you are taking cisplatin (Platinol-AQ).
Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Some medications are changed and broken down by the liver. Black cohosh might decrease how quickly the liver breaks down some medications. Taking black cohosh along with some medications that are change by the liver may increase the effects and side effects of your medication. Before taking black cohosh talk to your healthcare provider if you take any medications that are changed by the liver.
Some medications that are changed by the liver include amitriptyline (Elavil), clozapine (Clozaril), codeine, desipramine (Norpramin), donepezil (Aricept), fentanyl (Duragesic), flecainide (Tambocor), fluoxetine (Prozac), meperidine (Demerol), methadone (Dolophine), metoprolol (Lopressor, Toprol XL), olanzapine (Zyprexa), ondansetron (Zofran), tramadol (Ultram), trazodone (Desyrel), and others.
Medications that can harm the liver (Hepatotoxic drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
There is concern that black cohosh might harm the liver. Taking black cohosh along with medication that might also harm the liver can increase the risk of liver damage. Do not take black cohosh if you are taking a medication that can harm the liver.
Some medications that can harm the liver include acetaminophen (Tylenol and others), amiodarone (Cordarone), carbamazepine (Tegretol), isoniazid (INH), methotrexate (Rheumatrex), methyldopa (Aldomet), fluconazole (Diflucan), itraconazole (Sporanox), erythromycin (Erythrocin, Ilosone, others), phenytoin (Dilantin), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), and many others.
Medications moved by transporters in cells (Organic anion-transporting polypeptide (OATP) substrates)Interaction Rating: Minor Be cautious with this combination.Talk with your health provider.
Some medications are moved by transporters in cells. Black cohosh can make these transporters less active and decrease how much of some medications get absorbed by the body. This might decrease the effectiveness of some medications.
Some medications that are moved by these transporters include aliskiren (Tekturna), amiodarone (Cordarone), atorvastatin (Lipitor), fexofenadine (Allegra), fluvastatin (Lescol), glyburide (Diabeta, Micronase), and rosuvastatin (Crestor).
The following doses have been studied in scientific research:
- Menopausal symptoms: 20-80 mg of black cohosh extract once or twice daily for up to 6 months. Also black cohosh extract equivalent to 40-127 mg of black cohosh rootstock has been taken in one or two divided doses per day for 12 weeks. Specific products used in research include CR BNO 1055 (Bionorica), Remifemin (Schaper & Brümmer GmbH & Co.), and Remixin (Mikro-Gen).
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Health Solutions From Our Sponsors
Antoine, C., Liebens, F., Carly, B., Pastijn, A., and Rozenberg, S. Safety of alternative treatments for menopausal symptoms after breast cancer: a qualitative systematic review. Climacteric. 2007;10(1):23-26. View abstract.
Boblitz N, Schrader E, Henneicke-von Zepelin HH, and et al. Benefit of a fixed drug combination containing St. John's wort and black cohosh for climacteric patients -- results of a randomised clinical trial (poster presentaion from 6th Annual Symposium on Complementary Health Care, Exeter, England, December 2-4, 1999). Focus Alt Comp Ther (FACT) 2000;5(1):85-86.
Booth, N. L., Nikolic, D., van Breemen, R. B., Geller, S. E., Banuvar, S., Shulman, L. P., and Farnsworth, N. R. Confusion regarding anticoagulant coumarins in dietary supplements. Clin Pharmacol.Ther 2004;76(6):511-516. View abstract.
Borrelli F, Mascolo N, Russo A, and et al. Cimicifuga racemosa: a systematic review of its clinical and pharmacological effects. 8th Annual Symposium on Complementary Health Care, 6th-8th December 2001 2001;
Borrelli, F. and Ernst, E. Black cohosh (Cimicifuga racemosa) for menopausal symptoms: a systematic review of its efficacy. Pharmacol.Res 2008;58(1):8-14. View abstract.
Borrelli, F. and Ernst, E. Black cohosh (Cimicifuga racemosa): a systematic review of adverse events. Am J Obstet.Gynecol. 2008;199(5):455-466. View abstract.
Borrelli, F. and Ernst, E. Cimicifuga racemosa: a systematic review of its clinical efficacy. Eur J Clin Pharmacol 2002;58(4):235-241. View abstract.
Bruno, D. and Feeney, K. J. Management of postmenopausal symptoms in breast cancer survivors. Semin.Oncol. 2006;33(6):696-707. View abstract.
Buettner, C., Mukamal, K. J., Gardiner, P., Davis, R. B., Phillips, R. S., and Mittleman, M. A. Herbal supplement use and blood lead levels of United States adults. J.Gen.Intern.Med. 2009;24(11):1175-1182. View abstract.
Burdette, J. E., Chen, S. N., Lu, Z. Z., Xu, H., White, B. E., Fabricant, D. S., Liu, J., Fong, H. H., Farnsworth, N. R., Constantinou, A. I., van Breemen, R. B., Pezzuto, J. M., and Bolton, J. L. Black cohosh (Cimicifuga racemosa L.) protects against menadione-induced DNA damage through scavenging of reactive oxygen species: bioassay-directed isolation and characterization of active principles. J Agric.Food Chem 11-20-2002;50(24):7022-7028. View abstract.
Carroll, D. G. Nonhormonal therapies for hot flashes in menopause. Am Fam.Physician 2-1-2006;73(3):457-464. View abstract.
Centre for Reviews and Dissemination. Complementary and alternative therapies for the management of menopause-related symptoms: a systematic evidence review (;Structured abstract). Database of Abstracts of Reviews of Effects, 2012;(3)
Cheema, D., Coomarasamy, A., and El Toukhy, T. Non-hormonal therapy of post-menopausal vasomotor symptoms: a structured evidence-based review. Arch Gynecol.Obstet 2007;276(5):463-469. View abstract.
Cimicifuga racemosa - Monograph. Altern.Med Rev 2003;8(2):186-189. View abstract.
Colau, J. C., Vincent, S., Marijnen, P., and Allaert, F. A. Efficacy of a non-hormonal treatment, BRN-01, on menopausal hot flashes: a multicenter, randomized, double-blind, placebo-controlled trial. Drugs R.D 9-1-2012;12(3):107-119. View abstract.
Daiber W. Menopause symptoms: success without hormones. Arztl Praxis 1983;35:1946-1947.
Davis, V. L., Jayo, M. J., Ho, A., Kotlarczyk, M. P., Hardy, M. L., Foster, W. G., and Hughes, C. L. Black cohosh increases metastatic mammary cancer in transgenic mice expressing c-erbB2. Cancer Res 10-15-2008;68(20):8377-8383. View abstract.
Einbond, L. S., Shimizu, M., Nuntanakorn, P., Seter, C., Cheng, R., Jiang, B., Kronenberg, F., Kennelly, E. J., and Weinstein, I. B. Actein and a fraction of black cohosh potentiate antiproliferative effects of chemotherapy agents on human breast cancer cells. Planta Med 2006;72(13):1200-1206. View abstract.
Einbond, L. S., Soffritti, M., Esposti, D. D., Park, T., Cruz, E., Su, T., Wu, H. A., Wang, X., Zhang, Y. J., Ham, J., Goldberg, I. J., Kronenberg, F., and Vladimirova, A. Actein activates stress- and statin-associated responses and is bioavailable in Sprague-Dawley rats. Fundam.Clin Pharmacol. 2009;23(3):311-321. View abstract.
Einbond, L. S., Su, T., Wu, H. A., Friedman, R., Wang, X., Jiang, B., Hagan, T., Kennelly, E. J., Kronenberg, F., and Weinstein, I. B. Gene expression analysis of the mechanisms whereby black cohosh inhibits human breast cancer cell growth. Anticancer Res 2007;27(2):697-712. View abstract.
Einbond, L. S., Su, T., Wu, H. A., Friedman, R., Wang, X., Ramirez, A., Kronenberg, F., and Weinstein, I. B. The growth inhibitory effect of actein on human breast cancer cells is associated with activation of stress response pathways. Int J Cancer 11-1-2007;121(9):2073-2083. View abstract.
Ernst, E. and Chrubasik, S. Phyto-anti-inflammatories. A systematic review of randomized, placebo-controlled, double-blind trials. Rheum.Dis Clin North Am 2000;26(1):13-27, vii. View abstract.
Fugh-Berman, A. and Ernst, E. Herb-drug interactions: review and assessment of report reliability. Br J Clin Pharmacol 2001;52(5):587-595. View abstract.
Garita-Hernandez, M., Calzado, M. A., Caballero, F. J., Macho, A., Munoz, E., Meier, B., Brattstrom, A., Fiebich, B. L., and Appel, K. The growth inhibitory activity of the Cimicifuga racemosa extract Ze 450 is mediated through estrogen and progesterone receptors-independent pathways. Planta Med 2006;72(4):317-323. View abstract.
Geller, S. E. and Studee, L. Contemporary alternatives to plant estrogens for menopause. Maturitas 11-1-2006;55 Suppl 1:S3-13. View abstract.
Genazzani E and Sorrentino L. Vascular action of acteina: active constituent of Actaea racemosa L. Nature 1962;194(4828):544-545.
Gingrich, P. M. and Fogel, C. I. Herbal therapy use by perimenopausal women. J Obstet.Gynecol.Neonatal Nurs. 2003;32(2):181-189. View abstract.
Grippo, A. A., Hamilton, B., Hannigan, R., and Gurley, B. J. Metal content of ephedra-containing dietary supplements and select botanicals. Am J Health Syst.Pharm 4-1-2006;63(7):635-644. View abstract.
Gurley, B. J., Barone, G. W., Williams, D. K., Carrier, J., Breen, P., Yates, C. R., Song, P. F., Hubbard, M. A., Tong, Y., and Cheboyina, S. Effect of milk thistle (Silybum marianum) and black cohosh (Cimicifuga racemosa) supplementation on digoxin pharmacokinetics in humans. Drug Metab Dispos. 2006;34(1):69-74. View abstract.
Guttuso, T., Jr. Effective and clinically meaningful non-hormonal hot flash therapies. Maturitas 2012;72(1):6-12. View abstract.
Hanna K, Day A O'Neill S Patterson C Lyons-Wall P. Does scientific evidence support the use of non-prescription supplements for treatment of acute menopausal symptoms such as hot flushes? Nutrition & Dietetics 2005;62(4):138-151.
He, K., Zheng, B., Kim, C. H., Rogers, L., and Zheng, Q. Direct analysis and identification of triterpene glycosides by LC/MS in black cohosh, Cimicifuga racemosa, and in several commercially available black cohosh products. Planta Med 2000;66(7):635-640. View abstract.
Hemachandra, L. P., Madhubhani, P., Chandrasena, R., Esala, P., Chen, S. N., Main, M., Lankin, D. C., Scism, R. A., Dietz, B. M., Pauli, G. F., Thatcher, G. R., and Bolton, J. L. Hops (Humulus lupulus) inhibits oxidative estrogen metabolism and estrogen-induced malignant transformation in human mammary epithelial cells (MCF-10A). Cancer Prev.Res (Phila) 2012;5(1):73-81. View abstract.
Hirschberg, A. L., Edlund, M., Svane, G., Azavedo, E., Skoog, L., and von, Schoultz B. An isopropanolic extract of black cohosh does not increase mammographic breast density or breast cell proliferation in postmenopausal women. Menopause. 2007;14(1):89-96. View abstract.
Hostanska, K., Nisslein, T., Freudenstein, J., Reichling, J., and Saller, R. Apoptosis of human prostate androgen-dependent and -independent carcinoma cells induced by an isopropanolic extract of black cohosh involves degradation of cytokeratin (CK) 18. Anticancer Res 2005;25(1A):139-147. View abstract.
Huang, Y., Jiang, B., Nuntanakorn, P., Kennelly, E. J., Shord, S., Lawal, T. O., and Mahady, G. B. 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):118-124. View abstract.
Huntley, A. L. and Ernst, E. A systematic review of herbal medicinal products for the treatment of menopausal symptoms. Menopause. 2003;10(5):465-476. View abstract.
Johnson, B. M. and van Breemen, R. B. In vitro formation of quinoid metabolites of the dietary supplement Cimicifuga racemosa (black cohosh). Chem.Res Toxicol. 2003;16(7):838-846. View abstract.
Julia Molla, M. D., Garcia-Sanchez, Y., Romeu, Sarri A., and Perez-lopez, F. R. Cimicifuga racemosa treatment and health related quality of life in post-menopausal Spanish women. Gynecol.Endocrinol. 2009;25(1):21-26. View abstract.
Kanadys, W. M., Leszczynska-Gorzelak, B., and Oleszczuk, J. [Efficacy and safety of Black cohosh (Actaea/Cimicifuga racemosa) in the treatment of vasomotor symptoms--review of clinical trials]. Ginekol.Pol. 2008;79(4):287-296. View abstract.
Kang, H. J., Ansbacher, R., and Hammoud, M. M. Use of alternative and complementary medicine in menopause. Int.J Gynaecol.Obstet. 2002;79(3):195-207. View abstract.
Kelley, K. W. and Carroll, D. G. Evaluating the evidence for over-the-counter alternatives for relief of hot flashes in menopausal women. J.Am.Pharm.Assoc.(2003.) 2010;50(5):e106-e115. View abstract.
Kim, C. D., Lee, W. K., Lee, M. H., Cho, H. S., Lee, Y. K., and Roh, S. S. Inhibition of mast cell-dependent allergy reaction by extract of black cohosh (Cimicifuga racemosa). Immunopharmacol Immunotoxicol. 2004;26(2):299-308. View abstract.
Kupferer, E. M., Dormire, S. L., and Becker, H. Complementary and alternative medicine use for vasomotor symptoms among women who have discontinued hormone therapy. J Obstet.Gynecol.Neonatal Nurs. 2009;38(1):50-59. View abstract.
Li, W., Sun, Y., Liang, W., Fitzloff, J. F., and van Breemen, R. B. Identification of caffeic acid derivatives in Actea racemosa (Cimicifuga racemosa, black cohosh) by liquid chromatography/tandem mass spectrometry. Rapid Commun.Mass Spectrom. 2003;17(9):978-982. View abstract.
Liske E and Wüstenberg P. Therapy of climacteric complaints with Cimicifuga racemosa: herbal medicine with clinically proven evidence [poster presentation]. Menopause 1998;5(4):250.
Liske E, Wüstenberg P, and Boblitz N. Human-pharmacological investigations during treatment of climacteric complaints with Cimicifuga racemosa (Remifemin): No estrogen-like effects. ESCOP 2001;1:1.
Long, L., Soeken, K., and Ernst, E. Herbal medicines for the treatment of osteoarthritis: a systematic review. Rheumatology.(Oxford) 2001;40(7):779-793. View abstract.
Loprinzi, C. L., Barton, D. L., Sloan, J. A., Novotny, P. J., Dakhil, S. R., Verdirame, J. D., Knutson, W. H., Kelaghan, J., and Christensen, B. Mayo Clinic and North Central Cancer Treatment Group hot flash studies: a 20-year experience. Menopause. 2008;15(4 Pt 1):655-660. View abstract.
Low, Dog T. Menopause: a review of botanical dietary supplements. Am J Med 12-19-2005;118 Suppl 12B:98-108. View abstract.
Lundstrom, E., Christow, A., Kersemaekers, W., Svane, G., Azavedo, E., Soderqvist, G., Mol-Arts, M., Barkfeldt, J., and von, Schoultz B. Effects of tibolone and continuous combined hormone replacement therapy on mammographic breast density. Am J Obstet.Gynecol. 2002;186(4):717-722. View abstract.
Lundstrom, E., Hirschberg, A. L., and Soderqvist, G. Digitized assessment of mammographic breast density--effects of continuous combined hormone therapy, tibolone and black cohosh compared to placebo. Maturitas 2011;70(4):361-364. View abstract.
Maclennan, A. H. Evidence-based review of therapies at the menopause. Int.J Evid.Based.Healthc. 2009;7(2):112-123. View abstract.
Mahady, G., Low, Dog T., Sarma, D. N., and Giancaspro, G. I. Suspected black cohosh hepatotoxicity--causality assessment versus safety signal. Maturitas 10-20-2009;64(2):139-140. View abstract.
Mazaro-Costa, R., Andersen, M. L., Hachul, H., and Tufik, S. Medicinal plants as alternative treatments for female sexual dysfunction: utopian vision or possible treatment in climacteric women? J.Sex Med. 2010;7(11):3695-3714. View abstract.
McBane, S. E. Easing vasomotor symptoms: Besides HRT, what works? JAAPA. 2008;21(4):26-31. View abstract.
McKenna, D. J., Jones, K., Humphrey, S., and Hughes, K. Black cohosh: efficacy, safety, and use in clinical and preclinical applications. Altern Ther Health Med 2001;7(3):93-100. View abstract.
McKenzie, S. C. and Rahman, A. Bradycardia in a patient taking black cohosh. Med J Aust. 10-18-2010;193(8):479-481. View abstract.
Mohamed, M. E. and Frye, R. F. Inhibitory effects of commonly used herbal extracts on UDP-glucuronosyltransferase 1A4, 1A6, and 1A9 enzyme activities. Drug Metab Dispos. 2011;39(9):1522-1528. View abstract.
Mohamed, M. F., Tseng, T., and Frye, R. F. Inhibitory effects of commonly used herbal extracts on UGT1A1 enzyme activity. Xenobiotica 2010;40(10):663-669. View abstract.
Naser, B. and Liske, E. Liver failure associated with the use of black cohosh for menopausal symptoms. Med J Aust. 1-19-2009;190(2):99. View abstract.
Nash LI, Desindes S. Canadian consensus conference on menopause 2006 update. J Obstet Gynaecol Can 2006;28:S69-74.
Nedrow, A., Miller, J., Walker, M., Nygren, P., Huffman, L. H., and Nelson, H. D. Complementary and alternative therapies for the management of menopause-related symptoms: a systematic evidence review. Arch Intern.Med 7-24-2006;166(14):1453-1465. View abstract.
Nesselhut T, Schellhase C, Dietrich R, and et al. [Investigations into the growth-inhibitive efficacy of phytopharmacopia with estrogen-like influences on mammary gland carcinoma cells] (translated from German). Arch Gynecol Obstet 1993;254:817-818.
Newton, K. M., Reed, S. D., LaCroix, A. Z., Grothaus, L. C., Ehrlich, K., and Guiltinan, J. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med 12-19-2006;145(12):869-879. View abstract.
Ng, S. S. and Figg, W. D. Antitumor activity of herbal supplements in human prostate cancer xenografts implanted in immunodeficient mice. Anticancer Res 2003;23(5A):3585-3590. View abstract.
Nisslein, T. and Freudenstein, J. Effects of an isopropanolic extract of Cimicifuga racemosa on urinary crosslinks and other parameters of bone quality in an ovariectomized rat model of osteoporosis. J Bone Miner.Metab 2003;21(6):370-376. View abstract.
Noguchi, M., Nagai, M., Koeda, M., Nakayama, S., Sakurai, N., Takahira, M., and Kusano, G. Vasoactive effects of cimicifugic acids C and D, and fukinolic acid in cimicifuga rhizome. Biol Pharm Bull 1998;21(11):1163-1168. View abstract.
Nuntanakorn, P., Jiang, B., Einbond, L. S., Yang, H., Kronenberg, F., Weinstein, I. B., and Kennelly, E. J. Polyphenolic constituents of Actaea racemosa. J Nat Prod 2006;69(3):314-318. View abstract.
Nuntanakorn, P., Jiang, B., Yang, H., Cervantes-Cervantes, M., Kronenberg, F., and Kennelly, E. J. Analysis of polyphenolic compounds and radical scavenging activity of four American Actaea species. Phytochem.Anal. 2007;18(3):219-228. View abstract.
Onorato, J. and Henion, J. D. Evaluation of triterpene glycoside estrogenic activity using LC/MS and immunoaffinity extraction. Anal.Chem 10-1-2001;73(19):4704-4710. View abstract.
Palacio, C., Masri, G., and Mooradian, A. D. Black cohosh for the management of menopausal symptoms : a systematic review of clinical trials. Drugs Aging 2009;26(1):23-36. View abstract.
Pang, X., Cheng, J., Krausz, K. W., Guo, D. A., and Gonzalez, F. J. Pregnane X receptor-mediated induction of Cyp3a by black cohosh. Xenobiotica 2011;41(2):112-123. View abstract.
Petho A. Climacteric complaints are often helped with black cohosh. Ärztliche Praxis 1987;47:1551-1553.
Pierard, S., Coche, J. C., Lanthier, P., Dekoninck, X., Lanthier, N., Rahier, J., and Geubel, A. P. Severe hepatitis associated with the use of black cohosh: a report of two cases and an advice for caution. Eur J Gastroenterol Hepatol. 2009;21(8):941-945. View abstract.
Pinkerton, J. V., Stovall, D. W., and Kightlinger, R. S. Advances in the treatment of menopausal symptoms. Womens Health (Lond Engl.) 2009;5(4):361-384. View abstract.
Rhyu, M. R., Lu, J., Webster, D. E., Fabricant, D. S., Farnsworth, N. R., and Wang, Z. J. Black cohosh (Actaea racemosa, Cimicifuga racemosa) behaves as a mixed competitive ligand and partial agonist at the human mu opiate receptor. J Agric.Food Chem 12-27-2006;54(26):9852-9857. View abstract.
Richardson, M. K. Black cohosh...a cautionary tale! Menopause. 2008;15(4 Pt 1):583. View abstract.
Roberts, H. Safety of herbal medicinal products in women with breast cancer. Maturitas 2010;66(4):363-369. View abstract.
Rock, E. and DeMichele, A. Nutritional approaches to late toxicities of adjuvant chemotherapy in breast cancer survivors. J Nutr 2003;133(11 Suppl 1):3785S-3793S. View abstract.
Ross, S. M. 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. View abstract.
Rostock, M., Fischer, J., Mumm, A., Stammwitz, U., Saller, R., and Bartsch, H. H. Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints - a prospective observational study. Gynecol.Endocrinol. 2011;27(10):844-848. View abstract.
Sammartino, A., Tommaselli, G. A., Gargano, V., di, Carlo C., Attianese, W., and Nappi, C. Short-term effects of a combination of isoflavones, lignans and Cimicifuga racemosa on climacteric-related symptoms in postmenopausal women: a double-blind, randomized, placebo-controlled trial. Gynecol.Endocrinol. 2006;22(11):646-650. View abstract.
Schmid, D., Woehs, F., Svoboda, M., Thalhammer, T., Chiba, P., and Moeslinger, T. Aqueous extracts of Cimicifuga racemosa and phenolcarboxylic constituents inhibit production of proinflammatory cytokines in LPS-stimulated human whole blood. Can J Physiol Pharmacol. 2009;87(11):963-972. View abstract.
Sevior, D. K., Hokkanen, J., Tolonen, A., Abass, K., Tursas, L., Pelkonen, O., and Ahokas, J. T. Rapid screening of commercially available herbal products for the inhibition of major human hepatic cytochrome P450 enzymes using the N-in-one cocktail. Xenobiotica 2010;40(4):245-254. View abstract.
Shao, Y., Harris, A., Wang, M., Zhang, H., Cordell, G. A., Bowman, M., and Lemmo, E. Triterpene glycosides from Cimicifuga racemosa. J Nat Prod 2000;63(7):905-910. View abstract.
Shi, S. and Klotz, U. Drug interactions with herbal medicines. Clin Pharmacokinet. 2-1-2012;51(2):77-104. View abstract.
Shord, S. S., Shah, K., and Lukose, A. Drug-botanical interactions: a review of the laboratory, animal, and human data for 8 common botanicals. Integr Cancer Ther 2009;8(3):208-227. View abstract.
Shulman, L. P., Banuvar, S., Fong, H. H., and Farnsworth, N. R. Discussion of a well-designed clinical trial which did not demonstrate effectiveness: UIC center for botanical dietary supplements research study of black cohosh and red clover. Fitoterapia 2011;82(1):88-91. View abstract.
Stolze H. [An alternative to treat menopausal complaints]. Gynecologie 1982;1:14-16.
Struck D, Tegtmeier M, and Harnischfeger G. Flavones in extracts of
Tamaki, H., Satoh, H., Hori, S., Ohtani, H., and 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):170-179. View abstract.
Umland, E. M. Treatment strategies for reducing the burden of menopause-associated vasomotor symptoms. J.Manag.Care Pharm. 2008;14(3 Suppl):14-19. View abstract.
van Breemen, R. B., Liang, W., Banuvar, S., Shulman, L. P., Pang, Y., Tao, Y., Nikolic, D., Krock, K. M., Fabricant, D. S., Chen, S. N., Hedayat, S., Bolton, J. L., Pauli, G. F., Piersen, C. E., Krause, E. C., Geller, S. E., and Farnsworth, N. R. Pharmacokinetics of 23-epi-26-deoxyactein in women after oral administration of a standardized extract of black cohosh. Clin Pharmacol.Ther 2010;87(2):219-225. View abstract.
van de Meerendonk, H. W., van Hunsel, F. P., and van der Wiel, H. E. [Autoimmune hepatitis induced by Actaea racemosa. Side affects of an herb extract]. Ned.Tijdschr.Geneeskd. 2-7-2009;153(6):246-249. View abstract.
Vannacci, A., Lapi, F., Gallo, E., Vietri, M., Toti, M., Menniti-Ippolito, F., Raschetti, R., Firenzuoli, F., and Mugelli, A. A case of hepatitis associated with long-term use of Cimicifuga racemosa. Altern.Ther Health Med 2009;15(3):62-63. View abstract.
Viereck, V., Grundker, C., Friess, S. C., Frosch, K. H., Raddatz, D., Schoppet, M., Nisslein, T., Emons, G., and Hofbauer, L. C. Isopropanolic extract of black cohosh stimulates osteoprotegerin production by human osteoblasts. J Bone Miner.Res 2005;20(11):2036-2043. View abstract.
Vorberg G. Treatment of menopause symptoms. ZFA 1984;60:626-629.
Walji, R., Boon, H., Guns, E., Oneschuk, D., and Younus, J. Black cohosh (Cimicifuga racemosa [L.] Nutt.): safety and efficacy for cancer patients. Support.Care Cancer 2007;15(8):913-921. View abstract.
Wanwimolruk, S., Wong, K., and Wanwimolruk, P. Variable inhibitory effect of different brands of commercial herbal supplements on human cytochrome P-450 CYP3A4. Drug Metabol.Drug Interact. 2009;24(1):17-35. View abstract.
Warnecke G. Using phyto-treatment to influence menopause symptoms. Med Welt 1985;36:871-874.
Wong, V. C., Lim, C. E., Luo, X., and Wong, W. S. Current alternative and complementary therapies used in menopause. Gynecol.Endocrinol. 2009;25(3):166-174. View abstract.
Wuttke, W. and Seidlova-Wuttke, D. News about Black cohosh. Maturitas 2012;71(2):92-93. View abstract.
Yang, C. L., Chik, S. C., Li, J. C., Cheung, B. K., and Lau, A. S. Identification of the bioactive constituent and its mechanisms of action in mediating the anti-inflammatory effects of black cohosh and related Cimicifuga species on human primary blood macrophages. J Med Chem 11-12-2009;52(21):6707-6715. View abstract.
Zierau, O., Bodinet, C., Kolba, S., Wulf, M., and Vollmer, G. Antiestrogenic activities of Cimicifuga racemosa extracts. J Steroid Biochem.Mol.Biol 2002;80(1):125-130. View abstract.
Zimmermann, R., Witte, A., Voll, R. E., Strobel, J., and Frieser, M. Coagulation activation and fluid retention associated with the use of black cohosh: a case study. Climacteric. 2010;13(2):187-191. View abstract.
Shams T, Setia MS, Hemmings R, et al. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med 2010;16:36-44. View abstract.
Amato P, Christophe S, Mellon PL. Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause 2002;9:145-50. View abstract.
Amsterdam JD, Yao Y, Mao JJ, Soeller I, Rockwell K, Shults J. Randomized, double-blind, placebo-controlled trial of Cimicifuga racemosa (black cohosh) in women with anxiety disorder due to menopause. J Clin Psychopharmacol 2009;29:478-83. View abstract.
Assessment of case reports connected to herbal medicinal products containing cimicifugae racemosa rhizoma (black cohosh, root). Doc. Ref. EMEA/269259/2006. Available at: www.emea.eu.int/pdfs/human/hmpc/26925806en.pdf (Accessed 30 November 2007).
Australian Adverse Drug Reactions Advisory Committee. Black cohosh and liver toxicity - an update. Aust Adv Drug Reactions Bull 2007;26:11.
Bai W, Henneicke-von Zepelin HH, Wang S, et al. Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: A randomized, double blind, parallel-controlled study versus tibolone. Maturitas 2007;58:31-41. View abstract.
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]. Zhonghua Fu Chan Ke Za Zhi 2009;44:597-600. View abstract.
Baillie N, Rasmussen P. Black and blue cohosh in labour. N Z Med J 1997;110:20-1.
Bebenek M, Kemmler W, von Stengel S, Engelke K, Kalender WA. Effect of exercise and Cimicifuga racemosa (CR BNO 1055) on bone mineral density, 10-year coronary heart disease risk, and menopausal complaints: the randomized controlled Training and Cimicifuga racemosa Erlangen (TRACE) study. Menopause 2010;17:791-800. View abstract.
Beck V, Unterrieder E, Krenn L, et al. Comparison of hormonal activity (estrogen, androgen and progestin) of standardized plant extracts for large scale use in hormone replacement therapy. J Steroid Biochem Mol Biol 2003;84:259-68.. View abstract.
Bodinet C, Freudenstein J. Influence of Cimicifuga racemosa on the proliferation of estrogen receptor-positive human breast cancer cells. Breast Cancer Res Treat 2002;76:1-10.. View abstract.
Bodinet C, Freudenstein J. Influence of marketed herbal menopause preparations on MCF-7 cell proliferation. Menopause 2004;11:281-9.. View abstract.
Brasky TM, Lampe JW, Potter JD, et al. Specialty supplements and breast cancer risk in the VITamins And Lifestyle (VITAL) cohort. Cancer Epidemiol Biomarkers Prev 2010;19:1696-708. View abstract.
Briese V, Stammwitz U, Friede M, Henneicke-von Zepelin HH. Black cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational study. Maturitas 2007;57:405-14. View abstract.
Burdette JE, Liu J, Chen SN, et al. Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor. J Agric Food Chem 2003;51:5661-70. View abstract.
Burke BE, Olson RD, Cusack BJ. Randomized, controlled trial of phytoestrogen in the prophylactic treatment of menstrual migraine. Biomed Pharmacother 2002;56:283-8. View abstract.
Cheong JL, Bucknall R. Retinal vein thrombosis associated with a herbal phytoestrogen preparation in a susceptible patient. Postgrad Med J 2005;81:266-7.. View abstract.
Chitturi S, Farrell GC. Hepatotoxic slimming aids and other herbal hepatotoxins. J Gastroenterol Hepatol 2008;23:366-73. View abstract.
Chow ECY, Teo M, Ring JA, Chen JW. Liver failure associated with the use of black cohosh for menopausal symptoms. Med J Aust 2008;188:420-2. View abstract.
Chung DJ, Kim HY, Park KH, et al. Black cohosh and St. John's wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J 2007;48:289-94. View abstract.
Cohen B, Schardt D. Center for Science in the Public Interest. Letter to Food and Drug Administration. Commissioner Mark McClellan, MD, PhD. March 4, 2004.
Cohen SM, O'Connor AM, Hart J, et al. Autoimmune hepatitis associated with the use of black cohosh: a case study. Menopause 2004;11:575-7. View abstract.
Davis VL, Jayo MJ, Hardy ML, et al. Effects of black cohosh on mammary tumor development and progression in MMTV-neu transgenic mice. 94th Annual Meeting of the American Association for Cancer Research, Washington, DC. July 11-14, 2003;abstract R910.
Dixon-Shanies D, Shaikh N. Growth inhibition of human breast cancer cells by herbs and phytoestrogens. Oncol Rep 1999;6:1383-7.. View abstract.
Dog TL, Powell KL, Weisman SM. Critical evaluation of the safety of Cimicifuga racemosa in menopause symptom relief. Menopause 2003;10:299-313.. View abstract.
Dugoua JJ, Seely D, Perri D, et al. Safety and efficacy of black cohosh (cimicifuga racemosa) during pregnancy and lactation. Can J Clin Pharmacol 2006;13:e257-61. View abstract.
Dunbar K, Solga SF. Black cohosh, safety, and public awareness. Liver Int 2007;27:1017. View abstract.
Einbond LS, Shimizu M, Xiao D, et al. Growth inhibitory activity of extracts and purified components of black cohosh on human breast cancer cells. Breast Cancer Res Treat 2004;83:221-31. View abstract.
Einer-Jensen N, Zhao J, Andersen KP, Kristoffersen K. Cimicifuga and Melbrosia lack oestrogenic effects in mice and rats. Maturitas 1996;25:149-53. View abstract.
Enbom ET, Le MD, Oesterich L, Rutgers J, French SW. Mechanism of hepatotoxicity due to black cohosh (Cimicifuga racemosa): histological, immunohistochemical and electron microscopy analysis of two liver biopsies with clinical correlation. Exp Mol Pathol. 2014;96(3):279-83. View abstract.
Franco OH, Chowdhury R, Troup J, et al. Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 21;315(23):2554-63. View abstract.
Frei-Kleiner S, Schaffner W, Rahlfs VW, et al. Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial. Maturitas 2005;51:397-404. View abstract.
Freudenstein J, Dasenbrock C, Nisslein T. Lack of promotion of estrogen-dependent mammary gland tumors in vivo by an isopropanolic Cimicifuga racemosa extract. Cancer Res 2002;62:3448-52.. View abstract.
Fuchikami H, Satoh H, Tsujimoto M, Ohdo S, Ohtani H, Sawada Y. Effects of herbal extracts on the function of human organic anion-transporting polypeptide OATP-B. Drug Metab Dispos 2006;34:577-82. View abstract.
Garcia-Pérez MA, Pineda B, Hermenegildo C, Tarin JJ, Cano A. Isopropanolic Cimicifuga racemosa is favorable on bone markers but neutral on an osteoblastic cell line. Fertil Steril 2009;91:1347-50. View abstract.
Geller SE, Shulman LP, van Breemen RB, et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause 2009;16:1156-66. View abstract.
Gori L, Firenzuoli F. Is black cohosh a hepatotoxic medicinal herb? Forsch Komplementarmed 2007;14:109-10. View abstract.
Gunn TR, Wright IM. The use of black and blue cohosh in labour. N Z Med J 1996;109:410-1.
Gurley B, Hubbard MA, Williams DK, et al. Assessing the clinical significance of botanical supplementation on human cytochrome P450 3A activity: comparison of a milk thistle and black cohosh product to rifampin and clarithromycin. J Clin Pharmacol 2006;46:201-13. View abstract.
Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes. Clin Pharmacol Ther 2005;77:415-26. View abstract.
Gurley BJ, Swain A, Hubbard MA, et al. Clinical assessement of CYP2D6-mediated herb-drug interactions in humans: Effects of milk-thistle, black cohosh, goldenseal, kava kava, St. John's wort, and Echinacea. Mol Nutr Food Res 2008;52:755-63. View abstract.
Guzman G, Kallwitz ER, Wojewoda C, et al. Liver Injury with Features Mimicking Autoimmune Hepatitis following the Use of Black Cohosh. Case Rep Med. 2009;2009:918156. View abstract.
Henneicke-von Zepelin HH, Meden H, Kostev K, Schröder-Bernhardi D, Stammwitz U, Becher H. Isopropanolic black cohosh extract and recurrence-free survival after breast cancer. Int J Clin Pharmacol Ther 2007;45:143-54. View abstract.
Hepatotoxicity with black cohosh. Australian Adv Drug Reactions Bull 2006;25:6. Available at: www.tga.gov.au/adr/aadrb/aadr0604.htm#a1.
Hernandez Munoz G, Pluchino S. Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer. Maturitas 2003;44:S59-65.. View abstract.
Huntley A, Ernst E. A systematic review of the safety of black cohosh. Menopause 2003;10:58-64.. View abstract.
Ingraffea A, Donohue K, Wilkel C, Falanga V. Cutaneous vasculitis in two patients taking an herbal supplement containing black cohosh. J Am Acad Dermatol 2007;56:S124-6. View abstract.
Jacobson JS, Troxel AB, Evans J, et al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol 2001;19:2739-45. View abstract.
Jarry H, Thelen P, Christoffel V, et al. Cimicifuga racemosa extract BNO 1055 inhibits proliferation of the human prostate cancer cell line LNCaP. Phytomedicine 2005;12:178-82. View abstract.
Jiang B, Kronenberg F, Nuntanakorn P, et al. Evaluation of the botanical authenticity and phytochemical profile of black cohosh products by high-performance liquid chromatography with selected ion monitoring liquid chromatography-mass spectrometry. J Agric Food Chem 2006;54:3242-53. View abstract.
Jiang B, Ma C, Motley T, Kronenberg F, Kennelly EJ. Phytochemical fingerprinting to thwart black cohosh adulteration: a 15 Actaea species analysis. Phytochem Anal. 2011;22(4):339-51. View abstract.
Joy D, Joy J, Duane P. Black cohosh: a cause of abnormal postmenopausal liver function tests. Climacteric 2008;11:84-8. View abstract.
Kennelly EJ, Baggett S, Nuntanakorn P, et al. Analysis of thirteen populations of black cohosh for formononetin. Phytomedicine 2002;9:461-7.. View abstract.
Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med 2002;137:805-13.. View abstract.
Kruse SO, Lohning A, Pauli GF, et al. Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Planta Med 1999;65:763-4. View abstract.
Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012;9:CD007244. View abstract.
Lehmann-Willenbrock E, Riedel HH. [Clinical and endocrinologic studies of the treatment of ovarian insufficiency manifestations following hysterectomy with intact adnexa]. Zentralbl Gynakol 1988;110:611-8. View abstract.
Levitsky J, Alli TA, Wisecarver J, Sorrell MF. Fulminant liver failure associated with the use of black cohosh. Dig Dis Sci 2005;50:538-9. View abstract.
Lieberman S. A Review of the effectiveness of cimicifuga racemosa (Black Cohosh) for the symptoms of menopause. J Womens Health 1998;7:525-9. View abstract.
Light TD, Light JA. Acute renal transplant rejection possibly related to herbal medications. Am J Transplant 2003;3:1608-9. View abstract.
Liske E, Hanggi W, Henneicke-von Zepelin HH, et al. Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med 2002;11:163-74.. View abstract.
Liske E, Wustenberg P. Therapy of climacteric complaints with Cimicifuga racemosa: herbal medicine with clinically proven evidence. Menopause 1998;5:250.
Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Adv Ther 1998;15:45-53. View abstract.
Liu J, Burdette JE, Xu H, et al. Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms. J Agric Food Chem 2001;49:2472-9.. View abstract.
Lontos S, Jones RM, Angus PW, Gow PJ. Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust 2003;179:390-1.. View abstract.
Loser B, Kruse SO, Melzig MF, Nahrstedt A. Inhibition of neutrophil elastase activity by cinnamic acid derivatives from Cimicifuga racemosa. Planta Med 2000;66:751-3.. View abstract.
Lynch CR, Folkers ME, Hutson WR. Fulminant hepatic failure associated with the use of black cohosh: a case report. Liver Transpl 2006;12:989-92. View abstract.
Mahady GB, Low Dog T, Barrett ML, et al. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause 2008;15:628-38. View abstract.
Maki PM, Rubin LH, Fornelli D, et al. Effects of botanicals and combined hormone therapy on cognition in postmenopausal women. Menopause 2009;16:1167-77. View abstract.
McFarlin BL, Gibson MH, O'Rear J, Harman P. A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice. J Nurse Midwifery 1999;44:205-16. View abstract.
Meyer S, Vogt T, Obermann EC, et al. Cutaneous pseudolymphoma induced by Cimicifuga racemosa. Dermatology 2007;214:94-6. View abstract.
MHRA. Black cohosh (Cimicifuga racemosa) - risk of liver problems. Herbal Safety News July 2006. Available at: http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary= true&ssDocName=CON2024131&ssTargetNodeId=663.
Mills SY, Jacoby RK, Chacksfield M, Willoughby M. Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study. Br J Rheumatol 1996;35:874-8. View abstract.
Minciullo PL, Saija A, Patafi M, et al. Muscle damage induced by black cohosh (Cimicifuga racemosa). Phytomedicine 2006;13:115-8. View abstract.
Nappi RE, Malavasi B, Brundu B, Facchinetti F. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol 2005;20:30-5. View abstract.
Newton KM, Reed SD, LaCroix AZ, et al. Treatment of vasomotor symptoms of menopause with black cohosh, mulitbotanicals, soy, hormone therapy, or placebo. Ann Intern Med 2006;145:869-79. Available at: http://www.annals.org/cgi/reprint/145/12/869.pdf.
Obi N, Chang-Claude J, Berger J, Braendle W, Slanger T, Schmidt M, Steindorf K, Ahrens W, Flesch-Janys D. The use of herbal preparations to alleviate climacteric disorders and risk of postmenopausal breast cancer in a German case-control study. Cancer Epidemiol Biomarkers Prev 2009;18:2207-13. View abstract.
Oktem M, Eroglu D, Karahan HB, Taskintuna N, Kuscu E, Zeyneloglu HB. Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized trial. Adv Ther 2007;24:448-61. View abstract.
Osmers R, Friede M, Liske E, et al. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol 2005;105:1074-83. View abstract.
Patel NM, Derkits RM. Possible increase in liver enzymes secondary to atorvastatin and black cohosh administration. J Pharm Pract 2007;20:341-6.
Pepping J. Black cohosh: Cimicifuga racemosa. Am J Health Syst Pharm 1999;56:1400-2.
Pockaj BA, Gallagher JG, Loprinzi CL, et al. Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol 2006;24:2836-41. View abstract.
Pockaj BA, Loprinzi CL, Sloan JA, et al. Pilot evaluation of black cohosh for the treatment of hot flashes in women. Cancer Invest 2004;22:515-21. View abstract.
Raus K, Brucker C, Gorkow C, Wuttke W. First-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055. Menopause 2006;13:678-91. View abstract.
Rebbeck TR, Troxel AB, Norman S, Bunin GR, DeMichele A, Baumgarten M, Berlin M, Schinnar R, Strom BL. A retrospective case-control study of the use of hormone-related supplements and association with breast cancer. Int J Cancer 2007;120:1523-8. View abstract.
Rockwell S, Fajolu O, Liu Y, et al. The herbal medicine black cohosh alters the response of breast cancer cells to some agents used in cancer therapy. Annual Meeting of the American Association for Cancer Research, Washington, DC. July 11-14, 2003;abstract 2721.
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;90:233-9. View abstract.
Rotem C, Kaplan B. Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep: randomized, controlled, double-blind pilot study. Gynecol Endocrinol 2007;23:117-22. View abstract.
Sakurai N, Wu JH, Sashida Y, et al. Anti-AIDS agents. Part 57: Actein, an anti-HIV principle from the rhizome of Cimicifuga racemosa (black cohosh), and the anti-HIV activity of related saponins. Bioorg Med Chem Lett 2004;14:1329-32. View abstract.
Seidlova-Wuttke D, Hesse O, Jarry H, et al. Evidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta. Eur J Endocrinol 2003;149:351-62. View abstract.
Seidlova-Wuttke D, Thelen P, Wuttke W. Inhibitory effects of a black cohosh (Cimicifuga racemosa) extract on prostate cancer. Planta Med 2006;72:521-6. View abstract.
Sen A. Orobuccolingual dyskinesia after long-term use of black cohosh and ginseng. J Neuropsychiatry Clin Neurosci 2013 Fall;25(4):E50. View abstract.
Shahin AY, Ismail AM, Shaaban OM. Supplementation of clomiphene citrate cycles with Cimicifuga racemosa or ethinyl oestradiol--a randomized trial. Reprod Biomed Online 2009;19:501-7. View abstract.
Shahin AY, Ismail AM, Zahran KM, Makhlouf AM. Adding phytoestrogens to clomiphene induction in unexplained infertility patients--a randomized trial. Reprod Biomed Online 2008;16:580-8. View abstract.
Spangler L, Newton KM, Grothaus LC, et al. The effects of black cohosh therapies on lipids, fibrinogen, glucose and insulin. Maturitas 2007;57:195-204. View abstract.
Stoll W. Phytotherapeutikum beeinflusst atrophisches Vaginal epithel. Doppelblindversuch Cimicifuga vs. Oestrogenpraeparat [Phytopharmaceutical influences on atrophic vaginal epithelium. Double-blind study on Cimicifuga vs. an estrogen preparation]. Therapeutickon 1987;1:23-32.
Sun J. Morning/evening menopausal formula relieves menopausal symptoms: a pilot study. J Altern Complement Med 2003;9:403-9. View abstract.
Teschke R, Bahre R, Genthner A, et al. Suspected black cohosh hepatotoxicity - challenges and pitfalls of causality assessment. Maturitas 2009;63:302-14. View abstract.
Thomsen M, Vitetta L, Schmidt M, Sali A. Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust 2004;180:598-600.. View abstract.
Tsukamoto S, Aburatani M, Ohta T. Isolation of CYP3A4 Inhibitors from the Black Cohosh (Cimicifuga racemosa). Evid Based Complement Alternat Med 2005;2:223-6. View abstract.
Uebelhack R, Blohmer JU, Graubaum HJ, et al. Black cohosh and St. John's wort for climacteric complaints: a randomized trial. Obstet Gynecol 2006;107(2 Pt 1):247-55. View abstract.
van der Sluijs CP, Bensoussan A, Chang S, Baber R. A randomized placebo-controlled trial on the effectiveness of an herbal formula to alleviate menopausal vasomotor symptoms. Menopause 2009;16:336-44. View abstract.
Verhoeven MO, van der Mooren MJ, van de Weijer PH, et al. CuraTrial Research Group. Effect of a combination of isoflavones and Actaea racemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause 2005;12:412-20. View abstract.
Vermes G, Bánhidy F, Acs N. The effects of remifemin on subjective symptoms of menopause. Adv Ther 2005;22:148-54. View abstract.
Vitetta L, Thomsen M, Sali A. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2003;178:411-2.. View abstract.
Whiting PW, Clouston A, Kerlin P. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2002;177:440-3. View abstract.
Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Menopause 2006;13:185-96. View abstract.
Wuttke W, Seidlova-Wuttke D, Gorkow C. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas 2003;44:S67-77. View abstract.