Hawthorn

The name hawthorn is derived from hedgethorn, reflecting this spiny tree's use as a living fence in much of Europe. Besides protecting estates from trespassers, hawthorn has also been used medicinally since ancient times. Roman physicians used hawthorn as a heart drug in the first century A.D., but most of the literature from that period focuses on its symbolic use for religious rites and political ceremonies. During the Middle Ages, hawthorn was used for the treatment of dropsy, a condition we now call congestive heart failure. It was also used for treating other heart ailments as well as for sore throat.

Meaningful evidence indicates that hawthorn is a safe and effective treatment for congestive heart failure (CHF). Like other treatments used for CHF, hawthorn improves the hearts pumping ability. However, it may offer some important advantages over certain conventional drugs used for this condition. Digoxin, as well as other medications that increase the power of the heart, also make the heart more susceptible to dangerous irregularities of rhythm (arrhythmias). In contrast, preliminary evidence indicates that hawthorn may have the unusual property of both strengthening the heart and stabilizing it against arrhythmias. It is thought to do so by lengthening what is called the refactory period. This term refers to the short period following a heartbeat during which the heart cannot beat again. Many irregularities of heart rhythm begin with an early beat. Digoxin shortens the refractory period, making such a premature beat more likely, while hawthorn protects against such potentially dangerous breaks in the hearts even rhythm. Another advantage of hawthorn is its lower toxicity. With digoxin, the difference between the proper dosage and the toxic dosage is dangerously small. Hawthorn has an enormous range of safe dosing. However, keep in mind that digoxin is itself an outdated drug. There are many newer drugs for CHF (such as ACE inhibitors) that are much more effective, and have been proven to save lives. Hawthorn has not been shown to provide the same benefit. And it is not clear whether one can safely combine hawthorn with other drugs that affect the heart. Furthermore, CHF is simply too dangerous a condition to rely solely on self-treatment. The bottom line: if you have CHF, do not use hawthorn except under close physician supervision. In addition to CHF, hawthorn is sometimes used as a treatment for annoying heart palpitations that have been thoroughly evaluated and found to be harmless. Common symptoms include occasional thumping as well as episodes of racing heartbeat. These may occur without any identifiable cause and may not require any medical treatment, except for purposes of comfort. However, there is no evidence that hawthorn is effective for this purpose. Furthermore, because there are many dangerous kinds of heart palpitations, it is absolutely necessary to get a thorough checkup first. It is only worth considering hawthorn as a treatment for palpitations if a doctor tells you that you have no medically significant heart problems. Finally, hawthorn is sometimes recommended for the treatment of high blood pressure, but its effects appear to be marginal at best. Hawthorn has also been tried for other heart-related conditions, such as angina and atherosclerosis in general, but there is little direct evidence to support these uses.

At least 9 double-blind, placebo-controlled trials, involving a total of more than 500 participants, have found hawthorn effective for the treatment of mild to moderate CHF; in addition, one study of more than 200 individuals found hawthorn helpful in more severe CHF, as well. In the most recent of these studies, 209 individuals with relatively advanced congestive heart failure (technically, New York Heart Association [NYHA] class III) were given either 1800 mg or 900 mg of standardized hawthorn extract or matching placebo. The results after 16 weeks of therapy showed significant improvements in the hawthorn groups as compared to the placebo groups. Benefits in the high-dose hawthorn group included a reduction in subjective symptoms as well as an increase in exercise capacity. Subjective symptoms improved to a similar degree in the lower-dose hawthorn group, but there was no improvement in exercise capacity. A comparative study suggests that hawthorn extract (900 mg) is about as effective as a low dose of the conventional drug captopril. However, while captopril and other standard drugs in the same family have been shown to help reduce hospitalizations and mortality associated with CHF, there is no similar evidence for hawthorn.

The usual dosage of hawthorn is 300 to 600 mg, 3 times daily of an extract standardized to contain about 2 to 3% flavonoids or 18 to 20% procyanidins. Studies indicate that full effects may take up to six months to develop, although some improvement should be apparent much sooner.

Hawthorn appears to be safe. Germanys Commission E lists no known risks, contraindications, or drug interactions with hawthorn, and mice and rats have been given very large doses without showing significant toxicity. In clinical trials, reported side effects were rare, consisting primarily of mild stomach upset and occasional allergic reactions (skin rash). Perhaps the biggest risk with hawthorn is that using it instead of conventional treatment might increase risk of death or other complications of CHF. In addition, it is not known whether hawthorn can be safely combined with other drugs that affect the heart. Therefore (to reiterate) do not self-treat CHF with hawthorn! A physicians supervision is essential. Safety in young children, pregnant or nursing women, or those with severe liver, heart, or kidney disease has not been established.

If you are taking any medications that affect the heart, it is possible that taking hawthorn could cause problems.