Liver failure associated with  the use of black cohosh for menopausal symptoms

Teschke, Rolf

doi:10.5694/j.1326-5377.2009.tb02293.x

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To the Editor: The case reported by Chow and colleagues of liver failure associated with the use of black cohosh1 requires comment regarding causality. The case has also been the subject of an adverse drug reaction report by the Therapeutic Goods Administration (TGA), and a possible causality has been proposed.2

Division of Gastroenterology and Hepatology, Klinikum Hanau, Hanau, Germany.

Correspondence: rolf_teschke@klinikum-hanau.de

1. Chow ECY, Teo M, Ring JA, Chen JW. Liver failure associated with the use of black cohosh for menopausal symptoms. Med J Aust 2008; 188: 420-422. <MJA full text>
2. Australian Government Department of Health and Ageing Therapeutic Goods Administration. Public case detail for case number 220336, recorded as reported to the Adverse Drug Reactions Unit, 25 July 2006.
3. Saitz R. Clinical practice. Unhealthy alcohol use. N Engl J Med 2005; 352: 596-607.
4. Teschke R, Schwarzenboeck A, Hennermann KH. Kava hepatotoxicity: a clinical survey and critical analysis of 26 suspected cases. Eur J Gastroenterol Hepatol 2008; 20:1182-1193.
5. European Medicines Agency, Committee on Herbal Medicinal Products (HMPC). Assessment of case reports connected to herbal medicinal products containing Cimicifugae racemosae rhizoma (black cohosh, root). London: EMEA, 2007. http://www.emea.europa.eu/pdfs/human/hmpc/26925806en.pdf (accessed Jul 2008).
6. Teschke R, Schwarzenboeck A. Suspected hepatotoxicity by Cimicifugae racemosae rhizoma (black cohosh, root): critical analysis and structured causality assessment. Phytomedicine 2008; doi 10.1016/j.phymed.2080.09.009.

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