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Black cohosh is a botanical product commonly used to treat menopausal symptoms, although its efficacy is unproven (JW Womens Health Feb 1 2007 and Mar 6 2008). In response to questions about whether black cohosh might be associated with liver toxicity, an Expert Committee of the U.S. Pharmacopeia (USP) analyzed 30 international adverse effects reports (AERs) of liver damage in black cohosh users.
Black cohosh formulations and doses ranged widely, from 20 mg of extract to 1500 mg of root, but all were within the recommended range. The AERs were rated with the Naranjo causality algorithm, which takes into account several perspectives: timing of substance use and adverse effect, existence of possible alternative causes, objective confirmation, …