Can Remifemin cause leukopenia?/nA 49-year-old woman is treated at the intensive care unit for lobu

Fråga: Can Remifemin cause leukopenia? A 49-year-old woman is treated at the intensive care unit for lobular pneumonia. A blood test showed leukopenia (0.3 x10(9)/L reference value 4.0-9.0 x10(9)/L) and a CRP of 500 but other blood values were normal. She has been taking paracetamol and dextropropoxyphen for her pain, she is also taking the herbal drug Remifemin.

Sammanfattning: No information about leukopenia as a side effect of Remifemin was found in the literature but the lack of information makes a causal-relationship impossible to assess.

Svar: Pneumonia can cause leukopenia but normally the values are above 2.0 (1).

Remifemin is an herbal agent comprised of Camiciguga racemosa, otherwise known as black cohosh (silverax in Swedish) (2). Its purported uses include rheumatism, dysmenorrhea, whooping cough, tinnitus, and insomnia (3).

Pharmacological actions have been observed in both animals and humans, although none support the traditional uses of the root (3).

Known side effects include nausea, vomiting, dizziness, visual and nervous disturbances, reduced pulse rate, increased perspiration (3), and estrogenic effects (4).

The literature about black cohoch is very scarce and a Medline search gave only three articles about the subject none of which spoke about side effects of the herb. No information about leukopenia as a side effect of black cohoch could therefore be found.

SADRAC (The Swedish Adverse Drug Reactions Advisory Committee) has received several reports about Remifemin causing mostly dermal or gynecological side effects. No reports of leukopenia as a side effect of Remifemin were found (5).

If the leukopenia disappears when Remifemin is withdrawn we recommend this case be reported to SADRAC.