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Complementary & Alternative Medicine
Index of Herbal Medicines, Supplements and Therapies
The decision to use products containing or claiming to contain hawthorn should be carefully considered.
Hawthorn (Crataegus laevigata, C. oxyacantha, C. monogyna, C. pentagyna)
Be aware that the U.S. Food and Drug Administration does not strictly regulate herbs and dietary supplements. There is no guarantee of strength, purity or safety of products containing or claiming to contain hawthorn. Decisions to use herbs or supplements should be carefully considered. Individuals using prescription drugs should discuss taking herbs or supplements with their pharmacists or health care providers before starting.
Scientists have studied hawthorn for the following health problems:
Congestive heart failure
A number of studies have shown that extracts of the leaves, berries and flowers of hawthorn can be helpful in treating mild-to-moderate congestive heart failure, improving symptoms, exercise tolerance, and quality of life in these patients. Standardized extracts show promise as adjunctive agents for the treatment of left ventricular dysfunction, as measured by ejection fraction. A combination of hawthorn and camphor has also been studied. However, further study is needed to learn how hawthorn compares with prescription drugs that are usually used for heart failure and what happens when hawthorn and these drugs are taken at the same time.
Coronary artery disease, angina
Early research suggests that hawthorn may help decrease symptoms of angina. However, it has not been tested in combination with drugs that are considered to be standard treatments. More study is needed before hawthorn can be recommended for the treatment of coronary artery disease or angina.
Preliminary research shows that hawthorn may help to decrease blood pressure in those with mildly high blood pressure (hypertension). Large, well-designed studies are needed before a recommendation can be made.
Low blood pressure on standing (orthostatic hypotension)
Preliminary trials have studied the efficacy of fresh hawthorn berries, camphor and a combination of both in treating orthostatic hypotension (a lowering of blood pressure that occurs when one goes from a lying down position to a standing position). The authors concluded that both the hawthorn berries and the camphor helped with orthostatic hypotension. This trial was small and more research is needed before hawthorn can be recommended for the treatment of orthostatic hypotension.
Hawthorn in combination with other herbs may help to reduce anxiety and anxious mood. A randomized, controlled clinical trial of patients suffering from adjustment disorder studied the effects of Euphytose, a combination product containing hawthorn, on the treatment of anxious mood. Euphytose contained Crataegus, Ballota, Passiflora, Valeriana, Cola, and Paullinia. All patients received two tablets a day and were then evaluated after 28 days. The study found that Euphytose was better than placebo in the treatment of adjustment disorder with anxious mood. It is unknown if hawthorn specifically had beneficial effects.
Hawthorn has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially very serious and even life-threatening. You should consult a health care provider before using hawthorn for any unproven use.
Chronic cardiac insufficiency
Coronary heart disease
Myocardial hypoxia (lack of oxygen to heart muscle)
Peripheral artery disease
People who are allergic or hypersensitive to hawthorn should avoid its use.
Hawthorn should be used under medical supervision. In recommended doses, hawthorn may rarely cause palpitations (irregular heart rhythm), sweating, gastrointestinal symptoms such as indigestion, mild rash, headache, dizziness, fatigue, agitation or insomnia. Toxiderma has been reported. Hawthorn should be used cautiously by elderly people and by those at risk of low blood pressure.
Pregnancy And Breast-Feeding
Hawthorn cannot be recommended during pregnancy or breast-feeding. Although many natural medicine experts believe that hawthorn is safe, there is limited scientific information. Be aware that many tinctures contain high levels of alcohol and should be avoided during pregnancy.
Interactions with drugs, supplements and other herbs have not been thoroughly studied. The interactions listed below have been reported in scientific publications. If you are taking prescription drugs, speak with your health care provider or pharmacist before using herbs or dietary supplements.
Interactions With Drugs
Hawthorn appears to increase the effects of cardiac glycoside drugs, such as digoxin, and may add to the blood pressure-lowering effects of other drugs. Hawthorn should be used cautiously and under medical supervision with other heart drugs, such as those used for angina and arrythmias, as the effects and side effects may be increased or inhibited. Hawthorn may increase the effects of cholesterol-lowering drugs. Be aware that many tinctures contain high levels of alcohol and can cause nausea or vomiting when taken with metronidazole (Flagyl) or disulfiram (Antabuse).
Interactions With Herbs And Dietary Supplements
Hawthorn may add to the effects of cardiac glycoside herbs such as foxglove (Digitalis purpurea
). It may interfere with increases in blood pressure caused by other herbs, for example, ephedra.
Hawthorn may add to the action of cholesterol-lowering herbs or supplements, including garlic
The doses listed below are based on scientific research, publications or traditional use. Because most herbs and supplements have not been thoroughly studied or monitored, safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients even within the same brand. Combination products often contain small amounts of each ingredient and may not be effective. Appropriate dosing should be discussed with a health care provider before starting therapy; always read the recommendations on a product's label. The dosing for unproven uses should be approached cautiously, because scientific information is limited in these areas.
Adults (Aged 18 Or Older)
For Congestive Heart Failure
Dried extract: A dose of 160 to 900 milligrams per day, divided into two to three doses, has been taken by mouth.
In another trial, the efficacy of a standardized extract of fresh Crataegus berries (Rob 10) on exercise tolerance and quality of life was studied in 88 patients. In a three-month placebo-controlled, randomized, double-blind trial, these patients were treated with Rob 10 (25 drops three times daily) for six to 12 weeks.
Hawthorn should be used under the supervision of a qualified health care provider.
For High Blood Pressure
Study volunteers have taken a daily supplement for 10 weeks of 600 milligrams of magnesium, 500 milligrams of hawthorn extract, or a combination.
Hawthorn has also been used in part of a combination drink, Regazell-Energen, for revitalization and regeneration, regulation, and stimulation of the immune system and in the early metaphylaxis of treated cancer patients. However, further research is needed before hawthorn can be recommended for any indication.
Children (Younger Than 18)
There is not enough evidence to safely recommend hawthorn for children at this time.
Although hawthorn has been suggested for many conditions, it has been most studied for heart problems. Research suggests that hawthorn may be a safe and helpful treatment for people with congestive heart failure. Hawthorn should be avoided by children and by women who are pregnant or breast-feeding. It should be used cautiously by the elderly and those at risk of low blood pressure. Hawthorn may interact with several types of heart drugs and should be used under medical supervision. Consult your health care provider immediately if you experience side effects.
The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.
- Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
- National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research
Selected Scientific Studies: Hawthorn
Natural Standard reviewed more than 225 articles to prepare the professional monograph from which this version was created.
Some of the more recent studies are listed below:
- Anonymous. Even in advanced heart failure, hawthorn improves physical capacity [Article in German]. MMW Fortschr Med 2003;Jan 16, 145(1-2):52.
- Anonymous. Crataegus in heart failure and coronary heart disease: what is the value of this additional medication? [Article in German]. MMW Fortschr Med 2001;Feb 8, 143(6):56.
- Anonymous. Crataegus in cardiac insufficiency: taking a current position [Article in German]. Internist (Berl) 1993;Dec, 34(12 Suppl):1-8.
- Beier A, Konigstein RP, Samec V. Clinical experiences with a Crataegus pentaerythrityl-tetranitrate combination drug in heart diseases due to coronary sclerosis in old age [Article in German]. Wien Med Wochenschr 1974;Jun 15, 124(24):378-381.
- Belz GG, Loew D. Dose-response related efficacy in orthostatic hypotension of a fixed combination of D-camphor and an extract from fresh Crataegus berries and the contribution of the single components. Phytomedicine 2003,10(Suppl 4):61-67.
- Belz GG, Butzer R, Gaus W, Loew D. Camphor-Crataegus berry extract combination dose-dependently reduces tilt induced fall in blood pressure in orthostatic hypotension. Phytomedicine 2002;Oct, 9(7):581-588.
- Chen JD, Wu YZ, Tao ZL, et al. Hawthorn (shan zha) drink and its lowering effect on blood lipid levels in humans and rats. World Rev Nutr Diet 1995;77:147-154.
- Degenring FH, Suter A, Weber M, Saller R. A randomised double blind placebo controlled clinical trial of a standardized extract of fresh Crataegus berries (Crataegisan) in the treatment of patients with congestive heart failure NYHA II. Phytomedicine 2003;10(5):363-369.
- Di Renzi L, Cassone R, Lucisano V, et al. On the use of injectable Crataegus extracts in therapy of disorders of peripheral arterial circulation in subjects with obliterating arteriopathy of the lower extremities [Article in Italian]. Boll Soc Ital Cardiol 1969;14(4):577-585.
- Gildor A. Crataegus oxyacantha and heart failure. Circulation 1998;Nov 10, 98(19):2098. Comment in: Circulation 1997;Jun 3, 95(11):2591-2593.
- 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.
- Leuchtgens H. Crataegus Special Extract WS 1442 in NYHA II heart failure: a placebo controlled randomized double-blind study [Article in German]. Fortschr Med 1993;Jul 20, 111(20-21):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. Phytomedicine 1996;3(Suppl 1):92.
- Massoni G. On the use of hawthorn extract (Crataegus) in the treatment of certain ischemic myocardial diseases in old age [Article in Italian]. G Gerontol 1968;Sep, 16(9):979-984.
- O'Conolly M, Jansen W, Bernhoft G, Bartsch G. Treatment of decreasing cardiac performance: therapy using standardized Crataegus extract in advanced age [Article in German]. Fortschr Med 1986;Nov 13, 104(42):805-808.
- Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med 2003;Jun 1, 114(8):665-674. Comment in: Am J Med 2003;Jun 1, 114(8):700-701.
- Tankanow R, Tamer HR, Streetman DS, et al. Interaction study between digoxin and a preparation of hawthorn (Crataegus oxyacantha). J Clin Pharmacol 2003;Jun, 43(6):637-642.
- Tauchert M. Efficacy and safety of Crataegus extract WS 1442 in comparison with placebo in patients with chronic stable New York Heart Association class-III heart failure. Am Heart J 2002;May, 143(5):910-915.
- Tauchert M, Gildor A, Lipinski J. High-dose Crataegus extract WS 1442 in the treatment of NYHA stage II heart failure [Article in German]. Herz 1999;Oct, 24(6):465-474. Discussion, 475. Erratum in: Herz 1999;Nov, 24(7):586.
- Walker AF, Marakis G, Morris AP, Robinson PA. Promising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertension. Phytother Res 2002;Feb, 16(1):48-54.
- Weikl A, Assmus KD, Neukum-Schmidt A, et al. Crataegus Special Extract WS 1442: assessment of objective effectiveness in patients with heart failure (NYHA II) [Article in German]. Fortschr Med 1996;Aug 30, 114(24):291-296.
- 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;Dec, 4(4):293-294.
- Wolkerstorfer H. Treatment of heart disease with a digoxin-Crataegus combination [Article in German]. Munch Med Wochenschr 1966;Feb 25, 108(8):438-441.
- Wong SS, Nahin RL. National Center for Complementary and Alternative Medicine perspectives for complementary and alternative medicine research in cardiovascular diseases. Cardiol Rev 2003;Mar-Apr, 11(2):94-98.
- Zapfe JG. Clinical efficacy of Crataegus extract WS 1442 in congestive heart failure NYHA class II. Phytomedicine 2001;8(4):262-266.
- Zbinden S, Seiler Ch. Phytotherapy in cardiovascular medicine [Article in German]. Ther Umsch 2002;Jun, 59(6):301-306.
Last updated June 14, 2005
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