Black cohosh high-dose

Tier 4 — risky / avoid · Liver damage · Menopause

At standard doses of 20 to 40 mg per day, black cohosh may modestly relieve hot flashes. However, high doses above 160 mg per day and prolonged use have been linked to rare but serious liver injury, including cases requiring liver transplant. If you use the standard dose form, liver function monitoring is recommended during treatment.

Dose: AVOID high doses (>160 mg/day) or prolonged use; standard dose 20–40 mg/day requires liver monitoring