Note: Blue cohosh (Caulophyllum thalictroides) should not be confused with black cohosh (Cimicifuga racemosa), an over-the-counter herbal supplement sold as a menopause and menstrual remedy.
Background
Blue cohosh has been used for hundreds of years primarily to help women in the area of childbirth. It was used as a medicinal herb by Native American women to facilitate labor. Today, the herb is most commonly used to stimulate labor and to ease the effects of childbirth.
Modern herbalists often recommend blue cohosh as an emmenagogue to induce menstruation, and as a uterine stimulant and antispasmodic. It is also frequently employed as a diuretic to eliminate excess fluids, as an expectorant to treat congestion, and as a diaphoretic to eliminate toxins by inducing sweating. Traditional herbalists will often combine blue cohosh and black cohosh to effect a more balanced treatment for nerves and to enhance the herbs' antispasmodic effects. Blue cohosh is combined with other herbs to promote their effects in treating bronchitis, nervous disorders, urinary tract ailments, and rheumatism. Blue cohosh is also thought to help pelvic inflammatory disease, endometriosis, erratic menstruation, and retained placenta. In addition, the herb is also believed to relieve ovarian neuralgia (nerve pain).
Although blue cohosh has been indicated for many conditions, all indications lack sufficient scientific data to support their efficacy and safety at this time. More research is needed in these areas before firm conclusions can be drawn.
Evidence
DISCLAIMER:
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Tradition
WARNING:
DISCLAIMER:
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below. Abortifacient (induces abortion), amenorrhea (absence of menstruation), anti-inflammatory, antipyretic (reduces fever), antispasmodic, arthritis, bronchitis, cervical dysplasia (abnormal, possible pre-cancerous cells), colic in children, contraception, cramps, demulcent (soothes inflammation)t, deobstruent, diaphoretic (induces sweating), diuretic, earache, endometriosis, epilepsy, expectorant (expels phlegm), gastric disorders, genitourinary disorders, hormonal imbalances, inflammatory conditions, labor induction, labor pain, laxative, leukorrhea (vaginal discharge), liver cancer, menstruation irregularities, muscle weakness, nervous disorders, neuralgia (nerve pain), pain (pregnancy), pelvic inflammatory disease, pregnancy, rheumatic pain, sexually transmitted disease (chlamydia), uterine inflammation, uterine stimulant, vaginitis (inflammation of vagina).
Dosing
Adults (18 years and older)
Based on available scientific evidence, there is no proven safe or effective dose for blue cohosh. As a decoction, 4 grams twice daily or 1-3 grams every three to four hours has been used. As a fluid extract, 0.5-1.0 milliiliter (1:1 in 70% alcohol) three times daily as a preparation for pregnancy has been used. As an infusion/tea, 2-4 fluid ounces (1oz root to 1 pint boiling water) two to four times daily has been used. Also, 300-1,000 milligrams of the dried whole herb up to three times daily has been used.
Children (younger than 18 years)
There is not enough scientific evidence to safely recommend the use of blue cohosh in children.
Safety
DISCLAIMER:
Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.
Allergies
Avoid in individuals with a known allergy or sensitivity to blue cohosh (Caulophyllum thalictroides), any of its constituents, or members of the Berberidaceae family.
Side Effects and Warnings
One commonly reported effect of blue cohosh is its uterine-stimulating effects, which may be viewed as a desirable effect when used to induce labor, but an adverse effect when used for other purposes during pregnancy.
Other adverse effects of blue cohosh may include nausea, vomiting, abdominal pain, and cardiotoxic effects on the fetus (when used in pregnant women). Myocardial infarction (heart attack), congestive heart failure, shock, and myocardial toxicity have also been reported.
Strokes and seizures have been documented in infants whose mother ingested blue cohosh during pregnancy.
Due to nicotinic effects of the constituent N-methylcytisine, blue cohosh could cause dilated pupils, hyperventilation, nystagmus (involuntary, alternating, rapid and slow movements of the eyeballs), thirst, hyperthermia, seizures, hyper- or hypotension (high or low blood pressure), chest pain, tachycardia (fast heart rate), irregular pulse, or coma.
Blue cohosh may cause hyperglycemia (increased blood sugar levels) and anemia in infants following maternal use.
Patients who smoke or are quitting smoking, and those with diabetes should use blue cohosh cautiously and consult with a qualified healthcare professional, including a pharmacist.
Pregnancy and Breastfeeding
Pregnancy: Although there is conflicting evidence about the use of blue cohosh during pregnancy, it has traditionally been used to induce labor or abortion. The use of blue cohosh to induce abortion has been associated with adverse effects in the mother and/or fetus. There have been reports of cardiotoxicity in the newborn infants of the mothers who ingested blue cohosh; the resulting adverse effects included congestive heart failure, myocardial infarction (heart attack) or toxicity, stroke, and shock. Use of blue cohosh during pregnancy to stimulate the uterus in order to ease the effects of labor should only be used under medical supervision.
Breastfeeding: Blue cohosh is not recommended in breastfeeding women due to a lack of available scientific evidence.
Interactions
Interactions with Drugs
Blue cohosh may increase blood glucose levels. Caution is advised when using medications that may lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional. Medication adjustments may be necessary.
Blue cohosh may have antispasmodic effects. Individuals using blue cohosh with other drugs with antispasmodic effects should consult with a qualified healthcare professional, including a pharmacist.
Blue cohosh may cause coronary vasoconstriction (decreased blood flow due to constriction of blood vessels), tachycardia (increased heart rate), and possible increases in blood pressure. Individuals taking medications that affect heart rate or blood pressure should consult with a qualified healthcare professional, including a pharmacist.
A constituent of blue cohosh, methylcytisine, is similar to nicotine and may lead to nicotinic toxicity. Caution is advised in patients who smoke or use other products containing nicotine.
Blue cohosh may induce labor and should not be used with oxytocin (Pitocin ®).
Interactions with Herbs and Dietary Supplements
Blue cohosh may have antispasmodic effects. Individuals using blue cohosh with other herbs or supplements with antispasmodic effects should consult with a qualified healthcare professional, including a pharmacist.
Blue cohosh may cause coronary vasoconstriction, tachycardia, and possible increases in blood pressure. Individuals taking herbs and supplements that affect heart rate or blood pressure should consult with a qualified healthcare professional, including a pharmacist.
Blue cohosh may increase blood glucose levels. Caution is advised when using herbs or supplements that may alter blood sugar. Caution is advised.
Blue cohosh may induce labor and caution is advised when taking blue cohosh with other herbs and supplements that have labor-inducing effects.
A constituent of blue cohosh, methylcytisine, is similar to nicotine and may lead to nicotinic toxicity. Caution is advised in patients who smoke or use other products containing nicotine.
Attribution
This patient information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): James Ceurvels, PharmD (Northeastern University); Jessica Clubb, PharmD (Northeastern University); Molly Davis, PharmD (University of Rhode Island); Nicole Giese, MS (Natural Standard Research Collaboration); Juliann Goodfriend, PharmD (Northeastern University); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Wendy Weissner, BA (Natural Standard Research Collaboration).
Bibliography
DISCLAIMER:
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
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Edmunds J. Blue cohosh and newborn myocardial infarction? Midwifery Today Int.Midwife. 1999;(52):34-35.
Finkel RS, Zarlengo KM. Blue cohosh and perinatal stroke. N.Engl.J.Med. 7-15-2004;351(3):302-303.
Ganzera M, Dharmaratne HR, Nanayakkara NP, et al. Determination of saponins and alkaloids in Caulophyllum thalictroides (blue cohosh) by high-performance liquid chromatography and evaporative light scattering detection. Phytochem.Anal. 2003;14(1):1-7.
Gunn TR, Wright IM. The use of black and blue cohosh in labour. N.Z.Med.J. 10-25-1996;109(1032):410-411.
Jhoo JW, Sang S, He K, et al. Characterization of the triterpene saponins of the roots and rhizomes of blue cohosh (Caulophyllum thalictroides). J.Agric.Food Chem. 2001;49(12):5969-5974.
Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. J.Pediatr. 1998;132(3 Pt 1):550-552.
Kennelly EJ, Flynn TJ, Mazzola EP, et al. Detecting potential teratogenic alkaloids from blue cohosh rhizomes using an in vitro rat embryo culture. J.Nat.Prod. 1999;62(10):1385-1389.
Lin LT, Liu LT, Chiang LC, et al. In vitro anti-hepatoma activity of fifteen natural medicines from Canada. Phytother Res 2002;16(5):440-444.
Low DT. Blue cohosh and neonatal myocardial toxicity. Journal of the American Herbalists Guild 2001;2(2):9-10.
McFarlin BL, Gibson MH, O'Rear J, et al. A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice. J.Nurse Midwifery 1999;44(3):205-216.
Rao RB, Hoffman RS. Nicotinic toxicity from tincture of blue cohosh (Caulophyllum thalictroides) used as an abortifacient. Vet.Hum.Toxicol. 2002;44(4):221-222.
Reichert R. Neonatal congestive heart failure associated with maternal use of blue cohosh. Quarterly Review of Natural Medicine 1998;Winter:265-267.
Scott CC, Chen KK. The pharmacological action of n-methylcytisine. The Journal of Pharmacology and Experimental Therapuetics 1943;79:334-339.
Remember, keep this and all other medicines out of the reach of children,
never share your medicines with others, and use this medication only for the indication prescribed.
