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A Case of Hepatitis Associated With Long-Term Use of Cimicifuga Racemosa: A Case Report

Alfredo Vannacci, MD, PhD; Francesco Lapi, PharmD, PhD; Eugenia Gallo, MS; Michele Vietri, MS, PhD; Mario Toti, MD;
Francesca Menniti-Ippolito, MS, PhD; Roberto Raschetti, MD; Fabio Firenzuoli, MD; Alessandro Mugelli, MS, MD

Abstract
A survey of 107 patients continuously treated for more than 12 months with a Cimicifuga racemosa rhizome (black cohosh) herbal extract was recently conducted by Firenzuoli et al to verify its possible hepatotoxic effects.1 The paper concluded that, despite the alert released on July 2006 by the European Medicines Agency (EMEA) and the Committee on Herbal Medicinal Products (HMPC), C racemosa rhizome herbal extract should be considered safe with regard to liver toxicity. While the conclusions of the paper remain valid, here we report a case of hepatitis attributed to long-term consumption of an herbal formula containing C racemosa observed after publication of the cited survey. This clinical case is an example of how not noting the use of an herbal formula containing Cimicifuga racemosa can be relevant in the diagnosis of liver damage otherwise not explained. This paper has been written in light of the recent guidelines concerning submitting adverse event reports for publication.

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