✓ No active regulatory warningsFDA MedWatch, EMA EudraVigilance, WHO VigiBase, WADA Prohibited List · 2026-05-29
📰Read the full Black Cohosh evidence review on GMJ News →Complete clinical article, references and updates on news.gmj.ge. This page is the structured safety summary.⚠ NOT estrogenic — common misconception [1]
⚠ Hepatotoxicity cases including liver failure — limit 6 months [1]
⚠ New fatigue/dark urine/jaundice → stop and check LFTs [1]
ℹ️ Not obtained from food. Not applicable — this is not obtained from food in meaningful amounts; supplementation is the practical route.
🔬 Lab interpreter
Recommended test
ALT, AST
ALT, AST
Reference range / target
Normal
Normal
Hepatotoxicity monitoring [1].
Full lab monitoring ↓⚕ For professionals — confirm ranges against your local laboratory.
Clinical verdict
1 How much do I need?
👤 Adults: Specific dosage data under clinical review
👴 Elderly: Specific dosage data under clinical review
🤰 Pregnancy: See guidance
AVOID — possible uterotonic effects [1].
👦 Pediatric: See guidance
Not appropriate [1].
🏃 Athletes: Standard dose
⚖️ Obesity: Standard dose
Fat-soluble compounds may require dose adjustment in obesity.
🩺 Renal: Consult specialist
Dose adjustment may be needed in renal impairment.
🌱 Vegan: Standard dose
How to take
🍽 Timing: BID [2].
💊 With food: With food [1].
🚫 Avoid: Hepatotoxic drugs. Prolonged use >6 months. Pregnancy [1].
2 Which form?
| Form | Bioavailability | Vegan | Cost |
|---|---|---|---|
| ['Remifemin (isopropanolic extract)', 'preferred', 'Most studied brand. 20 mg BID. German pharmaceutical standard [2].'] | Standard | Check label | |
| ['Standardized extract (2.5% triterpene glycosides)', 'common', 'Various brands [1].'] | Standard | Check label |
3 Common questions
Is black cohosh safe for breast cancer survivors? ▼
Debated. Black cohosh is NOT estrogenic, which is reassuring. Some oncologists allow it; others advise caution. NAMS considers it 'probably safe' but data are limited [1].
What about liver damage? ▼
Rare hepatotoxicity cases have been reported, including liver failure requiring transplant. Regulatory agencies (Australia, EU) require liver warnings. Limit use to 6 months. Monitor for symptoms (fatigue, dark urine, jaundice) [1].
4 Clinical evidence
Strong
NOT estrogenic — does not bind estrogen receptors. This is established receptor binding data [1]. HIGH
Moderate
Hot flashes: some positive RCTs (Remifemin). German Commission E approved for menopausal complaints [2]. NAMS acknowledges black cohosh as a non-hormonal option [2]. MODERATE
Insufficient
5 Safety, toxicity & adverse events
Absolute contraindications
✕ Active liver disease — rare but documented hepatotoxicity
Relative
⚠ Hormone-sensitive conditions — estrogenicity uncertain
⚠ Concurrent hepatotoxic drugs
⚠ Pregnancy (except brief, supervised use at term)
⚠ Discontinue and seek care if jaundice or liver symptoms develop
🚩 Red flags
● Jaundice or dark urine in black cohosh user — liver injury [1]
● Prolonged use >6 months [1]
● Pregnancy — uterotonic [1]
6 Interactions
Drug interactions
Hepatotoxic drugs Major
Mechanism: Additive liver injury risk. [1]
Effect: Increased hepatotoxicity. [1]
Action: Avoid concurrent hepatotoxic medications [1].
CYP2D6 substrates Moderate
Mechanism: Black cohosh may inhibit CYP2D6. [1]
Effect: Elevated CYP2D6 drug levels. [1]
Action: Monitor [1].
Supplement synergies
Saffron Extract · 30 mg saffron
Both used for menopausal mood/vasomotor symptoms [1].
Both used for menopausal mood/vasomotor symptoms [1].
7 Regulatory
Germany (Commission E): Approved for menopausal complaints [2].
Australia/EU: Liver warning labels required [1].
United States: Dietary supplement [1].
8 US supplement products
147
on-market products containing Black Cohosh (NIH DSLD)
Brands carrying Black Cohosh (92)
Click a brand to see its Black Cohosh products.
9 Frequently paired with
10 Cite this page
Vancouver: Pkhakadze G. Black Cohosh — safety profile [Internet]. Tbilisi: PHIG; 2026 [cited 2026 Oct 16]. Available from: https://supplement.ge/ingredients/black-cohosh/
APA 7th: Pkhakadze, G. (2026). Black Cohosh — Safety profile. Public Health Institute of Georgia. https://supplement.ge/ingredients/black-cohosh/
📋 Editorial information
Author: Prof. G. Pkhakadze, MD, MPH, PhD
Institution: Public Health Institute of Georgia (PHIG)
Affiliation: David Tvildiani Medical University (DTMU)
First published: January 2026
Last reviewed: 2026-05-29
Next review: April 2027
References: 2 cited sources
COI: SupplementIndex receives no funding from supplement manufacturers. All content independently authored by PHIG.
Process: Systematic literature review
📄 License & reuse
Published under Creative Commons Attribution 4.0 International (CC BY 4.0). You may share and adapt for any purpose with attribution.
Pkhakadze G. "Black Cohosh — Safety Profile." SupplementIndex, PHIG, 2026. https://supplement.ge/ingredients/black-cohosh/ CC BY 4.0.
GP
Prof. G. Pkhakadze, MD, MPH, PhD
Professor of Public Health · Head of Department, DTMU
Editor-in-Chief, Georgian Medical Journal (ISSN 3088-4322)
Chair, Public Health Institute of Georgia · UEMS Public Health Section
Educational and public health purposes. CC BY 4.0. Consult your healthcare provider before starting any supplement. Corrections: info@accreditation.ge. Publisher: PHIG