Taxonomic class

Rosaceae

Common Trade Names

Alvita Teas Hawthorne Berry, Cardio Health Hawthorne Berry #6 Syrup, Cardiplant, Gaia Herbs Hawthorn Berry A/F, Gaia Herbs Hawthorn Berry Solid, Gaia Herbs Hawthorn Supreme, Gaia Herbs Hawthorn Supreme SFSE, Hawthorne Berry, Hawthorne Formula, Hawthorne Heart, Hawthorne Phytosome, Hawthorne Power, Heart Foods Company Hawthorne plus, Heart Foods Company Power Caps Hot Cayenne with Hawthorne and Ginger, Herbalist and Alchemist Hawthorn-Cactus Extract, Herbalist and Alchemist Hawthorn­Fruit/Flower Extrac, Natrol Hawthorne Berry Capsules, Nature’s Answer Hawthorne Berry Low Alcohol, Nature’s Answer Hawthorne C+ Combo, Standardized Full Potency Hawthorne Berry Extract Vegicaps

Common Forms

Available as biological extracts (4 mg/ml of vitexin-2-0-rhamnoside); capsules of berries (510 mg) or leaves (80 mg) standardized to 15 mg of oligomeric procyanidines; and extended-release capsules (300 mg of 1.8% vitexin-2-rhamnoside and hyperoside).

Source

Active ingredients are extracted from the berries, flowers, and leaves of

Crataegus species, commonly C. laevigata, C. monogyna, or C. folium. More than 300 Crataegus species are found in the temperate regions of North America, Asia, and Europe.

Chemical components

Hawthorn is composed primarily of proanthocyanidins and flavonoids (quercetin, hyperoside, vitexin, vitexinrhamnoside, rutin); other constituents include catechin and epicatechin.

Actions

Studies on animals and in vitro models have suggested CV actions that

include ACE inhibition, beta-blocking activity, dilation of coronary arteries, hypotensive effects, and negative and positive inotropic effects. The high bioflavonoid content in some hawthorn species may show antioxidant activity and be cardioprotective in experimental ischemic animal models; the extracts decreased myocardial oxygen consumption and left ventricular work . Prophylactic antiarrhythmic potential has also been shown in rabbits that received aconitine. Mild CNS depressant effects have been documented for the hawthorn flower extract.

Reported Uses

Claims for hawthorn surround its use in arteriosclerosis, Buerger’s disease, heart failure, hypertension, and paroxysmal tachycardia. It may be therapeutically useful in the treatment of New York Heart Association (NYHA) functional class II (mild to moderate) heart failure. Patients with this class of heart failure who received a daily dose of 600 mg of hawthorn extract showed significant clinical improvement over an 8­week period .

Hawthorn, either alone or with coenzyme Q10, was found to be beneficial and also compared favorably to captopril for patients with heart failure. Other studies have noted the herb’s usefulness in patients with stable angina pectoris .

Dosage

A dose of 160 to 900 mg of a standardized extract containing 2.2% flavonoids or 18.75% oligomeric procyanidines given P.O. b.i.d. or t.i.d. The amount of flavonoid (calculated as hyperoside) is 3.5 to 19.8 mg and that of procyanidins (as epicatechin) is 30 to 168.7 mg.

Adverse Reactions

CNS: fatigue, sedation (with high doses).

CV: arrhythmias and hypotension (with high doses).

GI: nausea.

Respiratory: respiratory failure (in animals).

Skin: sweating.

Interactions

Antihypertensives, nitrates: Increased risk of hypotension. Monitor blood pressure closely.

Cardiac glycosides: Increased effects of these drugs. Use cautiously.

CNS depressants: May cause additive effects. Use cautiously.

Contraindications and precautions

Hawthorn is contraindicated in patients who are hypersensitive to other members of the Rosaceae family and in pregnant or breast-feeding patients.

Special considerations

Monitor the patient for adverse CNS effects.

Instruct the patient to use hawthorn only under medical supervision.

Caution the patient to avoid hazardous activities until hawthorn’s CNS effects are known.

Inform the patient that other proven therapies for heart failure should be pursued before taking hawthorn.

Urge the patient to seek emergency medical treatment if he becomes short of breath or if pain occurs in the heart region and spreads to the arm, lower jaw, or upper abdomen.

Urge the patient who chooses to self-medicate to seek medical advice if symptoms continue for longer than 6 weeks.

Points of Interest

Germany’s Federal Institute for Drugs and Medical Devices has approved the use of hawthorn leaf with flower extracts in the treatment of NYHA functional class II heart failure. The extract of berries has not been approved because efficacy has not been shown.

Berry preparations are commonly advertised as a supplement to strengthen and invigorate the heart and circulatory system.

Commentary

Hawthorn has long been used for heart failure in Europe. Several foreign studies suggest that it may be effective in treating NYHA functional class II heart failure. Long-term studies using hawthorn that demonstrate prolonged survival are lacking. Future studies should focus on evaluating improvements in NYHA heart failure class, hospital admission rates, quality of life measurements, and whether hawthorn extracts have an effect on mortality.