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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.
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.
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.
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.
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.
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 procyanidines). 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 procyanidines). Some sources recommend a range of 240-480 milligrams per day for extracts standardized to 18.75% oligomeric procyanidines.
Not enough available scientific evidence.
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.
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.
Not recommended due to lack of sufficient data.
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.
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.
This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Cynthia Dacey, PharmD (CVS Pharmacy); Edzard Ernst, MD, PhD (University of Exeter); Ivo Foppa, MD, ScD (University of South Carolina); Paul Hammerness, MD (Harvard Medical School); Jenna Hollenstein, MS, RD (Natural Standard Research Collaboration); Beth Kerbel, PharmD (Northeastern University); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Mamta Vora, PharmD (Natural Standard Research Collaboration); Wendy Weissner, BA (Natural Standard Research Collaboration).
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.
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.
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.
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.
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.
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.
Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev 2008 Jan 23;(1):CD005312.
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.
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.
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.
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.
Zapfe JG. Clinical efficacy of crataegus extract WS 1442 in congestive heart failure NYHA class II. Phytomedicine 2001;8(4):262-266.
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