Blue Cohosh

Blue cohosh (Caulophyllum thalictroides) is used as an anticonvulsant, to increase menstrual flow, and to induce labor. A national survey of the certified nurse-midwives who endorse herbal medicine use found that 65% used it in labor. The active agent, methyl-cytisine, is similar to but less potent than nicotine. Synonyms for blue cohosh are blue ginseng, caulophyllum, papoose toot, squawroot, and yellow ginseng. Common trade

Commentary

Drs. Conry and Pearl provide a careful, evidence-based review of the data to support or refute claims of effectiveness and safety for herbal therapies in epilepsy. They follow the approach of Western medicine, the culture in which the editors of this book were educated and practice. So for us, the chapter is a beacon of light and honesty. Simple questions—Does it help?, Does it harm?—but incredibly difficult to answer. That is the problem that both lay individuals face as they decide whether to "try out" one of these therapies. It is also the problem that professionals face when they try to counsel patients on the use of these therapies.

The simple answer is that none are proven to work for epilepsy. Doubleblind studies find that placebos can significantly reduce seizures in up to 25% to 30% of epilepsy patients. Thus, it would be remarkable if small studies of any substance did not show some effectiveness, but what is the evidence? Drs. Conry and Pearl take a hard and close look at the evidence. Their review of the published literature reveals that the risks might actually outweigh the benefits, but that, ultimately, we are working with very limited information. The jury is out. It is leaning away from recommending any of these herbal remedies for the treatment of epilepsy. We desperately need well-controlled studies to define both safety and danger.

This chapter also highlights some of the potential dangers of using "herbal" therapies that are not produced and manufactured under any regulatory supervision. A young woman I follow was being treated with two antiepileptic drugs, but her mother had also obtained an "herbal" preparation for epilepsy from China. It was expensive, and both the mother and daughter were convinced that it helped control her seizures. One day the young woman decided to stop the Chinese herbs and shortly afterwards developed a severe cluster of seizures and symptoms suggesting withdrawal from a central nervous system depressant. Indeed, in the emergency room, a toxicology screen found that she had phenobarbital in her blood; the Chinese herb contained phenobarbital. Quite an herb! Who knows what else it contained?

Drs. Conry and Pearl take a somewhat negative voice in considering the use of various herbal preparations available in the United States and elsewhere. Their concern is justified because the negative consequences appear to outweigh the positive ones, based on the published data. In a similar way, American psychiatrists have warmly embraced the use of antiepileptic drugs for the treatment of behavioral disorders in patients without epilepsy. Mounting data suggest that many of the antiepileptic drugs do work in some psychiatric disorders, with a vast amount of positive data on patients with bipolar and pain disorders. Some drugs, however—in which well-controlled double-blind data show behavioral toxicity from epilepsy studies—are being used increasingly by psychiatrists to treat behavioral problems or counteract side effects (such as weight gain) from other psychotropic (behavioral) drugs. Medical doctors, as well as lay individuals, can easily fall into the frequent use of drugs for disorders in which the evidence is very scant. Once again, the bottom line is that we need more data. Keep in mind, once you take a plant or part of an animal, perform a series of chemical extractions, and transform it into a pill, powder, or liquid form—the end result is a drug.

names are: Blue Cohosh Low Alcohol®, Blue Cohosh Root®, Blue Cohosh Root Alcohol Free®, and Blue Cohosh Root Low Alcohol®. Caulophyllum thalictroides is a perennial found in the midwestern and eastern U.S. and Canada. The seeds are bright blue (as suggested by the name). Blue cohosh has some pharmacologic similarity to nicotine. Actions in animal studies include the stimulation of smooth muscle in coronary vessels, the small intestine, and uterus. Antifertility effects have been documented. Anti-inflammatory and antimicrobial actions have been reported.

Adverse reactions include chest pain, hypertension, abdominal cramps, diarrhea, hyperglycemia, and poisoning in children after ingestion of seeds. The bright blue seeds are attractive but poisonous to children. Blue cohosh is contraindicated in pregnancy because of increased uterine contractions and teratogenesis. At least two cases of severe neonatal heart failure were linked to the consumption during pregnancy. It should not be used by people with angina and other cardiac symptoms.

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