Published: February 2009

Black cohosh and hepatotoxicity - ask about use and look for signs

Prescriber Update 30(1): 1
February 2009

Very rare hepatotoxic reactions have been reported in association with the use of the herb black cohosh (Cimicifuga racemosa). Reported reactions include abnormal or elevated liver function test results, hepatitis, and hepatic failure sometimes requiring liver transplantation.1

Black cohosh is used predominantly by women seeking a natural alternative to hormone replacement therapy for the relief of symptoms associated with menopause. It is found in a number of dietary supplement-type products marketed directly to consumers, typically as the dried root/ rhizome or a dried alcoholic extract.

Prescribers are advised to look for signs of liver toxicity in patients taking black cohosh. This is also a timely reminder to prescribers of the importance of seeking information from patients about their use of complementary medicines (including herbal medicines and dietary supplements) and to report any adverse reactions in patients taking complementary medicines to CARM.

  1. Chow E C-Y, Teo M, Ring JA & Chen JW (2008) Liver failure associated with the use of black cohosh for menopausal symptoms Medical Journal of Australia 188(7): 420-2.