About Herbs, Botanicals & Other Products

Scientific Name
Crataegus monogyna
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Common Name

May flower, quickthorn, whitehorn

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Clinical Summary

Derived from the flower, leaves, and fruits of the plant. Hawthorn has been used as an digestive aid in traditional Chinese medicine for centuries. But currently, it is used primarily to treat heart failure.
Hawthorn extract exhibited anti-inflammatory, gastroprotective, and antimicrobial properties in vitro (15). Clinical studies suggest effectiveness against congestive heart failure (10) (12) (14) and diabetes (13). Further research is needed to establish efficacy.

Frequently reported adverse events include nausea, sweating, and fatigue. Signs of overdose include hypotension and arrhythmias.

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Purported Uses
  • Angina
  • Atherosclerosis
  • Congestive heart failure
  • Hypertension
  • Indigestion
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Constituents
  • Amines: Phenyletylamine, tyramine, O-methoxyphenethylamine
  • Flavonoids: Flavonol (kaempferol, quercetin) and flavone (apigenin, luteolin) derivatives, rutin, vitexin glycosides, oligomeric procyanidins
  • Tannins: Condensed proanthocyanidins
  • Other constituents: Saponins, cyanogenetic glycosides
    (1)
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Mechanism of Action

It is thought that hawthorn causes direct dilation of smooth muscle in coronary vessels thereby lowering their resistance and increasing blood flow. Hawthorn is also characterized as having positive inotropic effects leading to an increase in heart rate, nerve conductivity, and heart muscle irritability (4).

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Contraindications
  • Patients taking Digoxin should avoid hawthorn (16).
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Adverse Reactions

Common: Nausea, fatigue, sedation, and sweating
Toxicity: Hypotension, arrhythmia
(7)

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Herb-Drug Interactions
  • Digoxin: Hawthorn contains alkaloids that are structurally similar to digoxin and can interfere with its action (16).
  • UGT (Uridine 5’-diphospho-glucuronosyltransferase) substrates: Hawthorn modulates UGT enzymes in vitro and can increase the side effects of drugs metabolized by them (17).
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Literature Summary and Critique

Iwamoto M, et al. Klinische Wirkiung von Crataegutt bei Herzerkrankungen ischasemischer und/oder hypertensiver Genese. Planta Med 1981;42:1-16.
A hawthorn preparation containing 30 mg hawthorn extract, standardized to 1 mg procyanidins, was used in a double-blind controlled study of 80 patients (35 active, 45 placebo). The hawthorn group reported a greater overall improvement of cardiac function, dyspnea, and palpitations. Improvements in ECGs were not found to differ. Nausea, fatigue, and sweating were reported in the hawthorn group.

Schmidt U, et al. Efficacy of the hawthorn preparation in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomedicine 1994;1:17-24.
Seventy-eight patients were administered hawthorn extract 600 mg/day or a placebo. After a one-week washout, patients were treated for eight-weeks. An ergometer bicycle was used to determine working capacity at baseline and during treatment. Between day zero and fifty-six, the working capacity of those taking hawthorn increased by 28 watts compared to 5 watts in those receiving placebo. There was a significant decrease in systolic blood pressure and heart rate as compared to placebo.

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References
  1. Newall C, et al. Herbal Medicines: A Guide for Health Care Professionals. London: Pharmaceutical Press; 1996.
  2. Tyler V. Herbs of Choice, the Therapeutical Use of Phytomedicinals. Binghamton: Pharmaceutical Press; 1994.
  3. Gildor A. Crataegus oxyacantha and heart failure. Circulation 1998;98:2098.
  4. Schussler M, Holzl J, Fricke U. Myocardial effects of flavonoids from Crataegus species. Arzneimittelforschung 1995;45:843-5.
  5. Upton R, et al. Hawthorn Leaf with flower: quality control, analytical and therapeutical monograph. Belmont (CA): American Herbal Pharmacopoeia; 1999:1-29.
  6. Blumenthal M, et al. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council; 1998.
  7. Iwamoto M, Sato T, Ishizaki T. Klinische Wirkung von Crataegutt bei Herzerkrankungen ischaemischer und/oder hypertensiver Genese. Planta Med 1981;42:1-16.
  8. Brinker, F. Herb Contraindications and Drug Interactions, 2nd ed. Sandy (OR): Eclectic Medical Publications; 1998.
  9. Walker, AF, et al. Promising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertension. Phytotherapy Res 2002;16:48-54.
  10. Degenring FH, Suter A, Weber M, Saller R. 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):363-9.
  11. Werbach MR, et al. Botanical Influences on Illness: A Sourcebook of Clinical Research. Third Line Press, 1994.
  12. Schmidt U, et al. Efficacy of the hawthorn preparation in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomedicine 1994;1:17-24.
  13. 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.
  14. Pittler M, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev 2008;(1):CD005312.
  15. Tadiæ VM, Dobriæ S, Markoviæ GM, et la. 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.
  16. 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 Aug;134(8):1188-92.
  17. Mohamed ME, Frye RF. Effects of herbal supplements on drug glucuronidation. Review of clinical, animal, and in vitro studies. Planta Med. 2011 Mar;77(4):311-21.
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How It Works

Bottom Line: Hawthorn has been shown to improve heart function, shortness of breath, palpitations, and exercise tolerance in people with heart failure. There is no evidence to support any other effects.

Hawthorn is a fruit extract that has been used as an digestive aid in traditional Chinese medicine for centuries. Scientists think that hawthorn extract causes dilation of the smooth muscle that lines coronary arteries, thereby increasing blood flow to the heart. Hawthorn is also thought to increase heart muscle contraction, heart rate, nerve transmission, and heart muscle irritability.

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Purported Uses
  • To treat angina
    Hawthorn shows some benefit in patients with congestive heart failure.
  • To treat atherosclerosis
    Hawthorn shows some benefit in patients with heart disease.
  • To treat congestive heart failure
    A handful of European studies have found that hawthorn extract improves cardiac function, shortness of breath, palpitations, and exercise tolerance in patients in NYHA functional class II, but no changes in electrocardiogram have been found. It is not known whether hawthorn is effective in patients with more serious heart disease.
  • To lower high blood pressure
    Data are conflicting. More research is needed.
  • To relieve indigestion
    Hawthorn has been used to relieve indigestion in traditional Chinese medicine for centuries. But clinical studies are lacking.
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Research Evidence

Heart disease:
A similar clinical trial gave 30 mg of hawthorn extract to 45 patients, and a placebo pill to 35 others. The group taking hawthorn reported a greater overall improvement of cardiac function, shortness of breath, and palpitations, but no difference in electrocardiogram, compared to the placebo group. Nausea, fatigue, and sweating were reported side effects of hawthorn.

Seventy-eight patients with New York’s Heart Association functional class II were given 600 mg of hawthorn daily or a placebo pill. After eight weeks, the exercise tolerance (as measured on a stationary bicycle) was greater in the group taking hawthorn than the placebo group. Patients taking hawthorn also had a significant decrease in systolic blood pressure and heart rate.

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Do Not Take If
  • You are taking Digoxin (Hawthorn can interfere with its actions).
  • You are taking drugs that are substrates of UGT (Uridine 5’-diphospho-glucuronosyltransferase) enzymes (Hawthorn may increase the risk of side effects of these drugs).
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Side Effects
  • Nausea
  • Fatigue
  • Sedation
  • Sweating
  • Overdose can result in low blood pressure and cardiac arrhythmias.
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Dosage (Inside MSKCC Only)
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Aliases
Crataegus Monogyna
Shan Zha
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E-mail your questions and comments to aboutherbs@mskcc.org.
Last updated: June 16, 2011