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Updated 18 February 2013

Hawthorn - from Natural Standard

Hawthorn, a flowering shrub of the rose family, has an extensive history of use in cardiovascular disease, dating back to the 1st Century. Flavonoids and other compounds found in hawthorn may synergistically improve performance of the damaged heart muscles, and further, may prevent or reduce symptoms of coronary artery disease.

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BACKGROUND

Hawthorn, a flowering shrub of the rose family, has an extensive history of use in cardiovascular disease, dating back to the 1st Century. Flavonoids and other compounds found in hawthorn may synergistically improve performance of the damaged heart muscles, and further, may prevent or reduce symptoms of coronary artery disease.

Hawthorn is widely used in Europe for treating New York Heart Association (NYHA) Class I-II heart failure, with standardization of its leaves and flowers. Overall, hawthorn appears to be effective, safe and well tolerated, and in accordance with its indication, best used under the supervision of a medical professional.

The therapeutic equivalence of hawthorn extracts to drugs considered standard-of-care for heart failure (such as angiotensin converting enzyme inhibitors, diuretics, or beta-adrenergic receptor blockers) remains to be established, as does the effect of concomitant use of hawthorn with these drugs. Nonetheless, hawthorn is a potentially beneficial therapy for patients who cannot/will not take prescription drugs, and may offer additive benefits to prescription drug therapy.

EVIDENCE TABLE

Conditions

Uses
disclaimer: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Grade*

Congestive heart failure

Extracts of the leaves and flowers of hawthorn have been reported as effective in the treatment of mild-to-moderate congestive heart failure (CHF), improving exercise capacity and reducing symptoms of cardiac insufficiency. However, whether hawthorn is as effective as drugs considered standard-of-care for heart failure (such as angiotensin converting enzyme inhibitors, diuretics, or beta-adrenergic receptor blockers) is unclear, as is the effect of the combined use of hawthorn with these drugs. Nonetheless, hawthorn is a potentially beneficial treatment for patients who cannot/will not take prescription drugs and may offer additive benefits to established therapies. Further study of these issues is warranted.

A

Anxiety

Hawthorn in combination with other herbs may help to reduce anxiety and anxious mood. It is unknown if hawthorn specifically had beneficial effects.

C

Coronary artery disease (angina)

Hawthorn has not been tested in the setting of concomitant drugs such as beta-blockers or ACE-inhibitors, which are often considered to be standard-of-care. At this time, there is not enough evidence to recommend for or against hawthorn for coronary artery disease or angina.

C

Functional cardiovascular disorders

Herbal combinations containing hawthorn have been found effective in the treatment of functional cardiovascular symptoms. However, due to a lack of information on the use of hawthorn alone, there is not enough evidence to recommend for or against hawthorn for functional cardiovascular disorders.

C

High blood pressure

Studies in patients with type 2 diabetes support the historic use of hawthorn to lower blood pressure. More studies are needed before strong recommendations may be made.

C

Orthostatic hypotension (low blood pressure on standing up)

Fresh hawthorn berries may improve orthostatic hypotension (a lowering of blood pressure that occurs when a person goes from a lying down position to a standing position). Additional study is needed in this area.

C

*Key to grades: A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).

TRADITION

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below. Abdominal colic, abdominal pain, acne, amenorrhea (lack of menstrual period), antioxidant, appetite stimulant, arteriosclerosis, asthma, astringent, bacterial infections, bladder disorders, blood vessel disorders (Buerger's disease), cancer, cardiac murmurs, circulation, diabetes mellitus, diarrhea, dysentery, dyspnea (shortness of breath), edema, frostbite, heart rhythm disorders, hemorrhoids, HIV, hyperlipidemia, hypoxia (lack of oxygen), indigestion, insomnia, kidney disease, kidney stones, migraine, nephrosis, nervous disorders, peripheral artery disease, skin sores, sore throat, spasmolytic, stomach aches, sweating, varicose veins.

DOSING

disclaimer: The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

For congestive heart failure, high-quality trials have used doses of 60 milligrams three times per day or 80 milligrams twice a day for products containing standardized extract WS 1442 (18.75% oligomeric procyanidins). The U.S. brand HeartCare© (Nature's Way) is standardized in this fashion.

Other high-quality trials have used doses of 100 milligrams three times per day, 200 milligrams twice a day, and up to 300 milligrams three times a day for products containing standardized extract LI 132 (2.2% flavonoids).

The dosage range recommended in review literature is 160-900 milligrams hawthorn extract per day in 2-3 divided doses (corresponding to 3.5-19.8 milligrams flavonoids or 30-168.8 milligrams oligomeric procyanidins). Some sources recommend a range of 240-480 milligrams per day for extracts standardized to 18.75% oligomeric procyanidins.

Children (younger than 18 years)

Not enough available scientific evidence.

SAFETY

disclaimer: The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid if allergic to hawthorn or to members of the Crataegus genus. There is a case report of an immediate-type hypersensitivity reaction to hawthorn plants. It is not known if this applies to formulations taken by mouth.

Side Effects and Warnings

There are limited reports of adverse effects associated with hawthorn. Numerous human trials, observational studies including over 4,500 patients, and case reports have noted rare adverse effects, including abdominal discomfort, nausea, agitation, dizziness, headache, fatigue, shortness of breath, skin rash, insomnia, sweating, and rapid heart rate.

Pregnancy and Breastfeeding

Not recommended due to lack of sufficient data.

INTERACTIONS

disclaimer: Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

Additive inotropic effects when used with cardiac glycoside drugs such as digoxin have been noted in animals without added toxicity. In humans, hawthorn has been used with the intention of decreasing digoxin doses, although data on safe and efficacious dosing in this setting is still limited.

Hawthorn may have additive activity with medications that lower blood pressure. Hawthorn may add to the activity of drugs that dilate blood vessels, and may decrease the effects of vasoconstrictors such as phenylephrine (Neo-Synephrine©), ephedrine or norepinephrine. Hawthorn may interact with cholesterol-lowering agents.

Interactions with Herbs and Dietary Supplements

Hawthorn may add to the effects on the heart of agents containing cardiac glycosides, such as foxglove (Digitalis purpurea).

Hawthorn may add to the effects of agents that lower blood pressure, and may also interact with agents that increase blood pressure.

Hawthorn may have additive activity with agents that reduce cholesterol levels such as garlic, niacin, or fish oil (omega-3 fatty acids).

ATTRIBUTION

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

  • Bodigheimer K, Chase D. [Effectiveness of hawthorn extract at a dosage of 3x100mg per day]. Munch Med Wschr 1994;136 Suppl 1:s7-s11.
  • Degenring FH, Suter A, Weber M, et al. A randomised double blind placebo controlled clinical trial of a standardised extract of fresh Crataegus berries (Crataegisan) in the treatment of patients with congestive heart failure NYHA II. Phytomedicine 2003;10(5):363-369. View abstract
  • Holubarsch CJ, Colucci WS, Meinertz T, et al. Survival and prognosis: investigation of Crataegus extract WS 1442 in congestive heart failure (SPICE)—rationale, study design and study protocol. Eur J Heart Fail 2000;2(4):431-437. View abstract
  • Iwamoto M, Sato T, Ishizaki T. The clinical effect of Crataegus in heart disease of ischemic or hypertensive origin. A multicenter double-blind study. Planta Med 1981;42(1):1-16. View abstract
  • Koller M, Lorenz W, Aubke W, et al. Crataegus special extract WS 1442 in the treatment of early stages of CHD-associated heart failure MMW Fortschr Med. 2006;148(6):42. View abstract
  • Leuchtgens H. [Crataegus Special Extract WS 1442 in NYHA II heart failure. A placebo controlled randomized double-blind study]. Fortschr Med 1993;111(20-21):352-354. View abstract
  • Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med 2003;114(8):665-674. View abstract
  • Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev 2008 Jan 23;(1):CD005312. View abstract
  • Schmidt U, Kuhn U, Ploch M, et al. Efficacy of the hawthorn extract LI 132 (600mg/d) during eight weeks' treatment. Placebo-controlled double-blind trial with 78 NYHA stage II heart failure patients. Munch Med Wochenschr 1994;136(suppl 1):s13-s19.
  • Schmidt U, Albrecht M, Schmidt S. [Effects of an herbal crataegus-camphor combination on the symptoms of cardiovascular diseases]. Arzneimittelforschung 2000;50(7):613-619. View abstract
  • Tankanow R, Tamer HR, Streetman DS, et al. Interaction study between digoxin and a preparation of hawthorn (Crataegus oxyacantha). J Clin Pharmacol 2003;43(6):637-642. View abstract
  • 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. Munch Med Wochenschr 1994;136(suppl. 1):S27-S33.
  • Walker AF, Marakis G, Simpson E, et al. Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial. Br J Gen Pract 2006;56(527):437-43. View abstract
  • Weng WL, Zhang WQ, Liu FZ, et al. Therapeutic effect of Crataegus pinnatifida on 46 cases of angina pectoris—a double blind study. J Tradit Chin Med 1984;4(4):293-294. View abstract
  • Zapfe JG. Clinical efficacy of crataegus extract WS 1442 in congestive heart failure NYHA class II. Phytomedicine 2001;8(4):262-266. View abstract
disclaimer: Natural Standard Bottom Line Monograph, Copyright © 2011 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions. disclaimer: While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy. disclaimer: The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

Copyright © 2011 Natural Standard (www.naturalstandard.com)



Copyright © 2011 Natural Standard (www.naturalstandard.com)
 
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