Hawthorn berry

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Hawthorn berry

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Overview of Hawthorn berry

What is Hawthorn berry?

Hawthorn berries are small, tart fruits that grow on trees and shrubs belonging to the genus Crataegus. This genus includes hundreds of species found throughout temperate regions of the Northern Hemisphere, including parts of North America, Europe, and Asia. The berries, which are typically red but can also be black or yellow, are a type of pome fruit, similar in structure to miniature apples.

Botanical Profile and Composition

As members of the Rosaceae (rose) family, hawthorn plants are characterized by their thorny branches and white or pink flowers. While the leaves and flowers are often used in herbal preparations, the berries are particularly noted for their specific profile of bioactive compounds.

The primary constituents found within the fruit include:

  • Flavonoids: Such as hyperoside, vitexin, and quercetin.
  • Oligomeric Procyanidins (OPCs): These are condensed tannins that contribute to the plant's phytochemical activity.
  • Organic Acids: Including citric and tartaric acids, which provide the fruit's characteristic tartness.
  • Triterpenoids: Naturally occurring compounds found in the skin and pulp.

Historical and Traditional Use

Hawthorn has a long history of use in various traditional practices. In traditional Chinese medicine, the dried fruit (known as Shan Zha) has been utilized for centuries. Similarly, in European herbal traditions, the berries have been recognized since at least the first century for their distinct properties. Historically, the fruit was consumed as a food source in jellies, wines, and teas before becoming a common subject of botanical study.

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What side effects are possible with Hawthorn berry?

Possible Side Effects and Safety Information

The regulatory safety profile for Hawthorn berry preparations, classified as a phytotherapeutic cardiotonic agent, indicates that documented adverse reactions are typically mild and occur with low frequency.


Officially Documented Adverse Reactions

The adverse reactions associated with Hawthorn are officially grouped into several System-Organ Classes. These effects are generally classified as uncommon or rare in frequency, based on post-marketing surveillance and clinical data reviewed by regulatory authorities.

System-Organ Class Examples of Documented Effects
Nervous System Disorders Dizziness, headache, drowsiness
Gastrointestinal Disorders Nausea, stomach upset
Cardiac Disorders Palpitations (irregular or rapid heartbeat)

Serious adverse reactions are reported rarely. Official safety information cites the potential for severe allergic reactions and, in rare instances associated with overdose or non-standardized use, reports of serious cardiac events such as atrioventricular block.


Regulatory Safety Considerations

Official regulatory bodies have defined constraints and considerations for specific populations:

  • Pediatric Use: Use is not recommended in children or adolescents under the age of 12 years due to insufficient scientific evidence to establish safety in this population.
  • Pregnancy and Lactation: Use is not recommended during pregnancy or breastfeeding due to the absence of sufficient reliable safety data.

High-level safety notes advise caution when the preparation is used concurrently with prescription medications for heart disease or high blood pressure, as Hawthorn may enhance the effects of these cardiovascular drugs. The preparation is formally contraindicated for individuals with a known hypersensitivity or allergy to Crataegus species.

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Overdose and Emergency Response

Overdose and when to seek help

The official regulatory documents concerning standardized Hawthorn leaf and flower preparations indicate that no cases of overdose have been formally reported. This absence of documented clinical experience establishes the overdose profile for the regulated product. Signs associated with high intake may include transient dizziness, headache, or gastrointestinal distress.

Severe and potentially life-threatening outcomes, including fatal arrhythmia, severe bradycardia, hypotension, and depressed consciousness, have been documented in cases involving non-standardized Hawthorn root extracts or products found to be adulterated. These manifestations represent a risk outside of standard regulated use.

When any over-ingestion is suspected, regulatory guidance mandates that individuals seek immediate medical attention or contact a Poison Control Center immediately. Furthermore, consultation with a doctor is required if new cardiac symptoms appear during use, including pain in the heart region (especially if spreading), respiratory distress (dyspnea), or swollen ankles/legs. Management for resulting severe toxicity focuses on providing symptomatic and supportive treatment because no specific antidote is known.

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Therapeutic Uses of Hawthorn berry

What Hawthorn Berry Treats: Main Uses and Benefits

Hawthorn berry preparations are primarily recognized as a phytotherapeutic agent providing supportive care for the cardiovascular system. Its use is commonly used to help with supporting cardiovascular performance and contributing to the management of symptomatic discomfort across several chronic, mild clinical contexts. Recent research has focused primarily on its supportive effects in cardiovascular disease (CVD).


The remedy is commonly used in situations involving certain distressing symptoms, including mild chronic heart failure (specifically NYHA Functional Class I and II), functional cardiac weakness, and nervous heart complaints. It helps address symptom clusters such as fatigue and shortness of breath upon physical effort, and subjective symptoms like mild palpitations and feelings of oppression.

“The use of Hawthorn may support improvements in exercise tolerance, which assists with maintaining functional stability during routine daily activities.”

The overall benefit may contribute to easing the overall symptom load and supporting general well-being during symptomatic phases.

Quick Fact: Support for Effort Symptoms
Hawthorn is relevant for managing symptoms that are linked to organ-specific functional stress, such as the fatigue and shortness of breath that interfere with daily functioning during physical exertion.
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Eligibility and Restrictions for Use

Who can and cannot use Hawthorn berry

Official regulatory guidelines define specific populations who are eligible or restricted from using Hawthorn preparations (Crataegus spp., folium cum flore).

Use is generally established for Adults (18 years and older) and the Elderly for supportive care. Adolescents over 12 may use the preparations for the secondary indication of mild mental stress relief.


Eligibility Restrictions

Population Status Regulatory Classification
Children under 12 years Not recommended (lack of adequate data).
Adolescents under 18 (for heart use) Not recommended (condition requires medical advice).
Pregnancy and Lactation Not recommended (insufficient safety data).
Known Hypersensitivity Contraindicated (standard medical prohibition).

Conditional Use: Eligibility is restricted if a patient experiences worsening cardiac symptoms, such as pain in the heart region, respiratory distress, or swollen legs/ankles. These conditions necessitate immediate medical consultation to exclude serious underlying disease, and use is restricted until medical clearance is obtained. No specific restriction is officially documented for renal or hepatic impairment.

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What should I know about interactions with other medicines?

Interactions with other medicines and products

Hawthorn berry, a phytotherapeutic agent, is primarily associated with pharmacodynamic interactions due to its established effect on cardiovascular function, as documented in official regulatory sources. Clinically significant pharmacokinetic interactions (e.g., involving CYP enzymes or transporters) are generally not formally documented in prescribing information for standardized extracts.

Documented Pharmacodynamic Risks

Co-administration with several classes of prescription medicines may result in additive effects:

  • Cardiac Glycosides: There is documented pharmacodynamic synergism with medicines like Digoxin, which may increase the therapeutic and toxic potential of cardiac glycosides.
  • Antihypertensive Agents and Vasodilators: Hawthorn may contribute to an additive hypotensive effect when combined with blood pressure medications (e.g., Beta-blockers, ACE Inhibitors) or vasodilators, increasing the potential for excessive blood pressure reduction.
  • Anticoagulants/Antiplatelets: A potential additive effect on coagulation is noted, which may increase the risk of bruising and bleeding when co-administered with blood-thinning drugs.
  • Central Nervous System (CNS) Depressants: Co-use with substances such as alcohol may enhance CNS depression, potentially resulting in increased drowsiness.

Restriction Summary

Official regulatory-aligned materials note specific prohibitions or strong avoidance advice. Co-administration with certain agents that significantly prolong the QTc interval, such as Vandetanib, is advised to be avoided due to the documented risk of a serious additive effect.

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Mechanism of Action

The mechanism of Hawthorn extract involves the simultaneous action of its main components, Flavonoids and Oligomeric Procyanidins (OPCs), on cardiovascular regulatory systems.


Modulation of Myocardial Contraction and Ion Flux

Key flavonoid components subtly inhibit the Sodium-Potassium ATPase (Na^+/K^+-ATPase) enzyme in heart muscle cells. This modulation alters the electrochemical gradient, influencing the intracellular calcium (Ca^2+) flux. This leads to a mild, positive inotropic action, resulting in an increased force of myocardial contraction.


Endothelium-Driven Vasodilation and Resistance Reduction

OPCs stimulate the synthesis and release of Nitric Oxide (NO) from the vascular endothelium, activating the signaling cascade that causes vascular smooth muscle to relax. The resulting vasodilation reduces peripheral vascular resistance (afterload), changing the pressure the heart must eject against.


Cardioprotective Mechanisms Against Oxidative Stress

The compounds act as antioxidants, scavenging Reactive Oxygen Species (ROS) and reducing free radical-mediated effects on the cardiovascular tissue, thereby contributing to the structural integrity of the myocardium and blood vessels.

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Dosage and Administration Information

Administration Scope

The use of standardized Hawthorn preparations is restricted to the oral route, encompassing various dosage forms such as tablets, capsules, liquid extracts, and preparations from the comminuted herbal substance.

Property Official Administration Instruction
Route of Administration Exclusively Oral Use (by mouth).
Dosing Schedule Standardized Dry Extract (e.g., 4-7:1 DER) daily doses typically range from 240 mg to 900 mg for adults. Herbal tea daily consumption is limited to a maximum of 6 g of the comminuted substance.
Frequency and Timing The daily dose is typically administered in divided doses, generally two to four times per day (BID to QID). Oral forms are generally taken with a glass of water.
Preparation Requirements Preparation of herbal tea requires pouring approximately 150 ml of boiling water over 1 g to 2 g of the comminuted substance and straining after infusion.
Age-Group Rules Use is not recommended for children under 12 years of age due to the need for medical evaluation of the underlying condition. Use in adolescents (ge 12 years) is permitted only for specific, milder traditional uses.

Resulting Procedural Structure and Duration

Official step sequence:

  • The total prescribed daily dose of the appropriate preparation is administered in divided administrations (two to four times daily).
  • For supportive use, administration must be continued daily for a minimum of four to six weeks before assessing the therapeutic effect.
  • For temporary nervous complaints, if symptoms persist longer than two weeks, a qualified health practitioner should be consulted.

These instructions define a continuous, long-term oral administration protocol. The requirement for divided daily dosing ensures the consistent delivery of the active constituents, while the minimum duration sets the expected timeline for the administration course.

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Recent Clinical Evidence

Research Evidence / Overview of Studies for Hawthorn Berry


Evidence for Use in Mild Chronic Heart Failure

Research has primarily focused on studies evaluating Hawthorn berry's use in adults experiencing symptoms of mild to moderate chronic heart failure, often categorized as NYHA Functional Class I or II. The majority of the evidence is derived from Randomized Controlled Trials (RCTs), many of which were double-blind and included a comparison group. These individual trials have been combined and assessed in meta-analyses and systematic reviews to summarize the existing evidence.

Researchers used these studies to monitor outcomes reflecting daily functioning or activity level. Study outcomes examined included measurable aspects of heart function, such as maximal exercise tolerance, and patient-reported outcomes describing perceived discomfort, such as changes in fatigue and shortness of breath.

Evidence for Traditional Use in Nervous Cardiac Complaints

Hawthorn berry was studied for its use in conditions characterized by temporary heart complaints related to nervousness. The regulatory framework for this traditional indication references the history of its use over a long period. However, the evidence is limited for this use, as regulatory bodies note there is a significant lack of modern, rigorous clinical trial data. The certainty remains low because the effectiveness is based on historical use and plausibility.


Areas of Uncertainty and Research Gaps

Key limitations noted in scientific reviews include the heterogeneity across studies, meaning the specific hawthorn extract and the daily amount varied significantly between different trials. This variability contributes to uncertainty regarding a universal pattern of response. Furthermore, follow-up durations were limited in many early studies, and there is limited information for long-term outcomes, particularly concerning hospitalization and overall mortality.

Key Studies & References

  1. Hawthorn (Crataegus spp.) in the treatment of cardiovascular disease
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How should Hawthorn berry be stored and disposed of?

How to Store and Dispose of Hawthorn berry?

Official regulatory information requires that hawthorn berry products be stored correctly to maintain quality and stability.

  • Storage Temperature: Store processed hawthorn products below 25°C, generally at room temperature.
  • Protection: Keep the product in its original, tightly closed container to protect it from moisture. Raw hawthorn material must be protected from contamination by pests or debris.
  • Safety: As with all medicinal products, it must be stored out of the sight and reach of children.
  • Disposal: Do not use the product after the documented expiration date. Any unused product or waste material must be disposed of according to local environmental and pharmaceutical waste regulations.
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Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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