title: Black cohosh and liver toxicity: is there a relationship?
abstract: Herbal supplements are commonly used by patients for various problems. It is a well-known fact that most patients do not tell their physicians about the use of herbal supplements unless they are specifically asked. As a result, sometimes important information regarding drug side effects is missed in history taking. During our literature search, we found several retrospective studies and other meta-analyses that claim a lacking or weak link between black cohosh use and hepatotoxicity. We present a case of a 44-year-old female who developed subacute liver injury demonstrated on a CT scan and liver biopsy within a month of using the drug to resolve her hot flashes and discuss a possible temporal and causal association between black cohosh use and liver disease. Since the patient was not taking any other drugs, we concluded that the acute liver injury was caused by the use of black cohosh. We agree with the United States Pharmacopeia recommendations that a cautionary warning about hepatotoxicity should be labeled on the drug package.
authors.affiliation: Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73112, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Muqeet Adnan
authors.affiliation: Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73112, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Khan
authors.affiliation: Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73112, USA.
authors.forename: Syed
authors.initials: S
authors.lastname: Hashmi
authors.affiliation: Dow Medical College, Karachi 74200, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Hamza
authors.affiliation: University of Illinois at Chicago, Chicago, IL 60680, USA.
authors.forename: Sufyan
authors.initials: S
authors.lastname: AbdulMujeeb
authors.affiliation: Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
authors.forename: Syed
authors.initials: S
authors.lastname: Amer
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