by Neil Bauman, Ph.D.
A lady explained:
In your book ‘When Your Ears Ring‘ you speak of black cohosh as a possible tinnitus treatment. I have tinnitus and I am trying to get off HRT [hormone replacement therapy drugs]. I looked at a lot of web sites and it seemed that black cohosh especially as the product Remifemin might be a help to a lot of my problems.
After four days on Remifemin it seemed my tinnitus was a lot louder. Today, I found a few web sites that say that black cohosh contains salicylates and should not be used by people who need to avoid aspirin. (I believe that aspirin worsened my tinnitus several months ago when I took some for back pain. At that time I took about six or seven 325 mg. pills over the course of one day to try to fight a disk problem in my back. I had had steady tinnitus for five years before this, then developed a second noise in my left ear four days after taking the aspirin. Since then both ears have become louder.) Do you think the Remifemin is causing this increase? I sure thought I did my homework on this one.
I think you are wise in getting off the HRT. HRT is pretty harmful to your whole body from everything I’ve read. I’d never consider it if I were a woman. It’s just not worth the risk. I think that Remifemin is a much safer alternative. And yes, I think you did your homework very well.
Remifemin contains an extract of black cohosh (roots and rhizomes) equivalent to 20mg that is standardized to contain 1 mg of the active ingredient—triterpene—so that leaves 19 mg for anything else in the black cohosh.
There are a LOT of chemical compounds in black cohosh apart from triterpene glycosides. These compounds include phenolic acids, flavonoids, volatile oils and tannins. In addition, there are several acids such as acetic, butyric, formic, oleic, palmitic, and salicylic acids. Thus the amount of salicylates in Remifemin must be a very small part of the remaining 19 mg.
I don’t think that Remifemin tablets even contain 1 mg of salicylic acid. But even if they were ALL salicylic acid—the dose would still be well below what is needed to cause tinnitus in the typical person.
Let’s compare the salicylate content in Remifemin to that of a typical aspirin. Standard adult aspirin contain 325 mg of acetylsalicylic acid. It is generally accepted that it takes about 6 aspirins a day to cause tinnitus in the typical person—that would be about 1950 mg.
Since the normal dose of Remifemin is 2 tablets a day, the most salicylic acid you would be getting is maybe 2 mg a day—a far cry from the 1950 mg needed to cause tinnitus in the typical person.
However, having said that, everyone is different, and for some people maybe even small doses of salicylic acid can cause tinnitus—but I wouldn’t think it would be very common.
The good thing about tinnitus from aspirin (and related salicylates) is that typically the tinnitus only occurs while you are taking the drug. Once you have stopped, in 3 or 4 days the tinnitus should disappear. (Unfortunately, for a few people this is not true and they are left with permanent tinnitus, but this is not the norm.)