Cimicifuga

(BAN, rINN)

💊 Chemical information

Actée à grappes; Black Cohosh; Black Snakeroot; Bugbane; Cimicífuga; Cimicifugae rhizoma; Cohosh negro.

Pharmacopoeias.

Chin. includes the rhizome of Cimicifuga heracleifolia, C. dahurica, and C. foetida. Jpn includes the rhizome of C. simplex, C. heracleifolia, C. dahurica, and C. foetida. US includes the rhizome and roots of C. racemosa. US also includes the powdered form.

USP 31

(Black Cohosh). The dried rhizome and roots of Actaea racemosa (Cimicifuga racemosa). It contains not less than 0.4% triterpene glycosides, calculated as 23-epi-26-deoxyactein (C 37 H 56 O 10 = 660.8) with reference to the dried drug. Protect from light and moisture.

💊 Profile

Cimicifuga, the roots of Cimicifuga racemosa (Actaea racemosa) (Ranunculaceae), is used for menopausal and gynaecological disorders and is included in preparations for coughs.

Homoeopathy.

Cimicifuga has been used in homoeopathic medicines under the following names: Actaea racemosa; Actaea rac.; Cimicifuga racemosa; Cim. rac.

Adverse effects.

A systematic review of the limited data available on adverse effects for cimicifuga concluded that adverse effects are generally mild and transient.1 It has been reported that cimicifuga may cause dizziness, vertigo, headache, vomiting, and gastrointestinal irritation when taken in large doses.2 From January 1998 to February 2005, Health Canada3 had received 7 reports of adverse effects suspected of being associated with black cohosh, including dizziness, rash, pruritus, oedema, increased pulse, bradycardia, atrial fibrillation, changes in plasmathyroid hormone concentration, vaginal bleeding, and convulsions. However, lack of data meant that causality could not be proved. As of March 2006, the UK MHRA2 had received 21 reports of hepatotoxicity associated with cimicifuga ingestion since 1998, which represented more than two-thirds of the total number of reports for any reaction related to cimicifuga. Likewise, there have been similar reports of hepatotoxicity in other countries including the USA, Germany, and Sweden.2 Up to April 2006, 11 cases of liver impairment associated with cimicifuga had also been reported in Australia.4 Adverse liver reactions reported worldwide have included abnormal liver function tests, jaundice, hepatitis, and liver failure.2 In general, patients showed signs of recovery on stopping ingestion.2 Some regulatory authorities consider that the available evidence supports a rare association between cimicifuga and risk of liver toxicity, even though the level of risk is difficult to determine.2,5,6 They have recommended that warnings regarding potential adverse liver reactions should be added to product information and consumers are advised to stop taking cimicifuga if they develop symptoms of liver damage;2,5-7 also, patients who have previously had liver or other serious health problems should consult their doctor before starting to take cimicifuga.2,6
1. Huntley A, Ernst E. A systematic review of the safety of black cohosh. Menopause 2003; 10: 58–64
2. Medicines and Healthcare Regulatory Agency. UK Public Assessment Report. Black Cohosh (issued 31st July 2006). Available at: http://www.mhra.gov.uk/Howweregulate/Medicines/ Herbalandhomoeopathicmedicines/Herbalmedicines/ CON2024279 (accessed 30/05/08
3. Health Canada. Black cohosh: international reports of liver toxicity. Can Adverse React News 2005; 15 (3): 2. Also available at: http://www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/ pdf/medeff/carn-bcei_v15n3_e.pdf (accessed 31/10/05
4. Adverse Drug Reactions Advisory Committee (ADRAC). Hepatotoxicity with black cohosh. Aust Adverse Drug React Bull 2006; 25: 6. Also available at: http://www.tga.gov.au/adr/aadrb/ aadr0604.htm (accessed 25/05/06
5. EMEA. EMEA Public statement on herbal medicinal products containing cimicifuga racemosae rhizoma (black cohosh, root) — serious hepatic reactions (issued 18th July 2006). Available at: http://www.emea.europa.eu/pdfs/human/hmpc/ 26925906en.pdf (accessed 01/11/07
6. Australian Government Department of Health and Ageing: Therapeutic Goods Administration. Black cohosh (Cimicifuga racemosa): new labelling requirements and consumer information for medicines containing black cohosh (issued 29th May 2007). Available at: http://www.tga.gov.au/cm/0705blkcohosh.htm (accessed 01/11/07
7. Health Canada. Health Canada is advising consumers about a possible link between black cohosh and liver damage (issued 18th August 2006). Available at: http://www.hc-sc.gc.ca/ ahc-asc/media/advisories-avis/2006/2006_72_e.html (accessed 05/11/07)

Menopausal disorders.

Cimicifuga is used in menopausal disorders, particularly for the relief of hot flushes1-6 but several reviews and studies have concluded that there is little evidence of benefit.2,3,5,6
1. Pepping J. Black cohosh: Cimicifuga racemosa. Am J HealthSyst Pharm 1999; 56: 1400–2
2. Jacobson JS, et al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol 2001; 19: 2739–45
3. Borrelli F, Ernst E. Cimicifuga racemosa: a systematic review of its clinical efficacy. Eur J Clin Pharmacol 2002; 58: 235–41
4. Uebelhack R, et al. Black cohosh and St. John’s wort for climacteric complaints: a randomized trial. Obstet Gynecol 2006; 107: 247–55
5. Pockaj BA, et al. Phase III double-blind, randomized, placebocontrolled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC . J Clin Oncol 2006; 24: 2836–41
6. Newton KM, et al. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med 2006; 145: 869–79.

💊 Preparations

USP 31: Black Cohosh Fluidextract; Black Cohosh Tablets; Powdered Black Cohosh Extract.

Proprietary Preparations

Arg.: Herbaccion Menopausia†; Menofem; Austria: Agnukliman; Jinda; Klimadynon; Braz.: Amenopam; Aplause; Clifemin; Mencirax; Menocalm; Menoliv†; Tensiane; Chile: Ginemaxim; Mensifem†; Cz.: Cimisan; Menofem; Fr.: Cimipax; Ger.: Cefakliman mono; Cimisan; Evalin†; Femi; Femikliman uno; Femilla N†; Feminon C; Femisana gyn; Indianische Frauenwurzel†; Jinda; Klimadynon; Kofemin; Natu-fem; Remifemin; Sinei; Solcosplen C; Valverde Traubensilberkerze†; Hong Kong: Klimadynon; Hung.: Cefakliman mono; Cimicin; Femitan; Klimadynon; Klimapur; Remifemin; Indon.: Klimadynon; Remifemin; Malaysia: Remifemin; Mex.: Avala; Clifenal; Mensifem; Philipp.: Remifemin; Pol.: Klimasol; Menofem; Remifemin; Rus.: Klimadynon (Климадинон); Singapore: Klimadynon; Remifemin; Spain: Avala; Remifemin; Ymea; Switz.: Cimifemine; Climavita; Femicine; Maxifem; Thai.: Remifemin; UK: Menoherb. Multi-ingredient: Austral.: Cimicifuga Compound; Dong Quai Complex; Dyzco; Extralife Meno-Care; Extralife PMS-Care; Herbal PMS Formula†; Lifesystem Herbal Formula 4 Women’s Formula†; Medinat Esten†; PMT Complex†; Proesten†; Soy Forte with Black Cohosh†; Women’s Formula Herbal Formula 3†; Austria: Remifemin plus; Canad.: Natural HRT; Natural HRT Nightime; Cz.: Dr Theiss Rheuma Creme†; Dr Theiss Schwedenbitter; Ger.: Femisana†; Remifemin plus; Hong Kong: Phytoestrin†; Hung.: Remifemin Plus; Indon.: Anstrep; Femosa; Menose; Menoxa; Osteopor; Pectum; Voldilex; Ital.: Climil Complex; Climil-80; Hiperogyn; Malaysia: Gyno-Plus; Pol.: Klimax†; Naturapia Menopauza; S.Afr.: Bronchicough†; Bronchicum†; Singapore: Phytoestrin; UK: Gerard House Reumalex; Modern Herbals Rheumatic Pain; St Johnswort Compound; Vegetable Cough Remover; Vegetex; USA: Estrocare.
Published March 28, 2019.