Hepatotoxicity fromCimicifuga Racemosa? Recent Australian Case Report not Sufficiently Substantiated

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Abstract
The documentation and examination of adverse reactions to herbal medicines is absolutely essential. Let us not, however, apply double standards. It is without question that intentional or accidental adulterations of herbal medicines are absolutely unacceptable, and that companies producing herbal medicines should be expected to take every possible measure to avoid such events. Conversely, there are many over-the-counter pharmaceutical drugs, such as analgesics, which are directly hepatotoxic. Applying a risk-benefit analysis to Cimicifuga racemosa, it must be concluded that it is a safe and effective herb for menopausal complaints such as hot flashes and emotional symptoms. In a review of eight human studies on the effectiveness of an extract of Cimicifuga racemosa in alleviating menopausal symptoms, the authors concluded that the plant extract appears to be a safe and effective alternative to estrogen replacement therapy for those patients in whom estrogen replacement therapy is either refused or contraindicated (Liebermann, 1998). The gaps in the elucidation of the case reports of liver reactions by Whiting et al. (2002) do not allow conclusions to be drawn on the hepatotoxic potential of Cimicifuga racemosa, rather, they underline the necessity to return to a scientifically based discussion of the risks and benefits of herbal medicines

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