Black/Blue CohoshLiver Disease

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

Hi, I’m JR

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.