II. Mechanism

  1. Native North American plant
  2. Plant root contains Estrogenic steroids
    1. Triterpene glycosides (acetin, cimicifugoside)
    2. Isoflavonoid formononetin
  3. Effects
    1. Weak Estrogenic effects
      1. Some studies suggest no effect on Uterus or vagina
    2. Anti-Estrogen effects
      1. Anti-proliferative effects on Breast Cancer cells
    3. Decreases leuteinizing Hormone (LH) levels
    4. Oxytocin-like effect in pregnancy (contractions)

III. Indications: Current Use

  1. Menopausal symptoms
    1. Post-menopausal Hot Flushes
    2. Insomnia
    3. Mood disturbance
  2. Dysmenorrhea

IV. Contraindications

  1. Pregnancy (due to uterine contractions)
  2. Use caution if risk factors for Breast Cancer
    1. Black Cohosh has unclear effect on Breast Cancer risk

V. Efficacy

  1. No rigorous RCT studies to show efficacy to date

VI. Adverse Effects

  1. Gastrointestinal intolerance (Nausea, discomfort)
  2. Headache
  3. Dizziness
  4. Weight gain

VII. Drug Interactions

  1. No CYP enzyme or P-Glycoprotein interactions
  2. OATP2B1 Interactions that reduce efficacy of affected medications
    1. Amiodarone
    2. Fexofenadine
    3. Glyburide
    4. Statins

VIII. Cost

  1. Monthly: $12 to $30

IX. Dosing

  1. Remifemin (Standardized 1 mg terpene per 20 mg tablet)
    1. Typical dose: Two 20 mg tablets bid
    2. Effects anticipated at 2-4 weeks after starting

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