From the Guidelines
It is not recommended to take black cohosh with oxycodone without medical supervision. The potential interaction between black cohosh and oxycodone can lead to altered effectiveness or increased side effects of oxycodone, as black cohosh may affect liver enzymes that metabolize oxycodone 1. Both substances can cause drowsiness, and combining them might enhance this effect, leading to excessive sedation. Additionally, black cohosh may cause liver problems in some individuals, and oxycodone can strain the liver as well, potentially compounding risks.
When considering the use of opioids like oxycodone, it's crucial to weigh the benefits against the risks, especially given the potential for opioid use disorder, overdose, and other serious harms 1. The CDC clinical practice guideline for prescribing opioids for pain emphasizes the importance of discussing expected benefits, common risks, serious risks, and alternatives to opioids with patients before starting or continuing opioid therapy 1.
Given the potential risks associated with opioid therapy, consulting a healthcare provider before adding any herbal supplements, including black cohosh, to a regimen that includes oxycodone is essential. The healthcare provider can evaluate the patient's specific health situation, current medications, and medical history to determine if the combination is safe. It's also important to follow guidelines for safe opioid use, such as those outlined in the clinical policy for critical issues related to opioids in adult patients presenting to the emergency department 1, and to be aware of the risks of opioid overdose and the role of naloxone in reversing opioid-induced respiratory depression 1.
Key considerations include:
- The potential for black cohosh to interact with oxycodone, affecting its metabolism and increasing the risk of side effects.
- The risk of excessive sedation when combining black cohosh and oxycodone.
- The potential for liver problems with both black cohosh and oxycodone.
- The importance of medical supervision when using opioids and considering the addition of herbal supplements.
- The need for patient education on the risks and benefits of opioid therapy and the safe use of opioids.
From the Research
Safety of Black Cohosh with Oxycodone
- There is limited information available on the interaction between black cohosh and oxycodone 2, 3, 4, 5, 6.
- A study published in 2024 reported a case of serotonin toxicity and rhabdomyolysis in a woman taking black cohosh supplements with dual antidepressant use, highlighting the potential risk of interactions between black cohosh and certain medications 3.
- However, none of the studies provided directly address the safety of taking black cohosh with oxycodone.
- Black cohosh has been reported to have a positive safety profile with low toxicity and few side effects in clinical trials 2, 4, 5, 6.
- It is essential to note that patients should be aware of potential interactions between over-the-counter supplements like black cohosh and prescription medications like oxycodone, and consult with their healthcare provider before taking them together.
Potential Interactions
- Black cohosh may have serotonergic properties, which could potentially interact with other medications that affect serotonin levels, such as certain antidepressants 3.
- Oxycodone, an opioid medication, has a different mechanism of action and is not typically associated with serotonin toxicity.
- However, the lack of direct evidence on the interaction between black cohosh and oxycodone makes it difficult to determine the safety of taking them together.
Recommendations
- Patients taking oxycodone or other prescription medications should consult with their healthcare provider before taking black cohosh supplements 3.
- Healthcare providers should be aware of the potential risks of interactions between black cohosh and other medications, and monitor patients closely for any adverse effects.