Health Care Professional Information

Scientific Name
Crataegus monogyna
Common Name

May flower, quickthorn, whitehorn

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. 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). But a hawthorn extract did not affect blood pressure in hypertensive individuals (18).

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

Purported Uses
  • Angina
  • Atherosclerosis
  • Congestive heart failure
  • Hypertension
  • Indigestion
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
    (4) (15)
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. The cardiac action of the flavonoids is thought to be via inhibition of the 3',5'-cyclic adenosine monophosphate phosphodiesterase (4).

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

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

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).
  • Cytochrome P450 (CYP) 3A4 substrates: Hawthone extract induces CYP3A4 by activating pregnane X receptor (PXR). This may increase the clearance of substrate drugs when used concomitantly (19).
Literature Summary and Critique

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.
Seventy-nine patients with type 2 diabetes taking prescription drugs were randomised to receive 1200 mg hawthorn extract or a placebo, daily for 16 weeks. At baseline and outcome a well-being questionnaire was completed. Blood pressure and fasting blood samples were taken and a food frequency questionnaire was used to estimate nutrient intake. Researchers reported a significant group difference in mean diastolic blood pressure reductions (P = 0.035): the hawthorn group showed greater reductions (baseline: 85.6 mmHg, 95% confidence interval [CI] = 83.3 to 87.8; outcome: 83.0 mmHg, 95% CI = 80.5 to 85.7) than the placebo group (baseline: 84.5 mmHg, 95% CI = 82 to 87; outcome: 85.0 mmHg, 95% CI = 82.2 to 87.8). But there was no group difference in systolic blood pressure reduction from baseline (P = 0.329). The mean sugar intake was higher and there were indications of potential multiple micronutrient deficiencies.
Hawthorn may have hypotensive effects in diabetic patients.

Dosage (Inside MSKCC Only)
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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.
  18. Asher GN, Viera AJ, Weaver MA, Dominik R, Caughey M, Hinderliter 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 Mar 29;12:26.
  19. Xu Y, Zhang Y, Zhou F, et al. Human pregnane X receptor-mediated transcriptional regulation of CYP3A4 by extracts of 7 traditional Chinese medicines. Zhongguo Zhong Yao Za Zhi. 2011 Jun;36(11):1524-7.

Consumer Information

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 a 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.

Purported Uses
  • To treat angina
    Hawthorn showed benefit in patients with congestive heart failure.
  • To treat atherosclerosis
    Hawthorn showed benefit in patients with heart disease.
  • To treat congestive heart failure
    A few studies 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.
Research Evidence

Diabetes
Seventy-nine patients with type 2 diabetes taking prescription drugs were randomised to receive 1200 mg hawthorn extract or a placebo, daily for 16 weeks. At baseline and outcome a well-being questionnaire was completed. Blood pressure and fasting blood samples were taken and a food frequency questionnaire was used to estimate nutrient intake. Researchers reported a significant group difference in mean diastolic blood pressure reductions, but there was no group difference in systolic blood pressure reduction from baseline. The mean sugar intake was higher and there were indications of potential multiple micronutrient deficiencies. Hawthorn may be effective in lowering hypertension in diabetic patients.

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).
Side Effects
  • Nausea
  • Fatigue
  • Sedation
  • Sweating
  • Overdose can result in low blood pressure and cardiac arrhythmias
E-mail your questions and comments to aboutherbs@mskcc.org.