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Black Cohosh × Beta-2 Agonists

MODERATE Cyp-Inferred Evidence

Mechanism

Black Cohosh is a moderate inhibitor of CYP3A4, which decreases metabolism of CYP3A4 substrates, potentially increasing their plasma concentrations and risk of adverse effects.

Effect

Increased plasma levels of salmeterol (beta2-agonists), potentially leading to toxicity or enhanced adverse effects.

Management

Monitor for increased adverse effects of salmeterol. Dose reduction may be necessary. Consider alternative supplement or consult healthcare provider.

Plain Language Summary

✨ AI-generated · Qwen 3.6 · grounded in 2 sources · methodology

This combination carries a moderate risk because Black Cohosh can slow down how your body breaks down beta-2 agonists. This may cause the medication to build up in your system, potentially increasing the risk of side effects.

Source

Flockhart CYP450 Table (drug-interactions.medicine.iu.edu)

Research

Supporting Research

[Efficacy of black cohosh extracts for improving low estrogen status induced by postoperative GnRHa treatment in patients with endometriosis: a systematic review]
PMID:32762163 2020
Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause
PMID:28276200 DOI 2017
Suspected black cohosh hepatotoxicity: no evidence by meta-analysis of randomized controlled clinical trials for isopropanolic black cohosh extract
PMID:21228727 DOI 2011
Menopausal symptoms
PMID:19450302 2007
Menopausal symptoms
PMID:21696644 2011
Menopausal symptoms
PMID:21718582 2010
Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis
PMID:37192826 DOI 2023
Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis
PMID:20085176 2010
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Medical Disclaimer: This interaction record is for informational and educational purposes only and does not constitute medical advice. Always consult your healthcare provider or pharmacist before combining any supplement with prescription medications.