Blue cohosh is derived from the aerial parts of the plant, its roots, and its rhizomes. Pharmacologic effects are attributed to several glycosides and alkaloids, such as caulosaponin and methylcytisine. Caulosaponin is responsible for the herb's oxytocic effects and its effects on coronary vasculature as well as its ability to stimulate intestinal contractions. Methylcytisine produces nicotinic effects; for example, it elevates blood pressure and blood glucose level, stimulates respiration, and increases peristalsis. Blue cohosh is available as capsules, decoction, dried powder, liquid extract, tablets, tea, and tincture.

Benefits And Uses of Blue Cohosh

Blue cohosh is used to treat colic, sore throat, cramps, hiccups, epilepsy, urinary tract infections, inflammation of the uterus, asthma, memory problems, hypertension, muscle spasms, worm infestation, anxiety, restlessness and pain during pregnancy, and labor pains. It's used to stimulate uterine contractions and induce menstruation, and as an antispasmodic, antirheumatic, diaphoretic, expectorant, and laxative.

Blue cohosh may also have some antimicrobial activity. Low doses of the extract may inhibit ovulation. The roasted seeds of the herb are commonly used as a coffee substitute.

Administration

Dried rhizome or root: 0.3 to 1 g by mouth three times a day .

Tea: 1 cup three times a day; prepared by steeping herb in 5 oz of boiling water, then straining .

Liquid extract 0:1 in 70% alcohol): 0.5 to 1 ml by mouth three times a day.

Clinical considerations

In the past blue cohosh has been listed as a drug in the USP and the National Formulary; however, because of serious safety concerns, its use isn't recommended.

The root of this herb can be toxic, and the danger associated with its use seems to outweigh the reported medicinal benefits.

Don't confuse blue cohosh with black cohosh.

Monitor patient's blood pressure and blood glucose, blood urea nitrogen, uric acid, and protein bound iodine levels. . Monitor patient for signs and symptoms of overdose, which resemble those of nicotine toxicity. If overdose occurs, perform gastric lavage or induce vomiting, if needed.

Warn patient to avoid using blue cohosh during pregnancy, labor, and breast- feeding.

Tell patient to remind prescriber and pharmacist of any herbal or dietary supplement that he's taking when obtaining a new prescription.

Advise patient to consult his health care provider before using an herbal preparation because a treatment with proven efficacy may be available.

Research summary

There is virtually no credible evidence that blue cohosh is effective for any of the conditions for which it has been used. Several published reports cite cases of serious adverse effects in infants, apparently caused by blue cohosh.