Suspected black cohosh hepatotoxicity

Naser, Belal; Schnitker, J; Minkin, Mary Jane; Arriba, Susana Garcia de; Nolte, Klaus-Ulrich; Osmers, R.

doi:10.1097/gme.0b013e3181fcb2a6

Cited by 76 publications

(24 citation statements)

References 52 publications

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“…Remarkable improvement in the liver function after stopping the drug clearly demonstrates that there is a causal relationship. Our evidence may not be as strong as that which is presented by Teschke et al, Firenzouli et al, or Naser et al [3, 10, 12], but we have supporting case reports, such as those found in the paper published by Lim et al, in which black cohosh is described as causing fulminant hepatic failure to the extent that the patient needed transplantation [4]. The essence of this paper is to not discourage the use of black cohosh but to serve as a warning for patients to use it with caution, especially those who are prone to develop liver diseases.…”

Section: Discussioncontrasting

confidence: 88%

“…Teschke et al have reported about 69 cases of hepatotoxicity from black cohosh in their paper and say that the evidence of a causal relationship is weak, even nonexistent [10]. Multiple retrospective studies, prospective studies, and meta-analyses done in the past by Teschke et al, Firenzouli et al, and Naser et al claim that they found a lack of evidence demonstrating causality between black cohosh and liver injury [3, 10–12]. In their retrospective studies, they all claim either weak or insufficient evidence of black cohosh use causing hepatotoxicity.…”

Section: Discussionmentioning

confidence: 99%

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Black Cohosh and Liver Toxicity: Is There a Relationship?

Adnan

Khan

Hashmi

et al. 2014

Case Reports in Gastrointestinal Medicine

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Herbal supplements are commonly used by patients for various problems. It is a well-known fact that most patients do not tell their physicians about the use of herbal supplements unless they are specifically asked. As a result, sometimes important information regarding drug side effects is missed in history taking. During our literature search, we found several retrospective studies and other meta-analyses that claim a lacking or weak link between black cohosh use and hepatotoxicity. We present a case of a 44-year-old female who developed subacute liver injury demonstrated on a CT scan and liver biopsy within a month of using the drug to resolve her hot flashes and discuss a possible temporal and causal association between black cohosh use and liver disease. Since the patient was not taking any other drugs, we concluded that the acute liver injury was caused by the use of black cohosh. We agree with the United States Pharmacopeia recommendations that a cautionary warning about hepatotoxicity should be labeled on the drug package.

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Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Black Cohosh and Liver Toxicity: Is There a Relationship?

Adnan

Khan

Hashmi

et al. 2014

Case Reports in Gastrointestinal Medicine

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“…In 2006 EMEA published a warning advising against unrestricted use of Black cohosh (37). Recently a meta-analysis of RCT's on black cohosh showed no evidence of hepatotoxicity (38). Since CAM remedies are not regulated as drugs they can be bought over the counter in pharmacies and convenience stores, without prescription and information about adverse effects, which may lead to a false sense of safety (19).…”

Section: Discussionmentioning

confidence: 99%

Hot flushes, hormone therapy and alternative treatments: 30 years of experience from Sweden

et al. 2014

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Objectives The use of hormone therapy (HT) for hot flushes has changed dramatically over the past five decades.In this cross-sectional questionnaire study, the aim was to describe the use of HT and alternative treatments and to study the frequency of hot flushes. A further aim was to compare data from the present questionnaire with data from previous studies made in the same geographic area.Method A questionnaire was sent to a random sample of 2,000 women aged 47-56 years living in Östergötland County, Sweden. The results were compared with findings from previous studies regarding use of HT, alternative treatment and hot flushes, and the number of HT prescriptions dispensed during the corresponding time using data derived from the Swedish Prescribed Drug Registry. ResultsThe response rate was 66%. Six percent used HT, in line with prevalence data from the Swedish Prescribed Drug Registry. Alternative treatments were used by 10%. About 70% of postmenopausal women reported flushes and almost one third of those with flushes stated that they would be positive to HT if therapy could be shown to be harmless, a view more often stated by women with severe complaints of hot flushes (67%). ConclusionThe use of HT and alternative treatments is low and many women suffer from flushes that could be treated. Women considered their knowledge of the climacteric period and treatment options as insufficient. Individualized information should be given and women with significant climacteric complaints, without contraindications, should be given the opportunity to try HT.3

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“…A rigorous analysis of these cases showed only possible causality, and not probable or certain causality (Mahady et al, 2008;Teschke and Schwarzenboeck, 2009). Also, a meta-analysis of randomized controlled clinical trials for isopropanolic CR extract on 1020 women found no evidence of CR hepatotoxicity (Naser et al, 2011). Isolated cases of reversible complete heart block (McKenzie and Rahman, 2010), muscle damage were also reported (Minciullo et al, 2006), but only temporal relationship and the absence of other identified causal factors were invoked to support these claims.…”

Section: Safetymentioning

confidence: 76%

Osteoprotective Medicinal Plants - Part 1 (A Human Clinical Evidence-Based Review)

Dragoș¹,

Gîlcă²,

Găman³

et al. 2017

Afr J Tradit Complement Altern Med

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Background. Osteoporosis is a bone metabolic disease affecting a large percentage of aging population, which leads to an increased risk of fractures and has a negative impact on life quality. The available treatments for osteoporosis are effective, but are associated with several severe adverse reactions, hence the interest for alternative treatments devoid of such redoubtable side effects. Medicinal plants represent a viable resource for new therapeutic agents. The purpose of this review is to provide an overview about the medicinal plants that have been reported to have antiosteoporotic effects in human clinical studies. Materials and Methods. Relevant studies found in PubMed database, pertaining to efficacy in humans, mechanism of action, osteoactive phytochemicals and safety, were selected. For the inquiry, keywords such as "medicinal plant", "osteoporosis", "bone", "fracture", "osteoclast" and "osteoblast" were used in various combinations. The information extracted was integrated with the traditional knowledge on the correspondent medicinal plants. List of abbreviations: BMD-bone mineral density; CQ-Cissus quadrangularis; CR-Cimicifuga racemose; ESEleutherococcus senticosus; IGF-insulin like growth factor; OPG-osteoprotegerin; OVX-M -ovariectomized mice; OVX-R-ovariectomized rats; PC -Pueraria candollei; PL -Pueraria lobate; PN-Panax notoginseng; RANK-receptor activator of NF-kB; RANKL-receptor activator of NF-kB ligand; ROS -reactive oxygen species; Runx 2-runt related transcription factor 2; SM-Salvia milthiorriza Results. Eight medicinal plants (Cimicifuga racemosa, IntroductionOsteoporosis and osteopenia (low bone density) are bone metabolic diseases affecting a large percentage of aging population, increasing the risk of fractures and having a negative impact on quality of life patients. Risk factors for osteoporosis are: hormonal related risk factors (menopausal and andropausal hormonal disturbances, early menopause, Article HistoryReceived: Jan. 5, 2017. Revised Received: Apr. 7, 2017. Accepted Apr. 12, 2017. Published Online: Nov. 15, 2017 103 hyperparathyroidism, hyperthyroidism), environmental related risk factors (e.g. dioxin-related compounds, heavy metals), nutrition-related risk factors (vitamin D, calcium deficiencies), lifestyle related risk factors (e.g. smoking, sedentarism), drugs (corticosteroids, anticonvulsants, aromatase inhibitors, gonadotropin-releasing hormone agonists), advanced age, female gender (Gonzalez-Macias et al., 2015;Paunescu et al., 2013;Rzymski et al., 2015).Osteoporosis is caused by disturbances of bone remodeling process. The bone tissue is undergoing permanent build-up by osteoblasts and breakdown by osteoclasts. A good dynamic balance between the osteoblastogenesis and osteoclastogenesis is the key for a bone matrix of a high quality. The disbalance occurs especially when the breakdown process overwhelms the building process, being triggered by the risk factors (Leung and Siu, 2013).There are several factors important for osteoblastogenesis, such as run...

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Suspected black cohosh hepatotoxicity

Abstract: The results of this meta-analysis of five randomized, double-blind, and controlled clinical trials showed no evidence that iCR has any adverse effect on liver function.

Cited by 76 publications

References 52 publications

Black Cohosh and Liver Toxicity: Is There a Relationship?

Black Cohosh and Liver Toxicity: Is There a Relationship?

Hot flushes, hormone therapy and alternative treatments: 30 years of experience from Sweden

Osteoprotective Medicinal Plants - Part 1 (A Human Clinical Evidence-Based Review)

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