Black Cohosh (Cimicifuga racemosa) Dosing
The FDA-approved dosing for Black Cohosh tablets is 5 pellets taken 3-4 times daily with water for individuals 12 years and older, or 3 pellets for children ages 2-12 years. 1
Standard Dosing Regimen
- Adults and adolescents ≥12 years: Take 5 pellets orally with water, 3-4 times per day 1
- Children ages 2-12 years: Take 3 pellets orally with water, 3-4 times per day 1
- Children under 2 years: Consult a physician before use 1
Alternative Extract Dosing from Clinical Evidence
While the FDA label provides pellet dosing, clinical trials have primarily evaluated standardized extracts at different doses:
- Standard extract dose: 40-80 mg/day of Cimicifuga racemosa extract has been the most commonly studied dosage in clinical trials for menopausal symptoms 2
- Single daily dose: 40 mg/day of black cohosh extract was evaluated in a randomized controlled trial, though it did not demonstrate superiority over placebo for moderate to severe menopausal symptoms in that particular study 3
Duration and Safety Considerations
- Treatment duration: Black cohosh should be taken for a limited period, as long-term safety data beyond several months remains insufficient 4
- Common transient adverse effects: Nausea, vomiting, headaches, dizziness, mastalgia, and weight gain have been observed in clinical trials 2
- Hepatotoxicity monitoring: Although rare cases of liver toxicity have been reported, a direct causal relationship has not been definitively established; however, clinicians should remain vigilant 2
Clinical Context
The pellet formulation dosing differs substantially from the extract preparations studied in clinical trials, reflecting different pharmaceutical preparations and delivery systems. The FDA-approved pellet dosing represents homeopathic preparation standards, while clinical research has focused on standardized herbal extracts measured in milligrams 1, 2.