Black Cohosh

BCCT plans to write a summary on black cohosh (Actaea racemosa). While our summary is in development, you can visit these sites for more information:

Before using this therapy, consult your oncology team about interactions with other treatments and therapies. Also make sure this therapy is safe for use with any other medical conditions you may have.

Clinical Practice Guidelines

According to the Society for Integrative Oncology’s 2009 clinical practice guidelines, there is not enough evidence to recommend black cohosh for relieving hot flashes.1

Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Black cohosh is promoted as a treatment for hot flashes. However, evidence to date does not support this use.


The About Herbs summary for black cohosh lists several cautions, adverse reactions and herb-drug interactions, including interactions with chemotherapy. Refer to About Herbs: Black Cohosh. BCCT advises that before using this product, consult with a clinician knowledgeable in using natural products in cancer treatment.

According to CAM-Cancer, “Black cohosh appears to be relatively safe; but pre-existing liver damage is a contraindication.”2

According to the NIH office of dietary supplements, “Across the world, reports have described at least 83 cases of liver damage—including hepatitis, liver failure, elevated liver enzymes, and assorted other liver injuries—associated with black cohosh use. However, there is no evidence of a causal relationship. It is possible that at least some reported cases of hepatotoxicity were due to impurities, adulterants, or incorrect Acteae species in the black cohosh products used. However, no one independently analyzed these products to confirm the existence of these problems.”3 Another consideration is that black cohosh is often mixed with other herbs in formulas (such as for menopausal symptoms), and some of these other herbs such as skullcap, valerian and/or chaparral  have been associated with liver problems.4

The key takeaway is to read the label to be knowledgeable about all the ingredients in a product, and use quality supplements to make sure you're getting what's actually on the label. See the BCCT summary on Quality and Sources of Herbs, Supplements and Other Natural Products.


BCCT does not recommend therapies or doses, but only provides information for patients and providers to consider as part of a complete treatment plan. Patients should discuss therapies with their physicians, as contraindications, interactions and side effects must be evaluated.

Dosage recommendations are available from these sources:

Integrative Programs, Protocols and Medical Systems

For more information about programs and protocols, see our Integrative Programs and Protocols page.

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