II. Background

  1. Hawthorn is a Crataegus species within a genus of spiny shrubs and trees
  2. Oldest known European medication (use first described 2000 years ago)
  3. Most studied preparations are derived from the flowering tops of plants
  4. Chinese medications use the Hawthorn berries for jelly or jam as a digestive aid

III. Mechanism

  1. Oligomeric procyanidins: Attenuate Myocardium damage and increase coronary blood flow
    1. Inhibit human Neutrophil elastase
    2. Free radical scavenger
  2. Flavinoids: Vasodilation, platelet inhibitor and antioxidant
    1. Activate endothelium-derived relaxing factor
    2. Inhibit phosphodiesterase
    3. Antioxidant inhibits oxidation of LDL Cholesterol
    4. Inhibits platelet aggregation

IV. Indications

  1. Adjunctive treatment of Congestive Heart Failure (NYHA Class I-III)

V. Contraindications

  1. Hypersensitivity to Crataegus products

VI. Precautions

  1. Caution patients not to use in place of standard, conventional Congestive Heart Failure medications

VII. Drug Interactions

  1. Herbs and supplements with cardiovascular activity
    1. Danshen
    2. Epimedium
    3. Ginger
    4. Panax ginseng
    5. Turmeric
    6. Valerian Root
  2. May enhance Digitalis activity
  3. Postulated Drug Interactions
    1. Vasodilators (e.g. phosphodiesterase type 5 inhibitors such as Viagra)
    2. Antihypertensives
    3. AntiHyperlipidemics

VIII. Adverse Effects

IX. Efficacy

  1. Meta-analysis by Cochrane suggests improved Exercise tolerance and decreased Fatigue and Shortness of Breath
  2. Pittler (2008) Cochrane Database Syst Rev (1): CD005312 [PubMed]

X. Dosing

  1. Ranges from 160 to 1800 mg daily divided 2-3 times per day

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