Black cohosh not associated with liver disease, again
This is the second review published this year, and the second to conclude “there is no evidence for a causal relationship between treatment by black cohosh and the observed liver disease.”
In 42 patients, there appeared to be the possibility of a relationship between taking black cohosh (Cimicifugae racemosae rhizoma) and developing liver toxicity. However, an assessment by EMEA (European Medicines Agency) showed it was possible or probable that this reaction was a direct result of taking black cohosh in only 4 of these patients.
Reviewers from Goethe University of Frankfurt/Main in Germany evaluated those 4 cases.
First, the details.
- A diagnostic algorithm was applied in the 4 patients with suspected hepatotoxicity.
- It included an causality assessment using the updated system of the Council for International Organizations of Medical Sciences (CIOMS).
- This tool permitted the reviewers to objectively assess each case.
And, the results.
- Due to incomplete data, the 1st patient could not be evaluated.
- The 2nd patient was treated with steroids, responded well, and was eventually diagnosed with autoimmune hepatitis.
- The 3rd and 4th patients required liver transplantation, and were diagnosed as having herpetic hepatitis.
- Patients with herpetic hepatitis are almost always immunosuppressed.
The bottom line?
The authors concluded that by using a thorough assessment, “there is no evidence for a causal relationship between treatment by black cohosh and the observed liver disease in the 4 patients.”
Back in July, a review of 30 cases of presumed black cohosh-associated liver toxicity found that none of the cases were probably or certain to have been caused by black cohosh.
11/20/08 17:02 JR