Blue Cohosh and Breastfeeding

Summary of use during lactation

Blue cohosh (Caulophyllum thalictroides) root contains N-methylcytosine, which has nicotine-like effects, and caulosaponin, a glycoside that constricts coronary vessels and may have oxytocic activity. It has been used to promote labor.[1-3] Blue cohosh has no specific uses during breastfeeding. No data exist on the safety and efficacy of blue cohosh in nursing mothers or infants; however, it can cause severe gastrointestinal and cardiovascular toxicity, including in neonates whose mothers used it to stimulate labor. Most sources recommend strongly against its use during breastfeeding because of lack of safety data and potential toxicity.[3,4] Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site.

Drug levels in milk and infant serum

Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Relevant published information was not found as of the revision date.

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

References

1. Allaire A, Moos M, Wells S. Complementary and alternative medicine in pregnancy: A survey of North Carolina certified nurse-midwives. Obstet Gynecol 2000;95:19-23.10636495 PubMed
2. Low Dog T. The use of botanicals during pregnancy and lactation. Altern Ther Health Med 2009;15:54-8.19161049 PubMed
3. Dennehy C, Tsourounis C, Bui L, et al. The use of herbs by California midwives. J Obstet Gynecol Neonatal Nurs 2010;39:684-93.21044150 PubMed
4. Dugoua J, Perri D, Seely D, et al. Safety and efficacy of blue cohosh (Caulophyllum thalictroides) during pregnancy and lactation. Can J Clin Pharmacol 2008;15:e66-73.18204101 PubMed