Black cohosh warning highlights need for doctor awareness

By Jess Halliday

- Last updated on GMT

Related tags Black cohosh Medicine Alternative medicine

This week's warnings on the black cohosh and potential liver damage
may be the first time many general practitioners have heard of the
herbal, says complementary health expert, underscoring the need for
doctors to be aware of alternative medicine.

Black cohosh (referred to by the European Medicines Agency, or EMEA, as Cimicifugae racemosae rhizoma​) is a member of the buttercup family, and is a perennial plant native to North America. It has a long history of use for by women to reduce menopausal symptoms such as hot flushes.

The UK's Medicines and Healthcare Products Regulatory Agency (MHRA) said on Tuesday that is introducing voluntary warning labels for black cohosh following a review of safety data, and the European Medicines Agency (EMEA) advised patients to inform their doctors if they are taking it - and doctors, in turn, to ask their patients if they are taking it.

"The question is, do doctors know about black cohosh?" Professor Edzard Ernst, director of complementary medicine at the Peninsula Medical School, Universities of Exeter & Plymouth, told

"Many may only be aware of its use as a medicinal as a result of this statement. This highlights the need for doctors to get to grips with herbal medicine, and be aware of the essential knowledge."

A report published last year in the New England Journal of Medicine held that use of herbal medicines in the UK is amongst the lowest in Europe, and few GPs prescribe them.

At the other end of the scale German health insurance providers reimbursed US$283m (c €223m) for prescriptions of ginko, St John's wort, mistletoe, saw palmetto, ivy, hawthorn, stinging nettle root, myrtol, phytosterols and curcurbita in 2003.

French insurers paid out $91m (€72m) in partial reimbursements for ginko, saw palmetto and pygeum, with a total value of $196m (€155m).

Almost $5bn (€3.9bn) (at manufacturers' prices to wholesalers) was spent on over-the-counter herbal medicines in all European countries in 2003.

Scientists on both sides of the Atlantic have repeatedly stressed the need for more communication and awareness of herbs amongst doctors, since there is evidence that some may interact with certain prescription drugs, with potentially dangerous consequences.

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