Vitamin and mineral supplements should not replace a balanced diet. In very rare cases, black cohosh has been associated with liver failure. If you are experiencing yellowing of the skin or whites of the eyes, dark urine, nausea, vomiting, unusual tiredness, weakness, stomach or abdominal pain, and/or loss of appetite, you should stop using this product and see your doctor. If symptoms persist, talk to your health professional. Always read the label and follow the directions for use.