||Hawthorn Berry/Hawthorn Flower/Hawthorn
Leaf/Hawthorn Leaf with
Crataegus monogyna/Crataegus laevigata
Rosaceae (Plant Family)
flos/crataegi folium/crataegi folium cum
Hawthorn improves cardiac function in patients with New York Heart
Association stage II heart failure. Clinical trials support a minimum dose of
300 mg hawthorn extract to reduce debility from cardiac insufficiency. Various
tolerance markers (standard bicycle ergometry, spiroergometry, radionucleotide
ventriculography, and subjective complaints) support this conclusion. Further
study is required to determine the effects of hawthorn on other cardiovascular
conditions (hypertension, atherosclerosis, angina pectoris, and paroxysmal
tachycardia) considered by herbalists to be indications for hawthorn therapy.
Hawthorn is a thorny, deciduous shrub up to five feet tall, found in
deciduous forests of North America, Europe, North Africa, and western Asia.
Flower clusters, which bloom in May, have five petals, five sepals, and numerous
stamens. Leaves are variable, toothed or lobed, and alternate. Oval or round
fruit (haws), which are red when ripe, contain five nutlets. Crude drug is
prepared from leaves, white flowers, and berries.
Flavonoids (e.g., hyperoside, vitexin rhamnoside, rutin, vitexin, kaempferol,
apigenin); oligomeric procyanidins (e.g., epicatechin, catechin)
Leaves and flowers in crude drug contain about 1% flavonoids (hyperoside as
marker), 1% to 3% oligomeric procyanidins (epicatechin as marker); berries in
crude drug contain about 0.1% hyperoside.
Aqueous, aqueous-alcohol, solid, glycerite, dried (powdered), and compounded
extracts are available as liquid, tablet, or capsule, standardized to
flavonoid/oligomeric procyanidin content
Traditional: cardiotonic, hypotensive, coronary vasodilator, mild diuretic,
Conditions: coronary artery disease, congestive heart failure, essential
hypertension, angina pectoris, postmyocardial infarction rehabilitation, cardiac
weakness following infectious disease, antiarrythmias, possibly varicose veins,
Clinical applications: for diminishing or deteriorating cardiac capacity due
to stage II heart failure, according to New York Heart Association standards
Animal studies originated with a 1966 genetic experiment that focused on
gypsy moths. The colony, about to die due to inbreeding and a diet of alder
leaves, recovered completely when fed hawthorn leaves, and also became stronger
and larger. Subsequent in vivo and in vitro animal experiments showed that
hawthorn extracts increase coronary blood flow, cause vasodilation (and
hypotension), reduce peripheral resistance, benefit peripheral blood flow (and
circulation), and have positive inotropic effects (increasing rat myocyte
efficiency more than isoprenaline). Hawthorn extracts also block
beta-adrenoceptors, are antiarrhythmic, and, in rat hearts subject to ischemia
and reperfusion, increase recovery rate, reduce lactate release, reduce
ventricular fibrillation, and prolong survival.
In humans, hawthorn, a positive inotropic agent, increases the refractory
period that cardiac glycosides shorten, reducing the probability of arrhythmia
while stabilizing heart rhythm. Also a peripheral vasodilator, hawthorn reduces
blood pressure and increases coronary flow. It has positive dromotropic effects
and negative bathmotropic effects, and increases coronary and myocardial
circulatory perfusion. Actions may be due to inhibition of cAMP (cyclic
adenosine monophosphate) or TXA2 (thromboxane2) or to
other undetermined actions.
|Dosage Ranges and Duration of
To decrease NYHA stage II cardiac insufficiency:
- 160 to 900 mg standardized (4 to 20 mg flavonoids/30 to 160 mg
oligomeric procyanidins) fluid crude extract daily for at least six weeks
- 120 to 240 mg extract, standardized to 1.8% vitexin rhamnoside/10%
procyanidins three times daily for at least six weeks.
American Herbal Products Association (AHPA) safety rating: class 1 (safe with
Infrequent side effects: Two of 367 subjects in placebo-controlled trials
reported nausea, headache, migraine, palpitations, and soft stools.
Toxicity: After IP dosing of 3 g per kg body weight (rats and mice), toxicity
was indicated by sedation, difficulty breathing, and tremors, but not death.
Oral doses—30, 90, or 300 mg per kg body weight
administered to rats and dogs for 26 weeks and 300 to 600 mg per body weight
administered for one month—were nonfatal and
Advise patients not to self-medicate. If symptoms do not improve after six
weeks of treatment, reevaluate the condition. Encourage frequent follow-ups.
Take appropriate precautions regarding potential heart failure, imminent
surgery, and prescription change.
Patients should not use hawthorn during pregnancy.
Although hawthorn reportedly potentiates the activity of digoxin (Mashour et
al. 1998; Miller 1998), case reports of clinically significant interactions have
not been cited in the
In rat mesenteric artery, hawthorn fruit alcoholic extract counteracted the
effects of phenylephrine, a vasoconstrictive agent (Chen et al. 1993). The
extract completely inhibited the contraction induced by phenylephrine at a
concentration of 1 micromole. The clinical relevance of these experimental
findings is unknown at this time.
|Regulatory and Compendial
In the United States, the FDA classifies hawthorn as a dietary supplement; in
Canada, it has new-drug status and is not approved for self-treatment of
cardiovascular disease. Hawthorn is not licensed through the General Sale List
(GSL) in England, and while the Commission E in Germany approves the use of
hawthorn leaf and flower for the treatment of NYHA stage II heart failure, it
does not approve the use of hawthorn berry.
Bahorun T, Gressier B, Trotin F, et al. Oxygen species scavenging activity of
phenolic extracts from hawthorn fresh plant organs and pharmaceutical
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Guide to Herbal Medicines. Boston, Mass: Integrative Medicine
Blumenthal M, Riggins C. American Botanical Council's Popular Herbs in the
U.S. Market: Therapeutic Monographs. Austin, Tex: American Botanical
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oligomeric procyanidins in a crataegus extract of leaves and blooms.
Chen ZY, Zhang ZS, Kwan KY, et al: Endothelium-dependent relaxation induced
by hawthorn extract in rat mesenteric artery. Life Sci.
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placebo controlled randomized double-blind study [in German]. Fortschr Med.
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preparation in patients with heart failure stage I and II according to
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extract on the cardiac mechanical dysfunction in isolated perfused working rat
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Crataegus oxyacantha blossoms on TXA2 and PGI2 synthesizing activities of
cardiac tissue. Med Sci Res. 1993;21:534-436.
Vibes J, Lasserre B, Gleye J, Declume C. Inhibition of thromboxane A2
biosynthesis in vitro by the main components of Crataegus oxyacantha
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Copyright © 2000 Integrative Medicine
CommunicationsThis publication contains
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