{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:28:31Z","timestamp":1788481711168,"version":"build-2803163510"},"reference-count":51,"publisher":"Elsevier BV","issue":"4","license":[{"start":{"date-parts":[[2009,8,1]],"date-time":"2009-08-01T00:00:00Z","timestamp":1249084800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2009,8,1]],"date-time":"2009-08-01T00:00:00Z","timestamp":1249084800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","maturitas.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Maturitas"],"published-print":{"date-parts":[[2009,8]]},"DOI":"10.1016\/j.maturitas.2009.05.006","type":"journal-article","created":{"date-parts":[[2009,7,8]],"date-time":"2009-07-08T06:06:35Z","timestamp":1247033195000},"page":"302-314","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":52,"title":["Suspected black cohosh hepatotoxicity\u2014Challenges and pitfalls of causality assessment"],"prefix":"10.1016","volume":"63","author":[{"given":"Rolf","family":"Teschke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruediger","family":"Bahre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Genthner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Fuchs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Schmidt-Taenzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albrecht","family":"Wolff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.maturitas.2009.05.006_bib1","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1002\/hep.20800","article-title":"Outcome and prognostic markers in severe drug-induced liver disease","volume":"42","author":"Bj\u00f6rnsson","year":"2005","journal-title":"Hepatology"},{"key":"10.1016\/j.maturitas.2009.05.006_bib2","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1056\/NEJMra052270","article-title":"Drug-related hepatotoxicity","volume":"354","author":"Navarro","year":"2006","journal-title":"N Engl J Med"},{"key":"10.1016\/j.maturitas.2009.05.006_bib3","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1078\/0944-7113-00314","article-title":"Kava extracts: safety and risks including rare hepatotoxicity","volume":"10","author":"Teschke","year":"2003","journal-title":"Phytomedicine"},{"key":"10.1016\/j.maturitas.2009.05.006_bib4","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1097\/MEG.0b013e3283036768","article-title":"Kava hepatotoxicity: a clinical survey and critical analysis of 26 suspected cases","volume":"20","author":"Teschke","year":"2008","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"10.1016\/j.maturitas.2009.05.006_bib5","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1111\/j.1365-2125.2008.03264.x","article-title":"Causality assessment in hepatotoxicity by drugs and dietary supplements","volume":"66","author":"Teschke","year":"2008","journal-title":"Br J Clin Pharmacol"},{"key":"10.1016\/j.maturitas.2009.05.006_bib6","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.clpt.2006.02.012","article-title":"Drug-induced liver injury: Hy's rule revisited","volume":"79","author":"Bj\u00f6rnsson","year":"2006","journal-title":"Clin Pharmacol Ther"},{"key":"10.1016\/j.maturitas.2009.05.006_bib7","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1001\/archsurg.138.8.852","article-title":"High prevalence of potentially hepatotoxic herbal supplement use in patients with fulminant hepatic failure","volume":"138","author":"Estes","year":"2003","journal-title":"Arch Surg"},{"key":"10.1016\/j.maturitas.2009.05.006_bib8","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1093\/ajcp\/104.5.491","article-title":"What causes fulminant hepatic failure of unknown etiology?","volume":"104","author":"Mason","year":"1995","journal-title":"Am J Clin Pathol"},{"key":"10.1016\/j.maturitas.2009.05.006_bib9","first-page":"163","article-title":"Akute liver failure: clinical features, outcome analysis, and applicability of prognostic criteria","volume":"6","author":"Shakil","year":"2000","journal-title":"Liver Transpl"},{"key":"10.1016\/j.maturitas.2009.05.006_bib10","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1097\/00004836-200109000-00005","article-title":"Acute liver failure","volume":"33","author":"Gill","year":"2001","journal-title":"J Clin Gastroenterol"},{"key":"10.1016\/j.maturitas.2009.05.006_bib11","doi-asserted-by":"crossref","first-page":"432","DOI":"10.5694\/j.1326-5377.2002.tb04886.x","article-title":"Black cohosh and other herbal remedies associated with acute hepatitis","volume":"177","author":"Whiting","year":"2002","journal-title":"Med J Aust"},{"key":"10.1016\/j.maturitas.2009.05.006_bib12","doi-asserted-by":"crossref","first-page":"390","DOI":"10.5694\/j.1326-5377.2003.tb05606.x","article-title":"Acute liver failure associated with the use of herbal preparations containing black cohosh","volume":"179","author":"Lontos","year":"2003","journal-title":"Med J Aust"},{"key":"10.1016\/j.maturitas.2009.05.006_bib13","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1097\/01.gme.0000142914.55849.6a","article-title":"Autoimmune hepatitis associated with the use of black cohosh","volume":"11","author":"Cohen","year":"2004","journal-title":"Menopause"},{"key":"10.1016\/j.maturitas.2009.05.006_bib14","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1007\/s10620-005-2470-7","article-title":"Fulminant liver failure associated with the use of black cohosh","volume":"50","author":"Levitsky","year":"2005","journal-title":"Dig Dis Sci"},{"key":"10.1016\/j.maturitas.2009.05.006_bib15","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1002\/lt.20778","article-title":"Fulminant hepatic failure associated with the use of black cohosh: a case report","volume":"12","author":"Lynch","year":"2006","journal-title":"Liver Transpl"},{"key":"10.1016\/j.maturitas.2009.05.006_bib16","first-page":"441","article-title":"Black cohosh-induced hepatitis","volume":"79","author":"Nisbet","year":"2007","journal-title":"Del Med J"},{"key":"10.1016\/j.maturitas.2009.05.006_bib17","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1111\/j.1478-3231.2007.01517.x","article-title":"Black cohosh, safety, and public awareness","volume":"27","author":"Dunbar","year":"2007","journal-title":"Liver Int"},{"key":"10.1016\/j.maturitas.2009.05.006_bib18","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1080\/13697130701864056","article-title":"Black cohosh: a cause of abnormal postmenopausal liver function tests","volume":"11","author":"Joy","year":"2008","journal-title":"Climacteric"},{"key":"10.1016\/j.maturitas.2009.05.006_bib19","doi-asserted-by":"crossref","first-page":"420","DOI":"10.5694\/j.1326-5377.2008.tb01691.x","article-title":"Liver failure associated with the use of black cohosh for menopausal symptoms","volume":"188","author":"Chow","year":"2008","journal-title":"Med J Aust"},{"key":"10.1016\/j.maturitas.2009.05.006_bib20","unstructured":"EMEA: Assessment of case reports connected to herbal medicinal products containing Cimicifugae racemosae rhizoma (black cohosh, root). Available at: http:\/\/www.emea.europa.eu\/pdfs\/human\/hmpc\/26925806en.pdf. Accessed July 18, 2006."},{"key":"10.1016\/j.maturitas.2009.05.006_bib21","unstructured":"EMEA: Assessment of case reports connected to herbal medicinal products containing Cimicifugae racemosae rhizoma (black cohosh, root). Available at: http:\/\/www.emea.europa.eu\/pdfs\/human\/hmpc\/26925806.pdf. Accessed November 15, 2008."},{"key":"10.1016\/j.maturitas.2009.05.006_bib22","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1097\/gme.0b013e31816054bf","article-title":"United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity","volume":"15","author":"Mahady","year":"2008","journal-title":"Menopause"},{"key":"10.1016\/j.maturitas.2009.05.006_bib23","series-title":"Proceedings of the NIH, November 22","first-page":"24","article-title":"Herbal hepatitis\u2014black cohosh. Workshop on the safety of black cohosh in clinical studies","author":"Kerlin","year":"2004"},{"key":"10.1016\/j.maturitas.2009.05.006_bib24","doi-asserted-by":"crossref","first-page":"598","DOI":"10.5694\/j.1326-5377.2004.tb06109.x","article-title":"Acute liver failure associated with the use of herbal preparations containing black cohosh","volume":"180","author":"Thomsen","year":"2004","journal-title":"Med J Aust"},{"key":"10.1016\/j.maturitas.2009.05.006_bib25","first-page":"599","article-title":"Response to Letter to the Editor","volume":"180","author":"Cumming","year":"2004","journal-title":"Med J Aust"},{"issue":"Suppl","key":"10.1016\/j.maturitas.2009.05.006_bib26","first-page":"5165","article-title":"A case of autoimmune hepatitis associated with the use of black cohosh","volume":"98","author":"O\u2018Connor","year":"2003","journal-title":"Am J Gastroenterol"},{"key":"10.1016\/j.maturitas.2009.05.006_bib27","series-title":"Proceedings of the NIH, November 22","first-page":"22","article-title":"Hepatitis associated with black cohosh. Case 1. Workshop on the safety of black cohosh in clinical studies","author":"Cohen","year":"2004"},{"key":"10.1016\/j.maturitas.2009.05.006_bib28","unstructured":"Strom, LE; 2006. Nebraska judgement of September 8, 2006. Available at: www.ahpa.org\/Portals\/0\/pdfs\/06_0908_BlackCohosh_NebraskaDistrictCt.pdf."},{"key":"10.1016\/j.maturitas.2009.05.006_bib29","unstructured":"Strom, LE. American Herbal Products Association 2006. Available at: http:\/\/ahpa.org\/portals\/0\/pdfs\/06_0908_Blackcohosh_NebraskaDistrictCt.pdf. Accessed February 11, 2009."},{"key":"10.1016\/j.maturitas.2009.05.006_bib30","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1007\/s10620-007-9907-0","article-title":"Fulminant liver failure associated with the use of black cohosh","volume":"53","author":"Levitsky","year":"2008","journal-title":"Dig Dis Sci"},{"key":"10.1016\/j.maturitas.2009.05.006_bib31","series-title":"Proceedings of the NIH, November 22","first-page":"23","article-title":"Hepatitis associated with black cohosh. Case 2. Workshop on the safety of black cohosh in clinical studies","author":"Cohen","year":"2004"},{"key":"10.1016\/j.maturitas.2009.05.006_bib32","first-page":"233","article-title":"Questions regarding causality in presumed black cohosh hepatotoxicity","volume":"80","author":"Teschke","year":"2008","journal-title":"Del Med J"},{"key":"10.1016\/j.maturitas.2009.05.006_bib33","first-page":"235","article-title":"Response to questions regarding causality in presumed black cohosh hepatotoxicity","volume":"80","author":"Nisbet","year":"2008","journal-title":"Del Med J"},{"key":"10.1016\/j.maturitas.2009.05.006_bib34","doi-asserted-by":"crossref","first-page":"99","DOI":"10.5694\/j.1326-5377.2009.tb02292.x","article-title":"Liver failure associated with the use of black cohosh for menopausal symptoms","volume":"190","author":"Naser","year":"2009","journal-title":"Med J Aust"},{"key":"10.1016\/j.maturitas.2009.05.006_bib35","doi-asserted-by":"crossref","first-page":"99","DOI":"10.5694\/j.1326-5377.2009.tb02293.x","article-title":"Liver failure associated with the use of black cohosh for menopausal symptoms","volume":"190","author":"Teschke","year":"2009","journal-title":"Med J Aust"},{"key":"10.1016\/j.maturitas.2009.05.006_bib36","first-page":"100","article-title":"Response to Letters to the Editor","volume":"190","author":"Chow","year":"2009","journal-title":"Med J Aust"},{"key":"10.1016\/j.maturitas.2009.05.006_bib37","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/gme.0b013e31818d3f79","article-title":"United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity","volume":"16","author":"Teschke","year":"2009","journal-title":"Menopause"},{"key":"10.1016\/j.maturitas.2009.05.006_bib38","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/gme.0b013e31818d3f8a","article-title":"Letter to the Editor (Reply)","volume":"16","author":"Mahady","year":"2009","journal-title":"Menopause"},{"key":"10.1016\/j.maturitas.2009.05.006_bib39","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.phymed.2008.09.009","article-title":"Suspected hepatotoxicity by Cimicifugae racemosae rhizoma (black cohosh, root): critical analysis and structured causality assessment","volume":"16","author":"Teschke","year":"2009","journal-title":"Phytomedicine"},{"key":"10.1016\/j.maturitas.2009.05.006_bib40","doi-asserted-by":"crossref","unstructured":"Teschke R, Bahre R, Fuchs J, Wolff A. Black cohosh hepatotoxicity: quantitative causality evaluation in suspected 9 cases. Menopause; in press: 16.","DOI":"10.1097\/gme.0b013e31819d3904"},{"issue":"Suppl 2","key":"10.1016\/j.maturitas.2009.05.006_bib41","first-page":"114","article-title":"Adverse liver reactions to black cohosh: are they accurately reported?","volume":"11","author":"Naser","year":"2008","journal-title":"Climacteric"},{"key":"10.1016\/j.maturitas.2009.05.006_bib42","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/0168-8278(90)90124-A","article-title":"Criteria of drug-induced liver disorders. Report of an international consensus meeting","volume":"11","author":"B\u00e9nichou","year":"1990","journal-title":"J Hepatol"},{"key":"10.1016\/j.maturitas.2009.05.006_bib43","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/0895-4356(93)90101-6","article-title":"Causality assessment of adverse reactions to drugs. I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries","volume":"46","author":"Danan","year":"1993","journal-title":"J Clin Epidemiol"},{"key":"10.1016\/j.maturitas.2009.05.006_bib44","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/0895-4356(93)90102-7","article-title":"Causality assessment of adverse reactions to drugs. II. An original model for validation of drug causality assessment methods: case reports with positive rechallenge","volume":"46","author":"B\u00e9nichou","year":"1993","journal-title":"J Clin Epidemiol"},{"key":"10.1016\/j.maturitas.2009.05.006_bib45","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1002\/hep.22442","article-title":"Reliability of the Roussel Uclaf causality assessment method for assessing causality in drug-induced liver injury","volume":"48","author":"Rochon","year":"2008","journal-title":"Hepatology"},{"key":"10.1016\/j.maturitas.2009.05.006_bib46","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.1053\/j.gastro.2008.09.011","article-title":"Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States","volume":"135","author":"Chalasani","year":"2008","journal-title":"Gastroenterology"},{"key":"10.1016\/j.maturitas.2009.05.006_bib47","unstructured":"Teschke R, Schmidt-Taenzer W, Wolff A. Hepatotoxicity by black cohosh assumed in 22 spontaneous reports; a thorough analysis; in press."},{"key":"10.1016\/j.maturitas.2009.05.006_bib48","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/01.GME.0000056039.51813.21","article-title":"Critical evaluation of the safety of Cimicifuga racemosa in menopause symptom relief","volume":"10","author":"Low Dog","year":"2003","journal-title":"Menopause"},{"key":"10.1016\/j.maturitas.2009.05.006_bib49","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.maturitas.2007.04.008","article-title":"Black cohosh with or without St. Johns's wort for symptom-specific climacteric treatment\u2014results of a large-scale, controlled, observational study","volume":"57","author":"Briese","year":"2007","journal-title":"Maturitas"},{"key":"10.1016\/j.maturitas.2009.05.006_bib50","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1097\/gme.0b013e31818fc38f","article-title":"Letter to the Editor","volume":"16","author":"Sunyecz","year":"2009","journal-title":"Menopause"},{"key":"10.1016\/j.maturitas.2009.05.006_bib51","first-page":"1283","article-title":"Kava hepatotoxicity: a European view","volume":"121","author":"Teschke","year":"2008","journal-title":"N Zeal Med J"}],"container-title":["Maturitas"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0378512209001789?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0378512209001789?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T08:47:22Z","timestamp":1759913242000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0378512209001789"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,8]]},"references-count":51,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2009,8]]}},"alternative-id":["S0378512209001789"],"URL":"https:\/\/doi.org\/10.1016\/j.maturitas.2009.05.006","relation":{},"ISSN":["0378-5122"],"issn-type":[{"value":"0378-5122","type":"print"}],"subject":[],"published":{"date-parts":[[2009,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Suspected black cohosh hepatotoxicity\u2014Challenges and pitfalls of causality assessment","name":"articletitle","label":"Article Title"},{"value":"Maturitas","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.maturitas.2009.05.006","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Copyright \u00a9 2009 Elsevier Ireland Ltd. All rights reserved.","name":"copyright","label":"Copyright"}]}}