Leaf & Herb · Other
Black Cohosh (Actaea Racemosa)
Strong Evidencebotanical3 PubMed Studies
Hermetica Superfood Encyclopedia
Black cohosh contains triterpene glycosides, particularly 23-epi-26-deoxyactein, which interact with estrogen receptors to help regulate hormonal balance. This Native American herb primarily supports menopausal symptom relief and may benefit bone and cardiovascular health.
Black Cohosh, derived from the root of the Actaea racemosa plant, is native to North America. The roots are harvested and processed to extract active compounds used for women's health.
Several RCTs and systematic reviews suggest Black Cohosh may help reduce menopause symptoms, though results vary. More research is needed for conclusive evidence.
Commonly used in doses of 40-80 mg of standardized extract daily. Consult a healthcare provider before use.
- Rich in triterpene glycosides that support hormonal health. - Contains flavonoids with antioxidant effects. - Provides isoferulic acid, which supports vascular health.
Black cohosh's triterpene glycosides, including 23-epi-26-deoxyactein and cimiracemoside A, bind to estrogen receptors (particularly ER-β) and may influence serotonin pathways. The compounds also interact with GABA receptors and may inhibit inflammatory pathways through NF-κB modulation. These mechanisms contribute to its estrogenic and neuromodulatory effects.
Multiple randomized controlled trials with 50-350 participants have shown black cohosh (40-160mg daily) can reduce menopausal hot flashes by 20-50% compared to placebo. A 12-month study of 122 postmenopausal women found improved bone turnover markers with 40mg daily. However, cardiovascular benefits remain preliminary, with most evidence coming from smaller studies lasting 12-24 weeks. Overall evidence is moderate for menopausal symptoms but limited for other claimed benefits.
Black cohosh is generally well-tolerated but rare cases of hepatotoxicity have been reported, requiring liver function monitoring in some individuals. It may interact with medications metabolized by CYP2D6 enzymes and could potentially enhance effects of blood pressure medications. The herb is contraindicated during pregnancy and breastfeeding due to potential uterine stimulation. Common mild side effects include gastrointestinal upset, headache, and dizziness.
5 documented interactions for Black Cohosh (Actaea Racemosa). Click any row to read the full explanation. Always consult your healthcare provider before combining supplements with medications.
Black cohosh may interfere with tamoxifen anti-cancer effects — this combination is controversial and potentially risky.
What to do: Avoid black cohosh during tamoxifen therapy unless specifically approved by your oncologist. The risk of interfering with cancer treatment outweighs menopausal symptom relief.
Timing: Take Tamoxifen as prescribed. Black Cohosh can typically be taken with a meal at a different time. As a general rule, space botanicals 1-2 hours from prescription medications. St. John's Wort is the most interaction-prone botanical — it affects dozens of drugs via CYP enzyme induction. Always inform your prescriber about herbal supplements.
Full interaction details →Both black cohosh and statins can affect the liver — rare but worth monitoring.
What to do: Monitor liver enzymes if using both. Report any liver symptoms.
Timing: Take Atorvastatin in the evening. Black Cohosh can be taken with breakfast or lunch. Red yeast rice contains natural lovastatin — never combine it with a prescription statin. Grapefruit extract and St. John's Wort both affect CYP3A4, which metabolizes most statins.
Full interaction details →Both black cohosh and acetaminophen can stress your liver — combining may increase risk of liver damage.
What to do: Avoid chronic combined use. Limit acetaminophen to less than 2g/day if using black cohosh regularly. Monitor liver function if using both long-term.
Timing: Take Acetaminophen as prescribed. Black Cohosh can typically be taken with a meal at a different time. As a general rule, space botanicals 1-2 hours from prescription medications. St. John's Wort is the most interaction-prone botanical — it affects dozens of drugs via CYP enzyme induction. Always inform your prescriber about herbal supplements.
Full interaction details →Black cohosh may interact with birth control hormones, though the clinical importance is uncertain.
What to do: Inform your prescriber. Monitor for breakthrough bleeding or side effects.
Timing: Take Combined Oral Contraceptives at the same time every day. CRITICAL: St. John's Wort induces CYP3A4 and can reduce contraceptive hormone levels enough to cause failure — breakthrough bleeding is a warning sign. Other botanicals are generally safe. Black Cohosh can be taken at any convenient time.
Full interaction details →Black cohosh may add to or interfere with your estrogen therapy in unpredictable ways.
What to do: Inform your prescriber about black cohosh use. Monitor for signs of estrogen excess.
Timing: Take Estradiol as prescribed. Black Cohosh can typically be taken with a meal at a different time. As a general rule, space botanicals 1-2 hours from prescription medications. St. John's Wort is the most interaction-prone botanical — it affects dozens of drugs via CYP enzyme induction. Always inform your prescriber about herbal supplements.
Full interaction details →Educational information only. Always consult a qualified healthcare provider before changing your supplement or medication regimen.
