hawthorn

Complementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

REMS

Hypertension
Mild to moderate HF
Angina
Spasmolytic
Sedative

Action ⬆ ⬇

Active compounds in hawthorn include flavonoids and procyanidins.
Increase coronary blood flow.
Positive inotropic and chronotropic effects because of increased permeability to calcium and inhibition of phosphodiesterase.

Therapeutic effects:

Increased cardiac output.
Decreased BP, myocardial workload, and oxygen consumption.

Pharmacokinetics ⬆ ⬇

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	unknown	6–8 wk	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Pregnancy (potential uterine activity);
Lactation.

Use Cautiously in:

Concurrent use with ACE inhibitors and digoxin;
Do not discontinue use abruptly.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension (high dose), palpitations

Derm: rash

GI: nausea

Neuro: agitation, dizziness, fatigue, headache, sedation (high dose), sleeplessness, sweating, vertigo

Interactions ⬆ ⬇

Natural-Drug Products:

May potentiate effects of digoxin, calcium channel blockers, and beta blockers.
Concurrent use with phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil) and nitrates may potentiate vasodilatory effects.
May cause additive CNS depression when used with other CNS depressants.

Natural-Natural Products:

Additive effect with other cardiac glycoside–containing herbs (digitalis leaf, black hellebore, oleander leaf, and others).
Additive hypotensive effects with herbs than lower BP such as ginger, Panax ginseng, coenzyme Q-10, and valerian.
Additive effect with other cardioactive herbs (devil’s claw, fenugreek, and others).

Route/Dosage ⬆ ⬇

PO (Adults ): Heart failure: 160–1800 mg standardized hawthorn leaf with flower extract in 2–3 divided doses daily. Hawthorn fluid extract (1:1 in 25% alcohol): 0.5–1 mL tid; hawthorn fruit tincture (1:5 in 45% alcohol): 1–2 mL tid; dried hawthorn berries: 300–1000 mg tid.

Availability ⬆ ⬇

(Generic available)

Dried fruit: OTC
Liquid extract of the fruit or leaf: OTC
Tincture of the fruit or leaf: OTC

Assessment ⬆ ⬇

Monitor intake and output rations and daily weight. Assess for peripheral edema, auscultate lungs for rales and crackles during therapy.
Assess BP and pulse periodically during therapy.

Implementation ⬆ ⬇

Administered as 2–3 divided doses daily at the same time.
May be taken without regard to food.

Patient/Family Teaching ⬆ ⬇

Advise patients that there are other proven therapies available for treatment of heart failure. These therapies should be employed prior to initiating treatment with hawthorn.
Tell patient not to take hawthorn without the advice of health care professional.
Instruct patients in the symptoms of a heart attack (pain in the region of the heart, jaw, arm, or upper abdomen; sweating; chest tightness) and heart failure (shortness of breath, chest tightness, dizziness, sweating) and to promptly notify health care professional and obtain emergency services if they occur.
Advise patient to report weight gain or persistent swelling of the feet to health care professional.
May cause dizziness and fatigue. Patients should avoid driving or other activities that require mental alertness until response to herb is known.
Avoid alcohol and other CNS depressants while taking hawthorn without consulting health care professional.
Profuse sweating and dehydration under extreme heat may increase the BP-lowering properties of hawthorn, leading to severe hypotension. Caution patients to avoid exertion in hot weather to minimize the risk of side effects.
Instruct patients that hawthorn helps control the symptoms of heart failure but does not cure the disease. Lifestyle changes (salt restriction, weight management, exercise as tolerated, adherence to medication regimens) still need to be followed.
Instruct patient to consult health care professional before taking Rx, OTC, or other herbal products concurrently with hawthorn.
Advise females of reproductive potential to use effective contraception during therapy and to notify health care professional if pregnancy is planned or suspected or if breast feeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇