| doses of up to 890 mg/ay of cimicifuga racemosa fluid extract have been documented as seeming to be safe (brunton, 1892), "but additional safety testing is necessary in light of its reported effect on respiratory and circulatory systems of animals" (novitch & schweiker, 1982). overdoses may produce nausea with vomiting, and dizziness, and may reduce pulse and induce perspiration (duke, 1985). "occasional gastric problems" are the only noted adverse effects (schaper & brŸmmer 1997). willard (1991) describes a "mild non-violent emetic property" which can cause nausea as well as giddiness and headache in large doses. shengma (mainly c. foetida, c. dahurica) can cause vomiting "due to gastric irritation" (chang & but 1986).
DRUG INTERACTIONS
No specific drug interactions have been identified. Standardized extracts have been used in conjunction with estrogen replacement therapy with no adverse interactions.
PREGNANCY & LACTATION
Pregnancy
Cimicifuga is sometimes used by herbalists in combination with blue cohosh (Caulophyllum thalictroides) to induce and aid labor. There is a recent report of a child born with no spontaneous breathing, who subsequently suffered brain hypoxia and where unknown/unreported doses of a combination of black cohosh and blue cohosh was used to induce labor. The authors of this anecdotal report queried the possible role of the herb in contributing to the infant's initial low APGAR scores (Gunn & Wright 1996) but also raised the question of post-birth resuscitation mis-management. Unfortunately, no indication of dose was given, so conclusions about either herb's toxicity in labor cannot be definitive. The pharmacological contribution of Cimicifuga when used in conjunction with blue cohosh is unknown. However, blue cohosh (Caullophyllum) used alone, was recently implicated in a case of an infant, who suffered possible permanent injury possibly related to the 3rd trimester overdosage use (2X recommended dose for 3 weeks) of blue cohosh by the mother (Jones & Lawson 1998). The use of Cimicifuga (black cohosh) alone does not, at this time, have an established safe dosage range for any indication of use during pregnancy or labor.
An assessment of risks and benefits of use during pregnancy or labor should be undertaken seriously with the assistance of an informed health care provider.
Lactation
Little information exists regarding the use of Cimicifuga species during lactation. No record of adverse effects on lactation, or nursing children have been found (NAPRALERT 1996). No evidence from animal or human study exists regarding the entry of constituents into breastmilk. The documented estrogen-blocking receptor activity of Cimicifuga racemosa (Liske 1998) has as yet unclear implications for lactation, although other herbs with similar phytoestrogenic effects are reputed to promote milk flow. Several studies provide evidence that prolactin levels are not affected with use, however, these studies have been done with non-lactating subjects (Schaper & Brümmer 1997). Ethnobotanical records of use indicate that an infusion of the rhizome was used post-partum by the Iriquois to promote milk flow (Moerman 1986). No current descriptions of use as a lactogogue were found. The German Commission E does not contraindicate its use during lactation.
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