II. Mechanism

  1. Native North American plant
  2. Plant root contains Estrogenic steroids
    1. Triterpene glycosides (acetin, cimicifugoside)
    2. Isoflavonoid formononetin
  3. Effects
    1. Weak Estrogenic effects
      1. Some studies suggest no effect on Uterus or vagina
    2. Anti-Estrogen effects
      1. Anti-proliferative effects on Breast Cancer cells
    3. Decreases leuteinizing hormone (LH) levels
    4. Oxytocin-like effect in pregnancy (contractions)

III. Indications: Current Use

  1. Menopausal symptoms
    1. Post-menopausal Hot Flushes
    2. Insomnia
    3. Mood disturbance
  2. Dysmenorrhea

IV. Contraindications

  1. Pregnancy (due to uterine contractions)
  2. Use caution if risk factors for Breast Cancer
    1. Black Cohosh has unclear effect on Breast Cancer risk

V. Efficacy

  1. No rigorous RCT studies to show efficacy to date

VI. Adverse Effects

  1. Gastrointestinal intolerance (Nausea, discomfort)
  2. Headache
  3. Dizziness
  4. Weight gain

VII. Drug Interactions

  1. No CYP enzyme or P-Glycoprotein interactions
  2. OATP2B1 Interactions that reduce efficacy of affected medications
    1. Amiodarone
    2. Fexofenadine
    3. Glyburide
    4. Statins

VIII. Cost

  1. Monthly: $12 to $30

IX. Dosing

  1. Remifemin (Standardized 1 mg terpene per 20 mg tablet)
    1. Typical dose: Two 20 mg tablets bid
    2. Effects anticipated at 2-4 weeks after starting

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Ontology: Remifemin (C0650355)

Concepts Pharmacologic Substance (T121) , Biologically Active Substance (T123) , Organic Chemical (T109)
MSH C073419
English Remifemin, remifemin

Ontology: Black Cohosh Extract (C0771967)

Definition (NCI) A triterpene-containing herb isolated from the roots and rhizomes of the plant Cimicifuga racemosa (also known as Actaea racemosa). While the mechanism of action of black cohosh is not completely understood, it appears to act as a selective estrogen receptor modulator. In vitro, this preparation has been shown to induce cell cycle arrest and caspase-dependent apoptosis of estrogen-sensitive breast cancer cells. (NCI04)
Definition (NCI_NCI-GLOSS) An eastern North American perennial herb. A substance obtained from the root of the plant has been used in some cultures to treat a number of medical problems. It is being studied in the treatment of hot flashes and other symptoms of menopause. The scientific name is Cimicifuga racemosa.
Definition (PDQ) A triterpene-containing herb isolated from the roots and rhizomes of the plant Cimicifuga racemosa (also known as Actaea racemosa). While the mechanism of action of black cohosh is not completely understood, it appears to act as a selective estrogen receptor modulator. In vitro, this preparation has been shown to induce cell cycle arrest and caspase-dependent apoptosis of estrogen-sensitive breast cancer cells. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=302635&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=302635&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C26647" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
SnomedCT 412588001, 412589009
English Black cohosh, black cohosh (medication), BLACK COHOSH, cimicifuga racemosa, black cohosh extract, Black Cohosh Extract, black cohosh, Cimicifuga racemosa Root, Cimicifugae racemosae Rhizoma, Fariy Candle Root, Actaea racemosa Root, Black Cohosh, bugbane, black snakeroot, bugwort, rattlesnake root, Cimicifuga racemosa extract (substance), Cimicifuga racemosa extract, Cimicifuga racemosa preparation (product), Cimicifuga racemosa preparation, Black cohosh extract, Black cohosh preparation, BLACK COHOSH EXTRACT
Spanish extracto de raíz de culebra negra, extracto de cimicífuga, Cimicifuga racemosa, Cimicifuga racemosa (producto), preparación con Cimicifuga racemosa (producto), preparación con Cimicifuga racemosa, extracto de Cimicifuga racemosa (sustancia), extracto de Cimicifuga racemosa

Ontology: Cimicifuga racemosa (C0885226)

Definition (ALT) Black cohosh root.
Concepts Plant (T002)
MSH D031885
Portuguese Cimifuga, Raiz-Cascavel, Raiz-Preta-de-Cobra
Czech Cimicifuga racemosa, ploštičník hroznovitý, ploštičník hroznatý
German Trauben-Silberkerze, Silberkerze, Trauben-, Wanzenkraut
French Cimicifuge noire, Cimicaire en grappes, Cimicifuga racemosa, Actée à grappes noires, Actaea racemosa
English Bugbanes, Black, racemosa, Actaea, racemosas, Actaea, Black Cohoshs, Cimicifuga racemosas, Actaea racemosas, racemosa, Cimicifuga, Black Bugbanes, Cohoshs, Black, racemosas, Cimicifuga, Black Bugbane, Cimicifuga racemosa (L.) Nutt., Actaea racemosa L., cimicifuga racemosa, black cohosh, Cimicifuga racemosa, Actaea racemosa, Bugbane, Black, Cohosh, Black, Black Cohosh, Cimicifuga racemosa / black cohosh root, cimicifuga racemosa/black co
Italian Actaea racemosa, Cimicifuga racemosa, Estratto nero di Cohosh
Norwegian Klaseormedrue, Cimicifuga racemosa, Actaea racemosa
Dutch Kaars, zilver-, Zilverkaars
Spanish Bugbane Negra, Cohosh Negra, Cimifuga