Crataegus

Common Names: Crataegus; Hawthorn, Hedgethorn, Maythorn, Quickset, Red Haw, Thorn-apple tree, Whitethorn.

Clinical Names: Crataegus oxyacantha, Crataegus laevigata, Crataegus monogyna

Summary

botanical names: Crataegus oxyacantha (syn. C. laevigata), Crataegus monogyna.

alternate spelling: Crategus

common names: Hawthorn.

overview of interactions:
• herb affecting drug toxicity: Cardiac Glycosides, Digoxin

• herbal synergy: Herb group: Cardiovascular: Glycoside-containing Herbs

• herbal synergy: Herb group: Cardiovascular: Vasodilator Herbs

AHPA Botanical Safety Rating: 1





Clinical

botanical names: Crataegus oxyacantha (syn. C. laevigata) Crataegus monogyna.

alternate spelling: Crategus

common names: Hawthorn (Hawthorne), Hedgethorn, Maythorn, Quickset, Red Haw, Thorn-apple tree, Whitethorn.

parts used: Berries, flowers, leaves.

qualities: Sweet, slightly bitter, cool, dry, astringent.

affinities: Heart, arteries, blood.

actions: Cardiotonic, myocardial trophorestorative; coronary and peripheral vasodilator, anti-arrhythmic, antioxidant, hypocholesterolemic, hypotensive, positive inotrope.

dosage:
• Tincture: (flowers & leaves) 1 - 2 ml. three times daily. Tincture (berries) : 2 - 4 ml. three times daily. (Preparations may vary, some are 50/50 Flower/Berries.)
• Dried herb: Infusion (flowers & leaves); Decoction (berries) Two teaspoons per cup (30gm./500m.) One cup three times daily.
• Powdered dried herb: 500 - 1000 mg. three times daily.
• Standardized Extract: 100 - 250 mg. Three times daily. (Standardized to 1.8% vitexin or 10% total flavonoids as hyperoside).

therapy: Coronary artery disease; angina pectoris; myocardial hypoxemia; Cardiac insufficiency (NYHA Stage I and II), arrhythmias; senile degeneration of the heart and atherosclerosis; post-infectious weakening of myocardium; paroxysmal tachycardia; Buerger's disease, synergist to reduce dosage of cardiac glycoside containing herbs or cardiac glycoside pharmaceuticals such as digoxin..
(British Herbal Pharmacopoeia.1983: Weiss RF. 1988, 164-165)

specific indications: Hypertension with myocardial weakness, angina pectoris.

AHPA Botanical Safety Rating: 1

toxicity: Crataegus has minimal or negligible toxicity. The safe therapeutic dose range for hawthorn is wide. The herb may be used for extended periods where necessary, even at the higher doses. Generally dosage will be proportional to the severity of the condition. Adverse effects reported during therapy with Crataegus in 3664 patients with stage I or II heart failure were causally attributed to the Crataegus in only 22 cases. The majority (7) reported mild gastro-intestinal disturbance.
(Loew D, et al. 1996.)

contraindications:
None known or cited in literature. Cardiac patients taking prescription medications: See Interactions section.

constituents:
• Flavonoids: (hyperoside, vitexin rhamnosides).
• Oligomeric procyanidins and flavans: (catechin and epicatechin dimers to octomers).
• Triterpene derivatives: (including oleanolic acid, ursolic acid).
• Aromatic acids:(chlorogenic and caffeic acids).
• Alkylamines: (including acetylcholine, dopamine).
• Other: purines, uric acid, ascorbate, amygdalin, volatile oil.

pharmacology:
• Cardioactivity: It is established that Crataegus oligomeric procyanidins and flavonoids increase myocardial and coronary blood flow, that it is positively inotropic and hypotensive, but the mechanism of action is unclear. Crataegus flavonoids inhibit cAMP Phosphodiesterase, and myocardial Na⁺/K⁺ ATP'ase. The same compounds exhibit high antioxidant free radical scavenging activity, and are hypolipidemic via an action on hepatic LDL receptors and increased bile secretion. Crataegus also inhibits TXA2 (Thromboxane) formation, while stimulating prostacycline. Crataegus prolongs rather than reduces the myocardial refractory period, unlike most positive inotropes, hence reducing risk of arryhthmia. Animal studies have confirmed the ability of Crataegus to lower blood pressure, increase myocardial perfusion, minimize ischemic damage (reduces post infarct LDH by 50%).
(For comprehensive review see: American Herbal Pharmacopoeia, 1998.)

Clinical trials:
Several controlled studies have been performed with Crataegus extracts and NYHA stage I and II cardiac insufficiency patients. Crataegus increased exercise tolerance, decreased systolic BP and heart rate, decreased severity of symptoms subjectively as well as HR and BP. In another group (n=1476) Crataegus decreased symptom severity by 66%, and was associated with systolic drop of 10mm and diastolic drop of 5mm average blood pressure.
(Leuchtgens H. Fortschr. Med. 1993.111:352-354; Loew D, et al. Second International Congress on Phytomedicine. Munich 1996; Schmidt U, et al. Phytomedicine, 1994.1:17-24.)




Interactions

herb affecting drug toxicity: Digoxin, Cardiac glycosides

• Crataegus may potentiate the activity of cardiac glycosides including digitoxin, digoxin, etc., due to its positive inotropic effects. Patients using these medications should be monitored by a physician or practitioner familiar with the use of cardiac herbs because the dose of pharmaceutical drug will need to be reduced during intercurrent therapy.

herbal synergy: Herb Group: Cardiovascular: Glycoside-containing Herbs

• Crataegus will synergize in combination with the cardiac glycoside-containing herbs such as Convallaria, Digitalis, Strophanthus, Urginea, Apocynum and others, as well as the hypotensive alkaloids of Veratrum and Rauwolfia. Some synergistic activity can be expected with other vasodilator herbs (see below). Western clinical herbalists use Crataegus as an adjuvant to lower the required dose of these more toxic herbs, or to reduce the dose of pharmaceutical digoxin.
(Van Hellemont J. 1985.)

herbal synergy: Herb Group: Cardiovascular: Vasodilator Herbs

• Crataegus is vasodilatory, and may additively combine with herbs from this group. Vasodilatory herbs may potentiate hypotensive medications. Synergy with Allium sativum (Garlic) has been observed in animal studies in protecting against isoprenaline induced myocardial necroses.
(Ciplea AG, Richter KD. Arzneim-Forsch; 1988 38:1583-1592; Van Hellemont J. Compendium de Phytotherapie 1985.)

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Do not rely solely on the information in this article.

References

American Herbal Pharmacopoeia: Hawthorn Monograph . Santa Cruz, CA. 1998.

Bradley PR, ed. British Herbal Compendium, vol 1. Bournemouth, Dorset, UK: British Herbal Medicine Association, 1992.

Brinker F. Botanical Medicine Research Summaries. (from Eclectic Dispensatory of Botanical Therapeutics, vol.11), Sandy, Oregon: Eclectic Medical Publications, 1995.

British Herbal Medical Association. British Herbal Pharmacopoeia. West Yorks, England: BHMA, 1983.

Ciplea AG, Richter KD. The protective Effects of Allium sativum and Crataegus on iosprnaline induced necrosis in rats. Arzneim-Forsch; 1988 38:1583-1592.

Leuchtgens H. Crataegus-spezialextrakt WS 1442 bei Herzinsuffizienz NYHA II, Eine plazebokontrollierte randomisierte Doppleblindstudie. Fortschr. Med. 1993.111:352-354.

Loew D, et al. Efficacy and tolerability of a hawthorn preparation in patients with heart failure stage I and II according to NYHA - a surveillance study. 2nd International Congress on Phytomedicine. Munich 1996.

Schmidt U, et al., Efficacy of the Hawthorn preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomedicine, 1994.1:17-24.

Van Hellemont J. Compendium de Phytotherapie.Belgium, Association Pharmaceutique Belge; 1985.

Weiss RF. Herbal Medicine. Gothenburg, Sweden: Ab Arcanum; Beaconsfield, England: Beaconsfield Publishers, Ltd., 1988.