Hawthorn ( 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 , 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 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 ®, 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 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 and 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 for treating New York Heart Association (NYHA) Class I-II heart failure, with standardization of its and . 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 * Grade proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

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 A

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.

Coronary artery disease (angina)

Hawthorn has not been tested in the setting of concomitant drugs such as beta- blockers or ACE-inhibitors, which are often considered to be standard-of-care. At C

this time, there is insufficient evidence to recommend for or against hawthorn for coronary artery disease or angina.

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 C lack of controlled information on hawthorn monotherapy, there is insufficient evidence to recommend for or against hawthorn for functional cardiovascular disorders.

*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 StThate isdtosicallyage s rianggnifeic antrec otrialsmmen havdeed usin edrev dosiewes lit eratof 1u00re misill 16igr0a-m900s t hrmeeilligra timmess haperw tdayhor,n 20 ex0t ract disease, cancer, cardiac arrhythmia, circulation, diabetes insipidus, diabetes mellitus, CSihdmperieldi lligEfr edfenraay cts(ym inso u2taw-nn3icgd dere Wiv a idtar hdayedanni n, d 1gaos8s:nd esy earu (cp sorrto): 3es00p ondmillinigrga tmo s3. t5hre-19.e 8ti mmesilli graa dmays fforlav ponrodoiucdst sor c ont30-a1ini68.ng8 diarrhea, diuresis, dysentery, dyspepsia, dyspnea, edema, frostbite, fumitory, cardiac NTsmthotandilliger receraard armomeizs mliedomlige itndexoemdted.rac ereric pot LI prrt s13oc of2y aadv(2.nidi2%enesrs felav). ef Soonfecoidsmtse ass).ou socrciesated rec woitmhm haendwth aor rn.an Ngeu mofe 240rous-4 hu80m an murmurs, hemorrhoids, HIV, hyperlipidemia, hypertension, insomnia, orthostatic Thetm rialsbUie.lligSlo.w ,Fra obsodmodss eerva spn aderatr De idrbonuayags alAe fd or smotn iudinex sisctesirreaacnti toinciftnisc drlsoudietesandes nganrocardt h ovs, tprizeriucbtedl lyi4,c r aet50togiou n018.las ,tp etat75r haedient%ritbios olin saa,n lgo andu ssmeud,p ericocprasl eem xeprocpe enrreptts .oy Tortpaniihneisordin enh .i avsMes naeon. y gn uhotaeredrabnst eraaren doe f hypotension, nephrosis, peripheral artery disease, skin sores, sore throat, spasmolytic, sutrpeadvpnlgetmhe,e rspnutesri thyefa ovfrece s natofset, tb yince oefn lup trhdioodngruocut gsah, bdalyn tdoe msetfefienaldc, tas n dismd asyca ofveamtyry fa.o nYrtdo, u enaus fsfehcotuiveldea, nael wsagitsa ymsata ryeio andon, tp brdizoed puzrcointv leesanb.es Bl,s r.ahea Inf dysodac um haayhe,v bee a m ade dmifefedsritceomanlt lcyaco, nwdhiti htiaco vnahes,r oiarb a,le rev i nartagkicreinosdgie oentt hsve,eins re dverun.g ws,i theinr bths,e o sra smuep pbleramnedn. tTsh, ey obue lsohwo udlods sepse maka yw nitho ta a qpupalyl iftioe da lhl peraoltdhuccatrse. You sphroovuidlde re baedf oprreo dsutacrtt ilnagb eal sn,e awn dth deirsacpuys.s C doonsseuslt wai thhe aa lqthucaalirfeie dp rhoevaidltehrc iamrem perdoiavtideelyr ibf eyfoour ee xsptaerrtiienngc teh esriadpey e. ffects.

Aldlerultgsie (1s:8 years and older): FAvoroi cdon if gesalletrgicive heto artha wfailthure,orn orst attois mticeallymbe srsignif of ictheant C trrialsataeg havuse ge usnused .dos Theesre of is 60a c masilliegra reportms of tanhree im mtimediesat pee-try daype hy orpers 80 mensilliitgraivitmy sr eactwictioe na tdoa hya fwort hproornduc platsnt csont. It ainiis notng ksnowtandnard if tizhised ap explitracest Wto Soral 144 fo2r m(18.ulat75io%ns ol. igomeric 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 peer- reviewed 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 double- blind 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.