Uses of this Herb
Angina
Congestive Heart Failure
Hypertension
Varicose Veins
  Herbs with Similar Uses
View List by Use
  Drugs that Interact
Summary
Phenylephrine
Phenylephrine-containing Medications
  Herbs with Similar Side Effects
View List by Side Effect
  Herbs with Similar Warnings
View List by Warning
  Learn More About
Western Herbalism
Look Up > Herbs > Hawthorn
Hawthorn
  Hawthorn Berry/Hawthorn Flower/Hawthorn Leaf/Hawthorn Leaf with Flower (English)
Crataegus monogyna/Crataegus laevigata (Botanical)
Rosaceae (Plant Family)
Crataegi fructus/crataegi flos/crataegi folium/crataegi folium cum flore (Pharmacopeial)
Overview
Macro Description
Part Used/Pharmaceutical Designations
Constituents/Composition
Commercial Preparations
Medicinal Uses/Indications
Pharmacology
Dosage Ranges and Duration of Administration
Side Effects/Toxicology
Warnings/Contraindications/Precautions
Interactions
Regulatory and Compendial Status
References


Overview

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.


Macro Description

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.


Part Used/Pharmaceutical Designations
  • Flowers
  • Leaves
  • Fruit

Constituents/Composition

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.


Commercial Preparations

Aqueous, aqueous-alcohol, solid, glycerite, dried (powdered), and compounded extracts are available as liquid, tablet, or capsule, standardized to flavonoid/oligomeric procyanidin content


Medicinal Uses/Indications

Traditional: cardiotonic, hypotensive, coronary vasodilator, mild diuretic, astringent

Conditions: coronary artery disease, congestive heart failure, essential hypertension, angina pectoris, postmyocardial infarction rehabilitation, cardiac weakness following infectious disease, antiarrythmias, possibly varicose veins, thrombosis

Clinical applications: for diminishing or deteriorating cardiac capacity due to stage II heart failure, according to New York Heart Association standards


Pharmacology

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 Administration

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.

Side Effects/Toxicology

American Herbal Products Association (AHPA) safety rating: class 1 (safe with appropriate use)

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 nontoxic.


Warnings/Contraindications/Precautions

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.


Interactions

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 literature.

Phenylephrine

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 Status

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.


References

Bahorun T, Gressier B, Trotin F, et al. Oxygen species scavenging activity of phenolic extracts from hawthorn fresh plant organs and pharmaceutical preparations. Arzneimittelforschung. 1996;46:1086-1089.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998.

Blumenthal M, Riggins C. American Botanical Council's Popular Herbs in the U.S. Market: Therapeutic Monographs. Austin, Tex: American Botanical Council; 1997.

Chaterjee SS. In vitro and in vivo studies on the cardioprotective action of oligomeric procyanidins in a crataegus extract of leaves and blooms. Arzneimittelforschung. 1997;47:821-825.

Chen ZY, Zhang ZS, Kwan KY, et al: Endothelium-dependent relaxation induced by hawthorn extract in rat mesenteric artery. Life Sci. 1993;63(22):1983-1991.

The Criteria Committee of the New York Heart Association I. Diseases of the Heart and Blood Vessels: Nomenclature and Criteria for Diagnosis. 6th ed. Boston, Mass: Little, Brown; 1964.

Hoffmann D. Hawthorn: The Heart Helper. Alternative & Complementary Therapies. 1995;4:191-192.

Kowalchik C, Hylton W, eds. Rodale's Illustrated Encyclopedia of Herbs. Emmaus, Pa: Rodale Press; 1998.

Leuchtgens H. Crataegus special extract WS 1442 in NYHA II heart failure. A placebo controlled randomized double-blind study [in German]. Fortschr Med. 1993;111:352-354.

Loew D, Albrecht M, Podzuweit H. Efficacy and tolerability of a Hawthorn preparation in patients with heart failure stage I and II according to NYHA—a surveillance study. Presented at the Second International Congress on Phytomedicine; 1996; Munich, Germany.

Mashour NH, Lin GI, Frishman WH. Herbal medicine for the treatment of cardiovascular disease. Arch Intern Med. 1998;158:2225-2234.

McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, Fla: CRC Press; 1997.

Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(20):2200-2211.

Nasa Y, Hashizume AN, Hoque E, Abiko Y. Protective effect of crataegus extract on the cardiac mechanical dysfunction in isolated perfused working rat heart. Arzneimittelforschung. 1993;42II(9):945-949.

Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press; 1996.

Nikolov N, Wagner H, Chopin J, Della Monica G, Chari VM, Seligmann O. Recent investigations of crataegus flavonoids. Proceedings of the International Bioflavonoid Symposium; 1981; Munich, Germany.

Popping S, Rose H, Ionescu I, Fischer Y, Kammermeier H. Effect of a hawthorn extract on contraction and energy turnover of isolated rat cardiomycocytes. Arzneimittelforschung. 1995;45:1157-1161.

Schmidt U, Kuhn U, Ploch M, Hubner WD. Efficacy of the hawthorn (crataegus) preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomedicine. 1994;1:17-34.

Schulz V, Hänsel R, Tyler V. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. 3rd ed. Berlin: Springer; 1998.

Schussler M, Holzl J, Fricke U. Myocardial effects of flavonoids from crataegus species. Arzneimittelforschung. 1995;45:842-845.

Tauchert M, Ploch M, Hubner WD. Effectiveness of hawthorn extract LI 132 compared with the ACE inhibitor captopril: multicenter double-blind study with 132 NYHA stage II. Muench Med Wochenschr. 1994;136(suppl):S27-S33.

Vibes J, Lasserre B, Gleye J. Effects of a methanolic extract from 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 (hawthorn) flower heads. Prostaglandins Leukot Essent Fatty Acids. 1994;50:174-175.

Weikl A, Assmus KD, Neukum-Schmidt A, et al. Crataegus special extract WS 1442. Assessment of objective effectiveness in patients with heart failure. Fortschr Med. 1996;114:291-296.

Weiss R F. Herbal Medicine. Beaconsfield, England: Beaconsfield Publishers, Ltd; 1988:162-169.

Werbach M. Botanical Influences on Illness. Tarzana, Calif: Third Line Press; 1994.

Zapfe G, Assmus KD, Noh HS. Placebo-controlled multicenter study with Crataegus special extract WS 1442: clinical results in the treatment of NYHA II cardiac insufficiency. Presented at the Fifth Congress on Phytotherapy; June 11, 1993; Bonn, Germany.


Copyright © 2000 Integrative Medicine Communications

This publication contains information relating to general principles of medical care that should not in any event be construed as specific instructions for individual patients. The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. The reader is advised to check product information (including package inserts) for changes and new information regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.