Summary of Use during Lactation

Black cohosh (Cimicifuga racemosa, formerly Actaea racemosa) root was thought to have mild estrogenic activity based on its triterpene content, which is standardized based on 27-deoxyactein. However, recent studies have found no estrogenic activity.[1,2] It is primarily used for postmenopausal symptoms and has been used to promote labor.[3-8] Currently, it has no specific uses during breastfeeding, although historically it was supposedly used by native American women as a galactogogue.[9] No data exist on the safety and efficacy of black cohosh in nursing mothers or infants. In general, there is a low frequency of adverse reactions, but dizziness, nausea, headache, rash, vomiting, and rarely, hepatitis and allergic reactions have been reported.[3,10,11] Some sources recommend against its use during breastfeeding because of the lack of safety data and its potential estrogenic activity,[10] while others do not contraindicate its use.[9]

Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site.

Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

References

1.

Liske E, Hanggi W, Henneicke-von Zepelin HH, et al. Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med. 2002;11:163–74. [PubMed: 11975864]

2.

Ruhlen RL, Haubner J, Tracy JK, et al. Black cohosh does not exert an estrogenic effect on the breast. Nutr Cancer. 2007;59:269–77. [PubMed: 18001221]

3.

Dennehy C, Tsourounis C, Bui L, et al. The use of herbs by California midwives. J Obstet Gynecol Neonatal Nurs. 2010;39:684–93. [PubMed: 21044150]

4.

Zhang AL, Story DF, Lin V, et al. A population survey on the use of 24 common medicinal herbs in Australia. Pharmacoepidemiol Drug Saf. 2008;17:1006–13. [PubMed: 18816875]

5.

Dugoua JJ, Seely D, Perri D, et al. Safety and efficacy of black cohosh (Cimicifuga racemosa) during pregnancy and lactation. Can J Clin Pharmacol. 2006;13:e257–61. [PubMed: 17085773]

6.

Allaire AD, Moos MK, Wells SR. Complementary and alternative medicine in pregnancy: A survey of North Carolina certified nurse-midwives. Obstet Gynecol. 2000;95:19–23. [PubMed: 10636495]

7.

Tesch BJ. Herbs commonly used by women: an evidence-based review. Am J Obstet Gynecol. 2003;188(5) Suppl:S44–55. [PubMed: 12748451]

8.

Low Dog T. The use of botanicals during pregnancy and lactation. Altern Ther Health Med. 2009;15:54–8. [PubMed: 19161049]

9.

McKenna DJ, Jones K, Humphrey S, et al. Black cohosh: efficacy, safety, and use in clinical and preclinical applications. Altern Ther Health Med. 2001;7:93–100. [PubMed: 11347288]

10.

Hardy ML. Women's health series: Herbs of special interest to women. J Am Pharm Assoc (Wash). 2000;40:234–42. [PubMed: 10730024]

11.

Mahady GB, Low Dog T, Barrett ML, et al. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause. 2008;15:628–38. [PubMed: 18340277]

Substance Name

Black Cohosh

Scientific Name

Cimicifuga racemosa

CAS Registry Number

84776-26-1

Drug Class

Breast Feeding

Lactation

Complementary Therapies

Phytotherapy

Plants, Medicinal