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    United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity

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    Authors
    Mahady, Gail B.
    Low Dog, Tieraona
    Barrett, Marilyn L.
    Chavez, Mary L.
    Gardiner, Paula
    Ko, Richard
    Marles, Robin J.
    Pellicore, Linda S.
    Giancaspro, Gabriel I.
    Sarma, Dandapantula N.
    UMass Chan Affiliations
    Department of Family Medicine and Community Health
    Center for Integrated Primary Care
    Document Type
    Journal Article
    Publication Date
    2008-07-01
    Keywords
    Alternative and Complementary Medicine
    Dietetics and Clinical Nutrition
    Integrative Medicine
    Patient Safety
    Public Health
    Reproductive and Urinary Physiology
    
    Metadata
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    Link to Full Text
    https://doi.org/10.1097/gme.0b013e31816054bf
    Abstract
    OBJECTIVE: Black cohosh [Actaea racemosa L., formerly Cimicifuga racemosa (L.) Nutt.] is a botanical used mainly for the management of menopausal symptoms. Recently, regulatory agencies in Australia, Canada, and the European Union have released statements regarding the "potential association" between black cohosh and hepatotoxicity. In response, the Dietary Supplement Information Expert Committee of the US Pharmacopeia's Council of Experts reviewed safety information for black cohosh products. DESIGN: The Expert Committee analyzed information from human clinical case reports, adverse event reports, animal pharmacological and toxicological data, historical use, regulatory status, and contemporaneous extent of use. Reports were obtained from diverse sources, including the European Medicines Agency, Health Canada, the Australian Therapeutic Goods Administration, and the US Food and Drug Administration. Case reports pertaining to liver damage were evaluated according to the Naranjo causality algorithm scale. RESULTS: Thirty nonduplicate reports on use of black cohosh products concerning liver damage were analyzed. All the reports of liver damage were assigned possible causality, and none were probable or certain causality. The clinical pharmacokinetic and animal toxicological information did not reveal unfavorable information about black cohosh. CONCLUSIONS: Based on this safety review, the Dietary Supplement Information Expert Committee determined that black cohosh products should be labeled to include a cautionary statement. This is a change from the Expert Committee's decision of 2002, which required no such statement. With this decision, the US Pharmacopeia's Botanical Expert Committee may develop monographs for black cohosh, and the US Pharmacopeia may offer its verification programs to dietary supplement ingredient and product manufacturers.
    Source

    Menopause. 2008 Jul-Aug;15(4 Pt 1):628-38. doi: 10.1097/gme.0b013e31816054bf. Link to article on publisher's site

    DOI
    10.1097/gme.0b013e31816054bf
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/26830
    PubMed ID
    18340277
    Notes

    At the time of publication, Paula Gardiner was not yet affiliated with the University of Massachusetts Medical School.

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    ae974a485f413a2113503eed53cd6c53
    10.1097/gme.0b013e31816054bf
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