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, 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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    Re-evaluating the risk of liver toxicity from black cohosh

    Researchers from Johann Wolfgang Goethe University of Frankfurt/Main, in Hanau, Germany, reviewed the evidence and believe the risk is less than suspected.

    First, the details.

    • 69 reports of liver disease suspected to be caused by black cohosh (aka Actaea racemosa and Cimicifuga racemosa) were reviewed and analyzed.
    • The sources of the reports were 11 published case reports and 58 spontaneous reports to national regulatory agencies.

    And, the results.

    • Re-evaluation raised serious doubts about the ability of black cohosh to cause liver disease.
    • The reports that served as the sources of the reaction were of poor quality.
    • There were major inconsistencies for the same patient regarding reported data.
    • All cases had confounding variables such as…
      • Quality of reported data
      • Uncertainty of the black cohosh product, quality, and identification
      • Undisclosed indication for it’s use
      • Insufficient adverse event definition
      • Lack of temporal association and dechallenge (did the reaction resolve when black cohosh was discontinued?)
      • Missing or inadequate evaluation of alcohol use or the presence of other drugs and diseases
      • Failure to re-exposure test to black cohosh, and alternative cause of the patient’s condition

    The bottom line?

    The authors concluded, “The presented data do not support the concept of hepatotoxicity in a primarily suspected causal relationship to the use of black cohosh.”

    In other words, conclusive proof of a cause and effect relationship between black cohosh and liver toxicity is not available.

    “Nonetheless,” advises, “Patients with liver disease should consult a licensed healthcare professional before using black cohosh.”

    4/17/10 20:15 JR

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