Blue Cohosh

Botanical

What is it

Blue cohosh (Caulophyllum thalictroides) is a North American woodland plant whose root and rhizome have been used historically by Indigenous peoples and Western herbalists, mainly to influence menstruation and labor.

Evidence for 1 use

AI-assisted evidence assessment — talk to your doctor before relying on any single supplement.

Labor induction (historical)

Mixed Evidence

Historical use is documented but no controlled trials support safety or efficacy; case reports describe serious harm.

How it works

Blue cohosh contains glycosides (caulosaponin), alkaloids (methylcytisine), and other compounds with uterine-stimulating and cardiovascular activity in animal models. Methylcytisine is structurally similar to nicotine and may stimulate the autonomic nervous system, while caulosaponins can constrict coronary arteries. Clinical evidence for safety or efficacy is limited, and case reports have linked blue cohosh to serious adverse events, especially in pregnancy.

Dosage

No safe dose is established. Traditional use varied; modern herbalists who use it generally do so only acutely and at low doses. Self-use is not recommended.

When and how to take it

Self-use is not advised. Historical use was limited to acute situations under traditional practitioner guidance.

1 commercial form

Compare the main delivery options and what they’re best suited for.

Tincture / dried root

Historical preparations.

Alkaloids well absorbed orally.

Safety

Significant safety concerns. Case reports describe neonatal heart failure, maternal cardiotoxicity, stroke, and seizures associated with blue cohosh use during labor. Methylcytisine can cause nicotine-like toxicity.

Who should be cautious

Absolutely avoid in pregnancy (except possibly under expert supervision at term, though most authorities advise against it entirely). Avoid in children, in people with heart conditions, hypertension, or any cardiovascular risk.

Interactions

Potential interactions with cardiovascular medications, antihypertensives, nicotine, antiplatelet agents, and blood pressure drugs. Combining with stimulants is dangerous.

Frequently asked questions

Is blue cohosh safe in pregnancy?⌄

No. Serious cardiovascular events in newborns have been associated with maternal use. Most professional bodies advise against it.

Is it the same as black cohosh?⌄

No. They are unrelated plants with different uses and very different safety profiles.

References

Blue Cohosh on Wikidata — Wikidata link

Blue Cohosh on NIH DSLD (US supplement label database) — NIH Dietary Supplement Label Database link

Research on Blue Cohosh (PubMed search) — PubMed link

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Evidence-based·How we grade evidence

Disclaimer: These statements have not been evaluated by the FDA. This page is educational, not a substitute for personalized medical advice. Evidence grades are AI-assisted assessments — talk to your doctor before starting any new supplement, especially if you’re pregnant, breastfeeding, on medications, or managing a chronic condition.