Black cohosh appears to have a relatively small overall interaction risk, but laboratory evidence raises questions about tamoxifen, some chemotherapy medicines, simvastatin, and CYP3A4 substrates. Clinical relevance is not established for several of these findings.

Use with caution. Healthcare professional review recommended before use.

Contraindications

Pregnancy or breastfeeding
Active liver disease without medical guidance

Cautions

Rare but sometimes serious liver injury has been reported, although causation and product identity are uncertain.
Use in people with hormone-sensitive breast or uterine conditions remains uncertain.
Commercial products may contain the wrong herb or undeclared mixtures.

Drug Interactions

Drug Class / Substrate	Mechanism	Severity	Source
Tamoxifen	Laboratory findings suggest possible interference with tamoxifen action. Clinical relevance is not known.	Uncertain	Memorial Sloan Kettering About Herbs
Doxorubicin and docetaxel	Preclinical data suggest possible increased toxicity. Clinical significance is not established.	Uncertain	Memorial Sloan Kettering About Herbs
Simvastatin and other statins	Preliminary laboratory research suggests altered statin activity or adverse-effect risk.	Uncertain	NCCIH Menopausal Symptoms
CYP3A4 substrate medicines	Laboratory data suggest possible altered metabolism, but clinical relevance is not known.	Uncertain	Memorial Sloan Kettering About Herbs

Pregnancy

Not recommended during pregnancy. Consult a qualified healthcare provider before any use.

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before using herbal medicines, especially if you take prescription medications.