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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

✚ Updated · How we grade evidence

Evidence tier
Moderate
Research weight
Citations
10 verified / 10
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.

OutcomeEvidenceEffectStudies
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
Oligomeric procyanidins (condensed flavan-3-ol polymers)Flavonoids (vitexin, hyperoside, rutin, quercetin)Standardized extracts WS 1442 and LI 132 (leaf-and-flower extracts standardized to procyanidins/flavonoids)

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
Blood-pressure drugs & nitrates
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 ★ 10 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.
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.
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.
10 sources cited · 10 verified Search all studies on PubMed ↗

Common questions about Hawthorn

What is Hawthorn used for?

Hawthorn is most often taken for 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). Traditional cardiac tonic with real but modest add-on benefits in mild heart failure.

Does Hawthorn work — what does the evidence say?

Moderate evidence. Several controlled trials; effects real but modest or context-dependent. 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.

What is the typical dose of Hawthorn?

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.

Is Hawthorn safe? Any cautions or side effects?

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.

How many studies support Hawthorn?

NutriDex cites 10 sources for Hawthorn, graded "Moderate".

Does Hawthorn interact with any medications?

Yes — known or theoretical interactions include: Blood-pressure drugs (caution), Digoxin (heart medication) (caution). This is educational and not exhaustive; always check with your doctor or pharmacist before combining Hawthorn with any medicine.

Cite this page
APA

Peh, D. (2026). Hawthorn (Crataegus spp. (C. monogyna, C. laevigata)): Benefits, Dosage, Side Effects & Evidence. NutriDex — The Supplement Research Compendium. Retrieved 26 Jun 2026, from https://nutridex.info/s/hawthorn

BibTeX
@misc{nutridex_hawthorn,
  author       = {Peh, Daryl},
  title        = {Hawthorn (Crataegus spp. (C. monogyna, C. laevigata)): Benefits, Dosage, Side Effects \& Evidence},
  year         = {2026},
  howpublished = {NutriDex --- The Supplement Research Compendium},
  url          = {https://nutridex.info/s/hawthorn},
  note         = {Reviewed by Dr Daryl Peh, MBBS Singapore, MMed FM. Accessed 2026-06-26}
}

For medical claims, citing the underlying primary studies linked above is preferred. NutriDex is an educational reference, not medical advice.

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