Is it safe to use black cohosh with paroxetine (Selective Serotonin Reuptake Inhibitor - SSRI)?

From the Guidelines

Using black cohosh while taking paroxetine is not recommended due to potential interactions and increased risk of serotonin syndrome, and patients should consult their healthcare provider before combining these medications. The combination of black cohosh and paroxetine may increase the risk of serotonin syndrome, a potentially serious condition characterized by agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, and in severe cases, seizures or loss of consciousness 1. Black cohosh contains compounds that may interact with the liver enzymes that metabolize paroxetine, potentially altering its effectiveness or increasing side effects.

Some key considerations when evaluating the safety of combining black cohosh and paroxetine include:

• The potential for increased risk of serotonin syndrome, which can be life-threatening 1
• The potential for black cohosh to interact with the liver enzymes that metabolize paroxetine, potentially altering its effectiveness or increasing side effects 1
• The lack of established safety of black cohosh in patients taking SSRIs, such as paroxetine 1
• The potential for black cohosh to cause liver failure, which has been reported in several cases 1

Given these considerations, it is essential for patients to consult their healthcare provider before combining black cohosh and paroxetine, as they can evaluate the patient's specific health situation and medication regimen to determine if this combination is appropriate. Some patients may be able to use both under careful monitoring, while others may need to explore alternative treatments for their symptoms that don't carry the same interaction risks.

From the Research

Safety of Using Black Cohosh with Paroxetine

• There is limited information available on the safety of using black cohosh with paroxetine, a Selective Serotonin Reuptake Inhibitor (SSRI) 2, 3.
• Black cohosh has been reported to have serotonergic and dopaminergic activities, which may interact with paroxetine 4.
• A study comparing the efficacy of black cohosh and fluoxetine (another SSRI) in the treatment of postmenopausal symptoms found that both treatments were effective, but black cohosh was more effective in reducing hot flushes and night sweats, while fluoxetine was more effective in improving depression symptoms 5.
• However, there is a case report of a patient with unipolar depression who developed mania after taking black cohosh, highlighting the need for caution when using black cohosh in patients with a history of depression or bipolar disorder 4.
• The safety profile of black cohosh is generally considered positive, with low toxicity and few side effects, but the potential for interactions with other medications, including SSRIs like paroxetine, is not well understood 3, 6.

Potential Interactions and Precautions

• Patients taking paroxetine should exercise caution when using black cohosh, as the potential for interactions is not well understood 4.
• Black cohosh may have anti-estrogenic activity, which could potentially interact with paroxetine, but the clinical significance of this interaction is not clear 2.
• Patients with a history of depression or bipolar disorder should be closely monitored when using black cohosh, as it may exacerbate these conditions 4.
• Further studies are needed to fully understand the safety and efficacy of using black cohosh with paroxetine 6.