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Hawthorn (Crataegus spp.)

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Also listed as: Crataegus spp.
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • Adenylocrat® f, Aubepine, bei shanzha, bianco spino, bread and cheese tree, caffeic acid, Cardiplant®, catechin, Chinese hawthorn, cholorgenic acid, cockspur, cockspur hawthorn, cockspur thorn, common hawthorn, crataegi flos, Crataegi folium, Crataegi folium cum flore, Crataegi fructus, Crataegi herba, Crataegisan,Crataegus azaerolus, Crataegus cuneata, Crataegus fructi, Crataegus laevigata, Crataegus microphylla, Crataegus monogyna, Crataegus nigra, Crataegus orientalis, Crataegus oxyancantha, Crataegus oxyacanthoides, Crataegus pentagyna, Crataegus pinnatifida, Crataegus sanguinea, Crataegus sinaica boiss, Crataegus special extract WS 1442, Crataegutt® forte (WS 1442), Crataegutt® novo, Crataesor®, Cratoegi oxyacanthi, English hawthorn, epicatechin, epine blanche, epine de mai, Faros® 300 (LI 132), flavonoids, Fructus oxyacanthae, Fructus spinae albae, gazels, haagdorn, hagedorn, hagthorn, halves, harthorne, haw, Hawthorne Berry®, Hawthorne Formula®, Hawthorne Heart®, Hawthorne Phytosome®, Hawthorne Power®, Hawthorn Supreme System Support®, hawthorn tops, hazels, HeartCare®, hedgethorn, hesperidin, huath, hyperoside, isoquercitrin, isovitexin, ladies' meat, may, mayblossoms, maybush, mayhaw, maythorn, mehlbeerbaum, meidorn, midland hawthorn, myricitrin, nan shanzha, northern Chinese hawthorn, oleanolic acid, oligomeric procyanidins, O-methyoxyphenethylamine, oneseed, oneseed hawthorn, phenylethylamine, procyanidin B2, procyanidin clusters (DP 4, 5, 6), quercitrin, quickset, red haw, RN 30/9, Rosaceae, rutin, sanza, sanzashi, shanza, shanzai, shan zha rou, southern Chinese hawthorn, thornapple, thorn-apple tree, thorn plum, tocopherols, tree of chastity, tyramine, ursolic avid, vitamin C, vitexin, vitexin-2-O-rhamnoside, vitexin rhamnoside, Washington thorn, weissdorn, Weissdornblaetter mit Blueten, whitethorn, whitethorn herb.
  • Select combination products: CKBM-A01, Euphytose®, Korodin®, Neo40 Daily®, Sympathyl®.
  • Note: According to the United States Department of Agriculture (USDA) plants database, the common name "hawthorn" includes all members of the Crataegus genus, although certain species, such as C. monogyna, C. laevigata, C. oxyancantha, and C. pentagyna, tend to be more relevant in clinical literature.

Background
  • Hawthorn is a flowering shrub of the rose family and has a history of use in heart disease, dating back to the 1st Century. Flavonoids and other parts found in hawthorn may work together to improve damaged heart muscles, and may prevent or reduce symptoms of coronary artery disease.
  • Hawthorn is used in Europe for treating heart failure. Overall, hawthorn appears to be effective, safe and well tolerated, and is best used under the supervision of a medical professional.
  • The effectiveness of hawthorn extracts to drugs considered to be the 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 use of hawthorn in addition to these drugs. Nonetheless, hawthorn may be beneficial for people with heart failure and may offer additive benefits to prescription drug therapy.

Evidence Table

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 *


Extracts of the leaves and flowers of hawthorn have been found to be effective in the treatment of mild-to-moderate congestive heart failure (CHF). However, it is unclear if hawthorn is as effective as drugs considered to be the standard-of-care for heart failure (such as angiotensin converting enzyme inhibitors, diuretics, or beta-adrenergic receptor blockers). The effects of hawthorn in combination with these drugs also remain to be established. Nonetheless, hawthorn may be a beneficial treatment for those that cannot or will not take prescription drugs for heart failure. Further study is needed.

A


Hawthorn in combination with other herbs may help to reduce anxiety and anxious mood. It is unknown if hawthorn alone has beneficial anti-anxiety effects, and further research is needed in this area.

C


Initial research suggests that combination products of hawthorn and nitrate-based beet root reduce triglyceride levels. However, the effects of hawthorn alone are unclear, and further research in this area is needed before a firm conclusion may be made.

C


In early research, a combination extract improved aspects of mental function. Although promising, the effects of hawthorn alone are unclear. Further research is needed in this area.

C


Hawthorn has not been tested in combination with drugs such as beta-blockers or ACE-inhibitors, which are considered to be standard-of-care. At this time, there is not enough evidence to make any firm conclusions for or against hawthorn for coronary artery disease or angina.

C


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 make any firm conclusions for or against hawthorn for functional cardiovascular disorders.

C


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

C


In early research hawthorn has demonstrated mixed effects in HIV positive people that did not show symptoms of the disease. Further research in this area is needed.

C


In early research, hawthorn is reportedly the herb most often used for the treatment of non-alcoholic fatty liver disease (NAFLD). However, the effects of hawthorn alone are unclear. Further research is needed in this area before any firm conclusions may be made.

C


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


In healthy individuals, hawthorn has demonstrated a lack of effect on platelet aggregation. Further research is needed to form any firm conclusions 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 for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

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 distention, abdominal pain, acne, amenorrhea (absence of menstruation), antibacterial, antioxidant, appetite stimulant, arteriosclerosis, asthma, astringent, bladder disorders, cancer, cardiac arrhythmia (abnormal heart rhythm), cardiac murmurs, circulation, colic, depression, diabetes, diarrhea, digestion, diuresis, dysentery, dyspepsia, dyspnea, edema, fever, flatulence, frostbite, galactagogue (lactation stimulant), hemorrhoids, hyperlipidemia (high cholesterol), hypoxia (lack of oxygen), insomnia, kidney disease, kidney stones, menorrhagia, migraine, peripheral artery disease, pleurisy (inflammation of the lining of the lungs and chest), psychosomatic disorders, radioprotection (radiation protection), skin sores, sore throat, spasmolytic (oral), thrombosis (Buerger's disease), urolithiasis (bladder stones), varicose veins.

Dosing

Adults (18 years and older)

  • For congestive heart failure, 160-900 milligrams of hawthorn extract (WS 1442) in 2-3 divided doses has been used by mouth daily for a period of four weeks to two years. For products containing a standardized extract LI 132, 100-300 milligrams has been taken by mouth three times daily for up to eight weeks. A standardized extract of fresh berries has been taken by mouth as 30 drops three times daily for eight weeks.
  • For coronary artery (heart) disease, 400 milligrams of a hawthorn product has been taken by mouth three times daily for six months.
  • For high blood pressure, 1,200 milligrams of a hawthorn extract (LI 132) has been taken by mouth daily for 16 weeks.

Children (younger than 18 years)

  • There is no proven safe or effective dose for hawthorn in children.

Safety

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 in people with known allergy or sensitivity to hawthorn to members of the Crataegus genus.

Side Effects and Warnings

  • Hawthorn is likely safe when used in recommended doses under the supervision of a medical professional for the treatment of mild congestive heart failure (CHF).
  • Hawthorn is likely safe in doses ranging from 160-1,800 milligrams for 3-24 weeks.
  • Hawthorn may affect blood pressure. Caution is advised in people taking drugs or herbs and supplements that affect blood pressure.
  • Hawthorn may increase the risk of bleeding. Caution is advised in people with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
  • Hawthorn may also cause abnormal heart rhythm, agitation, angina (chest pain), arthritis, back pain, blood circulation failure, breathing difficulty, diarrhea, digestion problems, dizziness, facial pains, fatigue, fever, flu-like syndrome, gas, headache, increased bowel movements, increased sweating, infections, inflammation of bronchioles (lungs), inflammation of stomach and intestines, insomnia, itching, kidney failure, nausea, rapid heart rate, septic arthritis (due to bacterial infection in joints), severe constipation, skin eruptions, skin rash, sleepiness, stomach and intestinal bleeding, stomach discomfort, vertigo, weakness, and worsening of CHF.
  • Use caution in people with cardiovascular disorders and in those using cardiovascular agents, due to research suggesting hawthorn directly affects the cardiovascular system and may cause additive effects or interfere with treatment.
  • Use caution in people with skin, stomach and intestine, or lung conditions.
  • Use caution in people with reduced immune system activity, due to human case reports of infections following hawthorn exposure.
  • Use caution in people taking medications for nerves due to reports of headache, dizziness/vertigo, fainting, and fever.
  • Avoid use in children due to a lack of sufficient available evidence.
  • Avoid use in pregnant and breastfeeding women, due to a lack of sufficient available evidence.
  • Avoid in people with known allergy or sensitivity to hawthorn to members of the Crataegus genus.

Pregnancy and Breastfeeding

  • There is a lack of scientific evidence on the use of hawthorn during pregnancy or breastfeeding.

Interactions

Interactions with Drugs

  • Hawthorn may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
  • Hawthorn may cause low blood pressure. Caution is advised in people taking drugs that lower blood pressure.
  • Many tinctures contain high levels of alcohol, and may cause nausea or vomiting when taken with metronidazole (Flagyl®) or disulfiram (Antabuse®).
  • Hawthorn may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery
  • Hawthorn may also interact with agents for arthritis, agents for psychotic disorders, agents for the kidneys, agents for the nerves, agents for the skin, agents that affect the heart, agents that dilate the lungs, agents that expand blood vessels, agents that reduce the immune system, alpha agonists, beta-blockers, calcium channel blockers, cancer agents, cardiac glycosides (digoxin, digitoxin), cholesterol agents, chronotorpic agents (agents that affect the heart rate), nitrates, phosphodiesterase inhibitors, radiation protective agents, and stomach and intestine agents.

Interactions with Herbs and Dietary Supplements

  • Hawthorn may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
  • Hawthorn may cause low blood pressure. Caution is advised in people taking herbs or supplements that lower blood pressure.
  • Hawthorn may increase the amount of drowsiness caused by some herbs or supplements.
  • Hawthorn may also interact with agents for arthritis, agents for psychotic disorders, agents for the kidneys, agents for the nerves, agents for the skin, agents that affect the heart, agents that dilate the lungs, agents that expand blood vessels, agents that reduce the immune system, antioxidants, cancer agents, cardiac glycosides, cholesterol agents, d-camphor, radiation protective agents, and stomach and intestine agents.

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).

Bibliography
  1. Asher GN, Viera AJ, Weaver MA, et al. Effect of hawthorn standardized extract on flow mediated dilation in prehypertensive and mildly hypertensive adults: a randomized, controlled cross-over trial. BMC.Complement Altern.Med 2012;12:26.
  2. Dalli E, Colomer E, Tormos MC, et al. Crataegus laevigata decreases neutrophil elastase and has hypolipidemic effect: a randomized, double-blind, placebo-controlled trial. Phytomedicine. 6-15-2011;18(8-9):769-775.
  3. Dalli E, Valles J, Cosin-Sales J, et al. Effects of hawthorn (Crataegus laevigata) on platelet aggregation in healthy volunteers. Thromb.Res 2011;128(4):398-400.
  4. Francis MJ, Doherty RR, Patel M, et al. Curtobacterium flaccumfaciens septic arthritis following puncture with a Coxspur Hawthorn thorn. J Clin Microbiol. 2011;49(7):2759-2760.
  5. Harris EJ. Retained Hawthorn fragment in a child's foot complicated by infection: diagnosis and excision aided by localization with ultrasound. J Foot Ankle Surg. 2010;49(2):161-165.
  6. Hosseinimehr SJ, Mahmoudzadeh A, Azadbakht M, et al. Radioprotective effects of Hawthorn against genotoxicity induced by gamma irradiation in human blood lymphocytes. Radiat.Environ.Biophys. 2009;48(1):95-98.
  7. Mahmood ZA, Sualeh M, Mahmood SB, et al. Herbal treatment for cardiovascular disease the evidence based therapy. Pak J Pharm Sci 2010;23(1):119-124.
  8. Moon HI, Kim TI, Cho HS, et al. Identification of potential and selective collagenase, gelatinase inhibitors from Crataegus pinnatifida. Bioorg.Med Chem Lett. 2-1-2010;20(3):991-993.
  9. Rasmussen P. Hawthorn--Crataegus monogyna (common hawthorn) or Crataegus laevigata (midland hawthorn; Crataegus oxyacantha); also known as haw, thornapple, maythorn, whitethorn. J Prim.Health Care 2011;3(1):63-64.
  10. Raudonis R, Jakstas V, Burdulis D, et al. Investigation of contribution of individual constituents to antioxidant activity in herbal drugs using postcolumn HPLC method. Medicina (Kaunas.) 2009;45(5):382-394.
  11. Shi KQ, Fan YC, Liu WY, et al. Traditional Chinese medicines benefit to nonalcoholic fatty liver disease: a systematic review and meta-analysis. Mol.Biol Rep. 2012;39(10):9715-9722.
  12. Von Holubarsch CJ, Niestroj M, Wassmer A, et al. [Hawthorn extract WS 1442 in the treatment of patients with heart failure and LVEF of 25%-35%]. MMW.Fortschr.Med 7-1-2010;152 Suppl 2:56-61.
  13. Zand J, Lanza F, Garg HK, et al. All-natural nitrite and nitrate containing dietary supplement promotes nitric oxide production and reduces triglycerides in humans. Nutr Res 2011;31(4):262-269.
  14. Zick SM, Vautaw BM, Gillespie B, et al. Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial. Eur J Heart Fail. 2009;11(10):990-999.
  15. Zumdick S, Deters A, and Hensel A. In vitro intestinal transport of oligomeric procyanidins (DP 2 to 4) across monolayers of Caco-2 cells. Fitoterapia 2012;83(7):1210-1217.

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


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.

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