Hawthorn
Crataegus spp. (C. monogyna, C. laevigata)
Traditional cardiac tonic with real but modest add-on benefits in mild heart failure.
Moderate evidence
🫀Heart & Metabolic
Evidence tier
Moderate
Research weight
Citations
13 verified / 13
Classification
Heart & Metabolic
❝
What the evidence says. Several controlled trials; effects real but modest or context-dependent.
What is Hawthorn?
Hawthorn (Crataegus spp. (C. monogyna, C. laevigata)) is a heart and metabolic supplement used for improves symptoms of mild-to-moderate (nyha ii-iii) chronic heart failure such as exertional dyspnea and fatigue when added to standard therapy. NutriDex grades the human evidence as Moderate. Hawthorn (Crataegus spp.) is a long-used botanical whose standardized leaf-and-flower extracts have been studied as an add-on to conventional therapy for chronic heart failure. A 2008 Cochrane systematic review of 14 randomized placebo-controlled trials found that hawthorn extract improved heart-failure symptoms and objective measures such as maximal workload and the pressure-rate product. However, the large multinational SPICE trial (2,681 patients) found no significant effect on cardiac mortality or the combined cardiac event endpoint, so any benefit appears to be symptomatic rather than life-prolonging. Active constituents are thought to be oligomeric procyanidins and flavonoids, which exert mild positive inotropic, vasodilatory and antioxidant effects. Hawthorn is generally well tolerated, with infrequent, mild adverse events, but it can interact with cardiac drugs (notably digoxin) and should never replace evidence-based heart-failure pharmacotherapy. It is best viewed as an optional, physician-supervised adjunct of modest benefit.
Purported Benefits
✓Improves symptoms of mild-to-moderate (NYHA II-III) chronic heart failure such as exertional dyspnea and fatigue when added to standard therapy
✓Modestly increases exercise/work tolerance (roughly +5-7 watts on bicycle ergometry in pooled trials)
✓Lowers the pressure-rate product, indicating reduced cardiac oxygen demand
✓May modestly reduce blood pressure in some populations (weaker, less consistent evidence)
✓Does NOT improve survival or reduce cardiac mortality in heart failure (large SPICE trial showed no significant benefit)
Evidence by outcome
The same supplement can be well-proven for one use and unproven for another — here is the human evidence graded outcome by outcome.
| Outcome | Evidence | Effect | Studies |
|---|---|---|---|
| Chronic heart-failure symptoms (NYHA II-III)Cochrane/Pittler meta-analyses show improved dyspnea and fatigue as add-on therapy; symptomatic, not survival, benefit. | Moderate | ↑ benefit · small | 2 |
| Exercise / work tolerancePooled maximal workload up ~+5-7 W on ergometry; small effect and older trials. | Moderate | ↑ benefit · small | 2 |
| Cardiac mortality / eventsLarge SPICE trial (n=2,681) found no significant effect on cardiac mortality or event endpoint; no survival benefit. | Moderate | — no effect · negligible | 1 |
| Blood pressureOne 2025 meta-analysis shows ~-6.7 mmHg SBP, but an earlier review found inconsistent, weak effects. | Mixed | ↔ mixed · small | 2 |
Dosing & Compounds
Typical Dose
Standardized leaf-and-flower extract (e.g., WS 1442) 600-1800 mg/day in 2-3 divided doses, standardized to ~18.75% oligomeric procyanidins or ~2.2% flavonoids; benefits typically emerge over 6-12 weeks. Use only under medical supervision in diagnosed heart failure.
Active Compounds
Safety & Cautions
Generally well tolerated; the most common adverse effects are mild and transient (dizziness, nausea, GI upset, headache, palpitations). Because hawthorn has cardiovascular activity, it can interact additively with cardiac medications: it may potentiate digoxin and other cardiac glycosides, and may augment the effects of antihypertensives, nitrates, beta-blockers, calcium-channel blockers and PDE5 inhibitors, increasing risk of hypotension. Hawthorn can also interfere with some digoxin immunoassay measurements. It must NOT be used as a substitute for proven heart-failure therapy, and anyone with heart failure, arrhythmia, or cardiovascular disease should only use it under cardiologist supervision. Avoid in pregnancy and breastfeeding (insufficient safety data and theoretical uterine effects), and stop before surgery due to potential blood-pressure and cardiac effects. People on any cardiac, blood-pressure, or anticoagulant/antiplatelet medication should consult a clinician before use. Educational only — always check with your doctor or pharmacist before combining Hawthorn with any medicine.
Hawthorn drug interactions
Known or theoretical interactions between Hawthorn and common medications — educational, not exhaustive. Always check with your doctor or pharmacist before combining Hawthorn with any medicine.
Caution
May add to BP-lowering and vasodilator drugs, risking hypotension.
Hawthorn flavonoids cause vasodilation and mild BP lowering, additive with antihypertensives. MSKCC — Hawthorn
Caution
Digoxin
May add to digoxin's effect on heart contractility/rhythm; avoid uncontrolled co-use.
Hawthorn has positive inotropic, cardiac glycoside-like activity additive with digoxin. MSKCC — Hawthorn
Key Studies ★ 13 studies
Meta-analysis
Pharmaceuticals (Basel) 2025
✓ PubMed
Meta-analysis of 6 RCTs (n=428) found hawthorn reduced systolic blood pressure (pooled MD approximately -6.65 mmHg) in hypertensive patients, with a non-significant diastolic reduction.
Systematic review / meta-analysis (Cochrane)
8 trials, 632 patients (meta-analysis subset of 14 RCTs)
✓ PubMed
In a 2008 Cochrane review, hawthorn extract added to standard therapy improved maximal workload (weighted mean difference +5-7 watts) and pressure-rate product and reduced dyspnea and fatigue versus placebo in chronic heart failure.
Systematic review
Systematic review of controlled trials
✓ Full text
A systematic review of hawthorn for blood pressure found inconsistent and generally small effects, indicating evidence for an antihypertensive benefit is limited and not robust.
Meta-analysis
Pittler 2003 (Am J Med meta-analysis)
✓ PubMed
Meta-analysis of 13 RCTs (8 trials, 632 patients pooled) of hawthorn extract monopreparations in chronic heart failure showed greater maximal workload vs placebo (weighted mean difference +7 W, 95% CI 3-11, p<0.01), beneficial decrease in pressure-heart rate product (-20, 95% CI -32 to -8), and significant improvement in dyspnea and fatigue; adverse events infrequent, mild, transient.
Systematic review
Daniele 2006 (safety systematic review)
✓ PubMed
Systematic review of adverse-event profile across 24 clinical studies (5577 patients analyzed; doses 160-1800 mg/day, 3-24 weeks) found hawthorn monopreparations generally well tolerated; 166 adverse events, mostly mild-to-moderate (dizziness/vertigo, GI complaints, headache, palpitations); no drug interactions reported, though 8 severe events occurred with the LI 132 extract.
Clinical trial
Demiraǧ 2026
✓ PubMed
Randomised single-blind trial of hawthorn vinegar, black mulberry syrup, and green tea for oral mucositis and oral health-related quality of life in diabetes.
Agency / regulator
NCCIH
✓ Source
NIH/NCCIH evidence summary states hawthorn's effectiveness for heart failure is not established and warns of potential interactions with cardiovascular drugs such as digoxin.
Safety / toxicology
Pharmaceuticals (Basel) 2024
✓ Full text
Pharmacovigilance analysis of 1,527 VigiBase reports (1970-2023) found serious adverse reactions in ~12.6% of single-herb Crataegus cases, mainly GI, skin, and cardiac (palpitations, dizziness) events.
Large randomized controlled trial
2,681 patients (NYHA II-III, LVEF <=35%)
✓ PubMed
The SPICE randomized trial found Crataegus extract WS 1442 900 mg/day did not significantly reduce the primary cardiac event endpoint or cardiac mortality over ~2 years, though it was safe alongside guideline heart-failure medication.
Review
Louie 2026
✓ PubMed
The Gut-brain-adipose Axis in Ultra-processed Food and Obesity: A Mechanistic Synthesis and Its Implications for Food Classification
Review
Lafer 2026
✓ PubMed
Sedentary Behavior and Physical Activity in Individuals With Bipolar Disorder: An Evidence Synthesis and Position Statement From the ISBD Nutrition and Exercise Task Force (NExT)
Benefit-risk review
Review of randomized trials
✓ Full text
An evidence-based benefit-risk assessment concluded WS 1442 has a favorable safety profile and symptomatic benefit as adjunctive therapy in mild-to-moderate heart failure but no demonstrated mortality benefit.
Pharmacokinetic interaction study
8 healthy volunteers (crossover pharmacokinetic study)
✓ PubMed
Concomitant hawthorn (Crataegus oxyacantha) did not significantly alter digoxin pharmacokinetics over 3 weeks, but additive cardiac effects mean coadministration still warrants clinical caution.