Hawthorn
Crataegus laevigata; Crataegus monogyna; Crataegus oxyacantha; Hedgethorn
Hawthorn (Crataegus species) has been used to treat heart disease as far back as the 1st century. By the early 1800s, American doctors were using it to treat circulatory disorders and respiratory illnesses. Traditionally, the berries were used to treat heart problems ranging from irregular heartbeat, high blood pressure, chest pain, hardening of the arteries, and heart failure. Today, the leaves and flowers are used medicinally. There is even research to suggest that hawthorn might be effective when used in the treatment of mild-to-moderate heart failure.
Animal and laboratory studies report hawthorn contains antioxidants, including oligomeric procyandins (OPCs, also found in grapes) and quercetin. Antioxidants are substances that destroy free radicals, which are compounds in the body that damage cell membranes, tamper with DNA, and even cause cell death. Free radicals occur naturally in the body and grow in number as we age. Environmental toxins (including ultraviolet light, radiation, smoking, some medicines, and air pollution) can also increase the number of these damaging particles. Scientists believe free radicals contribute to the aging process (such as wrinkling), as well as the development of a number of health problems, including cancer and heart disease. Antioxidants in hawthorn may help stop some of the damage from free radicals, especially when it comes to heart disease.
Plant Description
Hawthorn is a common thorny shrub in the rose family that grows up to 5 feet tall on hillsides and in sunny wooded areas throughout the world. Its flowers bloom in May. They grow in small white, red, or pink clusters. Small berries, called haws, sprout after the flowers. They are usually red when ripe, but they may also be black. Hawthorn leaves are shiny and grow in a variety of shapes and sizes.
What is it Made Of?
Hawthorn contains many substances that may benefit the heart. These antioxidant flavonoids, including OPCs, may help dilate blood vessels, improve blood flow, and protect blood vessels from damage.
The berries, leaves, and flowers of the hawthorn plant have been used for medicinal purposes. Most modern preparations use the leaves and flowers, which are believed to contain more flavonoids than the berries.
Medicinal Uses and Indications
Hawthorn is used to help protect against heart disease and help control high blood pressure and high cholesterol. Both animal and human studies suggest hawthorn increases coronary artery blood flow, improves circulation, and lowers blood pressure. It has also been used on the skin to treat boils and skin sores.
Heart failure
Hawthorn has been studied in people with heart failure (a condition in which the heart is unable to pump enough blood to other organs in the body). More studies are needed to understand how effective it may be. A number of studies conclude that hawthorn significantly improved heart function. Studies also suggest that the herb can enhance a person's ability to exercise following heart failure. Participants in studies have reported that hawthorn significantly improved symptoms of the disease (such as shortness of breath and fatigue). One study found that hawthorn extract (900 mg/day) taken for 2 months was as effective as low doses of captopril (a prescription heart medication) in improving symptoms of heart failure.
A large study found that a standardized hawthorn supplement was effective in 952 people with heart failure. The study compared conventional methods of treating heart failure (with different medications) with hawthorn alone and in addition to the drugs. After 2 years, the clinical symptoms of heart failure (palpitations, breathing problems, and fatigue) decreased significantly in people taking the hawthorn supplement. People taking hawthorn also took less medication for their condition.
Heart failure is a serious condition, and you should never try to self treat with hawthorn. Ask your doctor if hawthorn is right for you.
Chest pain (Angina)
Preliminary evidence suggests hawthorn may help combat chest pain (angina), which is caused by low blood flow to the heart. In one early study, 60 people with angina were given either 180 mg/day of hawthorn berry leaf flower extract or placebo for 3 weeks. Those who received hawthorn experienced improved blood flow to the heart and were also able to exercise for longer periods of time without suffering from chest pain. However, more studies are needed to say for sure whether hawthorn is effective.
High blood pressure
Although hawthorn has not been studied specifically in people with high blood pressure, some people think its benefits in treating heart disease may carry over to treating high blood pressure (hypertension). However, there is not enough research to conclude whether hawthorn is effective at lowering blood pressure, and if so, by how much.
In one study, hawthorn extract was found to be effective for hypertension in people with type 2 diabetes who were also taking prescribed medicines. Participants took 1,200 mg hawthorn extract daily or placebo for 16 weeks. Those taking hawthorn had lower blood pressure than those taking the placebo.
You should talk with your doctor before taking hawthorn if you have high blood pressure.
Available Forms
Hawthorn is available in nonstandardized and standardized capsules and liquid extracts, along with tinctures and solid extracts. A bitter-tasting tea can also be made from dried hawthorn leaves, flowers, and berries.
How to Take It
Pediatric
Hawthorn should not be given to children.
Adult
Speak to a knowledgeable health care provider to find the right dose for you.
Precautions
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that may trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider qualified in the field of botanical medicine.
Side effects of Hawthorn are rare, but may include headache, nausea, and palpitations (a feeling of a racing heart). One review of 29 clinical studies with more than 5,500 people found that hawthorn was safe when used in recommended dosages. Doses found to be safe were from 160 to 1,800 mg daily, and from 3 to 24 weeks in length. You may not notice any improvement for 6 to 12 weeks.
Heart disease is a serious condition. DO NOT self treat heart conditions without telling your doctor. You should use hawthorn only under your doctor's supervision.
DO NOT use hawthorn if you are pregnant or breastfeeding.
It is important to note any changes you feel while you are taking hawthorn. People experiencing more pain, more angina attacks, or more exhaustion while walking or exercising should stop taking hawthorn and seek emergency medical attention. Even if you do not experience any of these symptoms, see your provider if your condition has not improved after 6 weeks of hawthorn treatment. Your progress should always be monitored by your doctor. Side effects may include dizziness, vertigo, headaches, migraines, and palpitations.
Possible Interactions
If you are taking prescription or nonprescription medicines, talk to your health care provider before taking herbal supplements. If you are currently being treated with any of the following medications, you should not use hawthorn without first talking to your provider:
Digoxin: Hawthorn may enhance the activity of digoxin, a medication used for irregular heart rhythms.
Beta-blockers: These drugs are used to treat heart disease by lowering blood pressure and dilating blood vessels. Hawthorn can make the effects of these drugs stronger. They include:
- Atenolol (Tenormin)
- Metoprolol (Lopressor, Toprol-XL)
- Propranolol (Inderal, Inderal LA)
Calcium channel blockers (CCBs): These drugs are used to treat high blood pressure and angina by dilating blood vessels. Hawthorn can make the effects of these drugs stronger. They include:
- Norvasc (amlodipine)
- Cardizem (diltiazem)
- Procardia (nifedipine)
Phenylephrine: In a laboratory study, an alcoholic extract of hawthorn fruit reduced the effects of phenylephrine, a medication that constricts blood vessels and is commonly found in nasal decongestant products. Natural remedies, including cat's claw, coenzyme Q10 (CoQ10), fenugreek, fish oil, ginger, and other herbs.
Medications for male sexual dysfunction (Phosphodiesterase-5 inhibitors): When used together with Hawthorn, it may result in blood pressure dropping too low.
Nitrates: These medications increase blood flow to the heart and taking Hawthorn together with them might increase the chance of dizziness or light headedness.
Supporting Research
Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:182-192.
Brixius K, Willms S, Napp A, et al. Crataegus special extract WS 1442 induces an endothelium-dependent, NO-mediated vasorelaxation via eNOS-phosphorylation at serine 1177. Cardiovasc Drugs Ther. 2006;20(3):177-84.
Daniele C, Mazzanti G, Pittler MH, et al. Adverse-event profile of Crataegus spp.: a systematic review. Drug Saf. 2006;29(6):523-35.
Dasgupta A, Kidd L, Poindexter BJ, Bick RJ. Interference of hawthorn on serum digoxin measurements by immunoassays and pharmacodynamic interaction with digoxin. Arch Pathol Lab Med. 2010;134(8):1188-92.
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.
Fugh-Berman A. Herbs and dietary supplements in the prevention and treatment of cardiovascular disease. Prev Cardiol. 2000;3(1):24-32.
Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 4th ed. Montvale, NJ: Thomson Healthcare; 2007;279-284.
Habs M. Prospective, comparative cohort studies and their contribution to the benefit assessments of therapeutic options: heart failure treatment with and without Hawthorn special extract WS 1442. Forsch Komplementarmed Klass Naturheilkd. 2004;11 Suppl 1:36-9.
Holubarsch CJ, Colucci WS, Meinertz T, Gaus W, Tendera M; Survival and Prognosis: Investigation of Crataegus Extract WS 1442 in CHF (SPICE) trial study group. The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial. Eur J Heart Fail. 2008 Dec;10(12):1255-63.
Hwang HS, Boluyt MO, Converso K, Russell MW, Bleske BE. Effects of hawthorn on the progression of heart failure in a rat model of aortic constriction. Pharmacotherapy. 2009;29(6):639-48.
LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp; 2000:456-457.
Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2007.
Miller L. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(20):2200-2211.
Morelli V, Zoorob RJ. Alternative therapies: Part II. Congestive heart failure and hypercholesterolemia. [Review]. Am Fam Physician. 2000;62(6):1325-1330.
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.
Rakel: Integrative Medicine. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012.
Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:231-235.
Rigelsky JM, Sweet BV. Hawthorn: pharmacology and therapeutic uses. Am J Health Syst Pharm. 2002;59(5):417-422.
Schandry R, Duschek S. The effect of Camphor-Crataegus berry extract combination on blood pressure and mental functions in chronic hypotension - a randomized placebo controlled double blind design. Phytomedicine. 2008 Oct 15. [Epub ahead of print]
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.
Tadic VM, Dobric S, Markovic GM, Dordevic SM, Arsic IA, Menkovic NR, Stevic T. Anti-inflammatory, gastroprotective, free-radical-scavenging, and antimicrobial activities of hawthorn berries ethanol extract. J Agric Food Chem. 2008 Sep 10;56(17):7700-9.
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.
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.
Zapfe JG. Clinical efficacy of crataegus extract WS 1442 in congestive heart failure NYHA class II. Phytomedicine. 2001;8(4):262-266.