Research: MINCIULLO and colleagues,

Listed in Issue 127


MINCIULLO and colleagues, Department of Human Pathology, Division and School of Allergy and Clinical Immunology, University of Messina, Italy, have described muscle damage induced by black cohosh.


Extracts of black cohosh (Cimicifuga racemosa) are commonly used for the treatment of symptoms associated with menopause. Adverse events with black cohosh are rare, mild and reversible. A few number of serious adverse events, including hepatic and circulatory conditions, have been also reported, but without a clear causality relationship.


This study reports the case of a woman with severe asthenia and very high blood levels of creatine phosphokinase and lactate dehydrogenase. The patient was taking a dietary supplement derived from black cohosh for menopausal symptoms. To exclude a possible involvement of this product, it was suggested to the patient to discontinue this therapy.


After the patient stopped taking the supplement, she showed a progressive normalization of biochemical parameters and improvement of clinical symptoms. The study hypothesizes a causative role for black cohosh in the muscle damage. Factors suggesting an association between black cohosh and the observed myopathy included the temporal relationship between use of herbal product and asthenia and the absence of other identified causative factors. Re-challenge with the suspected agent was inadvisable for ethical reasons because of the risk of a serious relapse.


This is the first time that muscle damage associated with black cohosh has been reported. It is thought to be of interest because of the widespread use of black cohosh as an alternative medicine for menopausal symptoms.


Minciullo PL, Saija A, Patafi M, Marotta G, Ferlazzo B, Gangemi S. Muscle damage induced by black cohosh (Cimicifuga racemosa). Phytomedicine 13 (1-2): 115-118, Jan 2006.

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