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Clinician’s Corner: Black Cohosh

After the results of the HERS trial in 2000, estrogen is to be used for relief of hot flashes, at the lowest possible dose for the shortest period of time. Estrogen is no longer recommended for prevention of chronic heart disease, osteoporosis, or prevention of dementia.

Indeed, estrogen has fallen out of favor, and our female patients are looking for relief of hot flashes and turn to the over the counter supplements such as black cohost, the active ingredient in Remifemin®. Your Thompson Pharmacist can help you to get relief.

Black Cohosh:

  • Cimicifuga racemose- the roots are used. It is a member of the buttercup family.
  • USE: extracts seem to modestly reduce symptoms of menopause, such as hot flashes. However, there is considerable variability in the preparations used in clinical trials, and in the results obtained.
  • Remifemin® contains only black cohosh, and has been one of Germany’s top proprietary herbs since the 1960’s, and is used for hot flashes and premenstrual symptoms. It is not recommended to be used over 6 months.

What the US studies show:  . There was no significant difference between black cohosh and placebo. Source:http://www.ncbi.nlm.nih.gov/pubmed/22972105 Results for evening primrose oil and flaxseed have also been disappointing.

Adverse effects: Stomach upset, headache are common side effects. There have been reports of liver damage in patients.

Drug interactions: because of the potential (not yet proven) estrogenic effects of black cohosh, do not take if you are prescribed tamoxifen (Nolvadex) for breast cancer.

Non-Hormonal alternatives for hot flashes:

  • most references recommend venlafaxine (Effexor), desvenlafaxine (Pristiq), paroxetine (Paxil, Brisdelle), citalopram (Celexa), and escitalopram (Lexapro) have a similar modest benefit for hot flashes. Most sources seem to favor citalopram as the favorite at a 20mg dose for hot flashes.
  • Gabapentin (Neurontin) is a good option for women who have their hot flashes at night. It is effective when the hot flashes occur in the first four hours of sleep, especially if the hot flashes wake up the woman.

So, as with so many of the herbal preparations there just isn’t a lot of evidence for use of black cohosh.  This drug seems to be safer than most herbal supplements for most of our middle-aged female patients, and for some it might be worth a try. Because of the lack of evidence for black cohosh, it might be best to save the money and turn on the ceiling fan in the bedroom!

Your Thompson Pharmacist is a great resource to help you through these “changing times” for our female patients.  Go ahead and ASK, at Thompson Pharmacy it’s all for YOU!