The C.A.M. Report
Complementary and Alternative Medicine: Fair, Balanced, and to the Point
  • About this web log

    This blog is intended as an objective and dispassionate source of information on the latest CAM research. Since my background is in pharmacy and allopathic medicine, I view all CAM as advancing through the development pipeline to eventually become integrated into mainstream medical practice. Some will succeed while others fail. But all are treated fairly here.

  • About the author

    John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at www.Vicus.com, a complementary and alternative medicine website.

  • Common sense considerations

    The material on this weblog is for informational purposes. It is not medical advice or counsel. Be smart, consult your health professional before using CAM.

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    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.

    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

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