Blue Cohosh (Caulophyllum thalictroides)

Commonly used by midwives as a uterine stimulant and for induction of labor. Major uses, therefore, include (1) inducing labor; (2) as an emmenagogue; (3) as an antispasmodic; and (4) as an abortifacient.

Properties also include anti-inflammatory, antipyretic, diuretic, expectorant, vasoconstrictor, and smooth muscle relaxants.

According to a national survey, 64% of midwives still use blue cohosh to induce labor and 7–45% of women use herbal medications during pregnancy.

Ingestion of the leaf or seeds can lead to severe toxicity.

Case reports document seizures, renal failure, and resp distress after use.

Avoidance is advised in diabetic pts due to concern for hyperglycemia and potential inhibition of antiglycemic medications.

Reports of perinatal stroke, aplastic anemia, chest pain (angina), hypertension, acute MI, CHF, shock, and multi-organ hypoxia in infants following maternal use from the first trimester to right before delivery.

Should not be used by women with estrogen-sensitive conditions or cancers, and in pts with diarrhea.

Also causes mucous membrane irritation, diarrhea, and cramping, and constricts coronary arteries.

Possesses several components that can be teratogens, cytotoxic, or lethal to embryos and/or can cause birth defects and congenital malformations.

Coronary artery vasoconstriction that can lead to myocardial ischemia

Alteration in antiglycemic and antihypertensive drug levels

Interaction with medications dependent on cytochrome P-450 enzymes

Differentiate from black or white cohosh, which have other physiologic effects.

Product safety and efficacy profiles differ among manufacturers.

Usage in pregnancy due to concern of uterine stimulation, teratogenicity, and neonatal multisystemic complications.

Usage in pts with diabetes, hypertension, or acute history of tobacco/nicotine use.