II. Background
- Hawthorn is a Crataegus species within a genus of spiny shrubs and trees
- Oldest known European medication (use first described 2000 years ago)
- Most studied preparations are derived from the flowering tops of plants
- Chinese medications use the Hawthorn berries for jelly or jam as a digestive aid
III. Mechanism
- Oligomeric procyanidins: Attenuate Myocardium damage and increase coronary Blood Flow
- Inhibit human Neutrophil elastase
- Free radical scavenger
- Flavinoids: Vasodilation, Platelet inhibitor and antioxidant
- Activate endothelium-derived relaxing factor
- Inhibit phosphodiesterase
- Antioxidant inhibits oxidation of LDL Cholesterol
- Inhibits Platelet aggregation
IV. Indications
- Adjunctive treatment of Congestive Heart Failure (NYHA Class I-III)
V. Contraindications
- Hypersensitivity to Crataegus products
VI. Precautions
- Caution patients not to use in place of standard, conventional Congestive Heart Failure medications
VII. Drug Interactions
- Herbs and supplements with cardiovascular activity
- Danshen
- Epimedium
- Ginger
- Panax ginseng
- Turmeric
- Valerian Root
- May enhance Digitalis activity
- Postulated Drug Interactions
- Vasodilators (e.g. phosphodiesterase type 5 inhibitors such as Viagra)
- Antihypertensives
- AntiHyperlipidemics
IX. Efficacy
- Meta-analysis by Cochrane suggests improved Exercise tolerance and decreased Fatigue and Shortness of Breath
- Pittler (2008) Cochrane Database Syst Rev (1): CD005312 [PubMed]
X. Dosing
- Ranges from 160 to 1800 mg daily divided 2-3 times per day