Download Hawthorn (Crataegus laevigata, C. oxyacantha, C. monogyna, C

Hawthorn (Crataegus laevigata, C. oxyacantha, C.
monogyna, C. pentagyna)
Natural Standard Bottom Line Monograph, Copyright © 2007 (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.
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.
Related Terms:
Aubepine, bei shanzha, bianco spino, bread and cheese tree, Cardiplant®, Chinese
hawthorn, cockspur, cockspur thorn, crataegi flos, Crataegi folium, Crataegi folium cum flore,
Crataegi fructus, Crataegi herba, Crataegisan, Crataegus azaerolus, Crataegus cuneata,
Crataegus fructi, Crataegus monogyna, Crataegus nigra, Crataegus oxyacanthoides,
Crataegus pentagyna, Crataegus pinnatifida, Crataegus sinaica boiss, Crataegutt®, English
hawthorn, epine blanche, epine de mai, Euphytose (EUP) (combination product), Fructus
oxyacanthae, Fructus spinae albae, gazels, haagdorn, hagedorn, hagthorn, halves,
harthorne, haw, Hawthorne Berry®, Hawthorne Formula®, Hawthorne Heart®, Hawthorne
Phytosome®, Hawthorne Power®, hawthorn tops, hazels, hedgethorn, huath, ladies' meat,
LI 132, may, mayblossoms, maybush, mayhaw, maythorn, mehlbeerbaum, meidorn, nan
shanzha, northern Chinese hawthorn, oneseed, oneseed hawthorn, quickset, red haw, RN
30/9, sanza, sanzashi, shanza, shan zha rou, southern Chinese hawthorn, thorn-apple tree,
thorn plum, tree of chastity, Washington thorn, weissdorn, Weissdornblaetter mit Blueten,
whitethorn, whitethorn herb, WS 1442.
Hawthorn, a flowering shrub of the rose family, has an extensive history of use in
cardiovascular disease, dating back to the 1st Century. Modern day animal and in vitro
studies suggest that flavonoids and other pharmacologically active compounds found in
hawthorn may synergistically improve performance of the damaged myocardium, and
further, may prevent or reduce symptoms of coronary artery disease.
Numerous well-conducted human clinical trials have demonstrated safety and efficacy of
hawthorn leaf and flower in New York Heart Association (NYHA) Class I-II heart failure
(characterized by slight or no limitation of physical activity). An international, multi-center
randomized controlled trial is currently underway to investigate long-term benefits.
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
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.
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.
Uses
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 efficacious in
the treatment of mild-to-moderate congestive heart failure (CHF), improving
exercise capacity, and alleviating symptoms of cardiac insufficiency. However, 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 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
Coronary artery disease (angina)
Hawthorn has not been tested in the setting of concomitant drugs such as betablockers or ACE-inhibitors, which are often considered to be standard-of-care. At
this time, there is insufficient evidence to recommend for or against hawthorn for
coronary artery disease or angina.
C
Functional cardiovascular disorders
Two randomized trials have found efficacy of herbal combinations containing
hawthorn in the treatment of functional cardiovascular symptoms. However, due to a
lack of controlled information on hawthorn monotherapy, there is insufficient
evidence to recommend for or against hawthorn for functional cardiovascular
disorders.
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).
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, antibacterial,
antioxidant, anxiety, appetite stimulant, asthma, astringent, bladder disorders, Buerger's
Statistically
The
dosagesignificant
range recommended
trials have used
in review
doses
literature
of 100 milligrams
is 160-900three
milligrams
times hawthorn
per day, 200
extract
disease,
cancer,
cardiac
arrhythmia,
circulation, diabetes insipidus, diabetes mellitus,
Children
Side
Effects
anddivided
Warnings:
18
years):
milligrams
per
day(younger
in 2-3
twice
athan
day,doses
and
up
(corresponding
to 300 milligrams
to 3.5-19.8
three times
milligrams
a day for
flavonoids
productsorcontaining
30-168.8
diarrhea, diuresis, dysentery, dyspepsia, dyspnea, edema, frostbite, fumitory, cardiac
standardized
milligrams
oligomeric
extract
LI
procyanidines).
132
(2.2% flavonoids).
Some associated
sources recommend
a range
of 240-480
Not
There
recommended.
are limited
reports
of adverse
effects
with hawthorn.
Numerous
human
hemorrhoids,
HIV, hyperlipidemia,
hypertension,
insomnia,
orthostatic
Themurmurs,
belowFood
U.S.
doses
and
are
Drug
based
Administration
onextracts
scientific
does
research,
not over
strictly
publications,
regulate
traditional
herbsoligomeric
and
use,
supplements.
or
expert
opinion.
Therehave
isMany
no guarantee
herbs and
of
milligrams
per
day
for
standardized
to 18.75%
procyanidines.
trials,
observational
studies
including
4,500
patients,
and
case
reports
noted
rare
hypotension,
nephrosis,
peripheral
artery
disease,
skin sores,
sore
throat,
spasmolytic,
supplements
strength,
purity
have
or safety
not
been
of products,
thoroughly
and
tested,
effects
and
may
safety
vary.
and
Youeffectiveness
should
always
may
read
notproduct
be
proven.
labels.
Brands
If youmay
have
beamade
adverse
effects,
including
abdominal
discomfort,
nausea,
agitation,
dizziness,
headache,
differently,
medical
condition,
withaches,
variable
or are
ingredients,
taking other
even
drugs,
within
herbs,
theor
same
supplements,
brand. The
you
below
should
doses
speak
maywith
notaapply
qualified
to allhealthcare
products. You
stomach
varicose
veins.
should read
provider
before
product
starting
labels,
a new
andtherapy.
discussConsult
doses with
a healthcare
a qualified
provider
healthcare
immediately
provider ifbefore
you experience
starting therapy.
side effects.
Adults (18 years and older):
Allergies:
Avoid
For
congestive
if allergic heart
to hawthorn
failure, or
statistically
to members
significant
of the Crataegus
trials havegenus.
used doses
Thereof
is 60
a case
milligrams
report of
three
an
immediate-type
times per dayhypersensitivity
or 80 milligramsreaction
twice a to
day
hawthorn
for products
plants.
containing
It is not known
standardized
if this applies
extract
WSoral
to
1442
formulations.
(18.75% oligomeric procyanidines). The U.S. brand HeartCare® (Nature's Way) is
standardized in this fashion.
fatigue, dyspnea, skin rash, insomnia, diaphoresis, and tachycardia.
Pregnancy and Breastfeeding:
Not recommended due to lack of sufficient data.
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 also have additive activity with medications that reduce cholesterol levels.
Interactions with Herbs and Dietary Supplements:
Hawthorn may add to the effects on the heart of agents containing cardiac glycosides.
Hawthorn may add to the effects of agents that lower blood pressure.
Hawthorn may have additive activity with agents that reduce cholesterol levels such as
garlic, niacin, or fish oil (omega-3 fatty acids).
This information is based on a systematic review of scientific literature edited and peerreviewed by contributors to the Natural Standard Research Collaboration
(www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the
available scientific articles. For comprehensive information about alternative and complementary therapies on the
professional level, go to www.naturalstandard.com. Selected references are listed below.
1.
Ammon HP, Handel M. [Crataegus, toxicology and pharmacology, Part I: Toxicity (author's transl)]. Planta Med
1981;43(2):105-120. View Abstract
2.
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]. Wien Med Wochenschr 1974;124(24):378-381. View Abstract
3.
Bodigheimer K, Chase D. [Effectiveness of hawthorn extract at a dosage of 3x100mg per day]. Munch Med Wschr
1994;136 Suppl 1:s7-s11.
4.
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
5.
Forster A, Forster K, Buhring M, et al. Crataegus bei massig reduzierter linksventrikularer Auswurffraktion.
Ergospirometrische Verlaufsuntersuchung bei 72 Patienten in doppel-blindem Vergleich mit Plazebo. [Crataegus for
moderately reduced left ventricular ejection fraction. Ergospirometric monitoring study with 72 patients in a double-blind
comparison with placebo]. Munch Med Wschr 1994;136(suppl 1):s21-s26.
6.
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
7.
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
8.
Leuchtgens H. [Crataegus Special Extract WS 1442 in NYHA II heart failure. A placebo controlled randomized doubleblind study]. Fortschr Med 1993;111(20-21):352-354. View Abstract
9.
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
10. 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.
11. 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
12. 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
13. 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.
14. 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
15. Zapfe JG. Clinical efficacy of crataegus extract WS 1442 in congestive heart failure NYHA class II. Phytomedicine
2001;8(4):262-266. View Abstract
Natural Standard Monograph (www.naturalstandard.com)
Copyright © 2007 Natural Standard Inc. Commercial distribution or reproduction prohibited.
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.