H
HAWTHORN
| Botanical Names: | Crataegus monogyna, Crataegus laevigata+ (Crataegus oxyacantha#) |
| Family: | Rosaceae |
| Plant Parts Used: | Leaf, berry |
+ Medicinally interchangeable species.
PRESCRIBING INFORMATION
| Actions | Hawthorn leaf and berry:cardioprotective, mild cardiotonic, hypotensive, peripheral vasodilator, antiarrhythmic, antioxidant, mild astringent, collagen stabilizing | |
| Potential Indications |
Based on appropriate evaluation of the patient, practitioners should consider prescribing hawthorn leaf and berry in formulations in the context of:
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In a postmarketing surveillance study involving 3664 patients with cardiac insufficiency corresponding to NYHA stages I and II, hawthorn extract (corresponding to 2.7 g/day of dried leaf and flower, containing 19.8 mg flavonoids) was well tolerated. Adverse reactions with a causal relationship to hawthorn therapy were confirmed in 22 cases and probable in another 4 (a total of 0.7%).
* This dose range is extrapolated from British Herbal Pharmacopoeia 1983 and the author’s education and experience.
SUPPORTING INFORMATION
The NYHA classifies loss of cardiac output:for stage I, the patient is symptom-free when at rest and on treatment; for stage II, patients have loss of capacity with medium effort.
• A meta-analysis reviewing eight clinical trials from 1989 to 1994 found standardized hawthorn leaf and flower extract to be efficacious for treating heart failure (mostly of NYHA stage II). A significant effect was observed for subjective findings in all but one trial, for pressure-rate product (which measures cardiac work performance) in four trials, and for work tolerance in three trials. Two trials were open, five were randomized, double-blind, and placebo-controlled, and one was a multicenter, double-blind, comparative trial with the drug captopril. Information available indicates that for four trials, a dose range equivalent to 0.9 to 2.7 g per day of dried leaf and flower standardized to 6.6 to 19.8 mg per day of flavonoids was administered. In two trials, a dose range equivalent to 0.8 to 1.2 g per day of dried leaf and flower standardized to 30 to 45 mg per day of OPC was administered. The randomized, double-blind, placebo-controlled trial that failed to find significant improvement for pressure-rate product had used a lower dose of hawthorn extract (equivalent to 0.9 g/day of leaf and flower and containing 6.6 mg/day of flavonoids).
• In a randomized, double-blind, placebo-controlled study, hawthorn leaf and flower extract (equivalent to 1.2 g/day leaf and flower standardized to 45 mg/day OPC) administered for 12 weeks increased exercise tolerance in patients with NYHA class II congestive heart failure. Exercise tolerance was reduced in the placebo group. No adverse reactions were reported in the hawthorn group. A number of biochemical indices were monitored, and these either remained within their normal ranges or did not differ in a clinically significant manner during therapy.5
• Significant benefit in cardiac parameters was achieved in a multicenter, double-blind, placebo-controlled trial using hawthorn leaf and berry extract in 80 patients with mild congestive heart disease resulting from ischemia or hypertension. No adverse interactions with conventional medication were observed.
• In a randomized, double-blind, placebo-controlled study, hawthorn extract significantly increased heart rate variability (HRV) in geriatric patients compared with placebo. (Low HRV is a risk factor in coronary heart disease, and a positive correlation exists between HRV and life expectancy.)
• In a randomized, double-blind, placebo-controlled clinical study, hawthorn extract (equivalent to 900 mg/day of dried herb for 3 weeks) was shown to improve pathology in patients with angina pectoris.
• In a postmarketing surveillance study, standardized hawthorn leaf and flower extract (equivalent to 2.7 g/day leaf and flower standardized to 19.8 mg/day of flavonoids for 8 weeks) was shown to be well tolerated and improved the symptom score on average by 66.6% in patients with heart disease (NYHA stages I and II). Clinicians rated overall efficacy as better than 90%. Patients with borderline hypertension, tachycardia, and cardiac arrhythmias exhibited excellent results, with blood pressure, heart rate, and incidence of arrhythmias being reduced. A large number of patients previously unsuccessfully treated with digoxin alone were compensated for rest and slight stress with relatively low oral doses of the glycoside in combination with hawthorn.
• In an uncontrolled trial, hawthorn berry tincture (equivalent to 4.3 g/day of berry) significantly reduced systolic and diastolic blood pressure. When treatment was stopped, blood pressures returned to their initial values over a 2-week period.
• In a randomized, double-blind, placebo-controlled study, hawthorn leaf and flower extract in combination with passion flower was efficacious in treating patients with dyspnea commensurate with NYHA stage II. The dosage of hawthorn corresponded to 1.6 g per day of leaf and flower and contained 15 mg per day of flavonoids and 28 mg per day of OPCs. The preparation was administered for 6 weeks.
• In a placebo-controlled, crossover study, the effect of a single dose of standardized hawthorn leaf and flower extract (equivalent to 2.7 g of leaf and flower, standardized to 19.8 mg/day of flavonoids) on the cutaneous microcirculation was compared with 0.3 mg medigoxin. Six hours after taking hawthorn, the hemocrit had dropped by a mean of 3.2%, whereas, 3 hours after taking the digoxin, erythrocyte aggregation increased significantly by a mean of 19%.
• In Germany, the Commission E supports using hawthorn leaf with flower to treat decreased cardiac output as described in NYHA stage II.6
Except when specifically referenced, the following book was referred to in the compilation of the pharmacological and clinical informationMills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Edinburgh: Churchill Livingstone, 2000.
1 British Herbal Medicine Association’s Scientific Committee. British herbal pharmacopoeia. Bournemouth: BHMA, 1983.
2 Felter HW. The eclectic materia medica, pharmacology and therapeutics. Portland: Eclectic Medical Publications, 1922. reprinted 1983
3 Vogel VJ. American Indian medicine. Norman, Okla: University of Oklahoma Press, 1970.
4 Rajalakshmi K, Gurumurthi P, Devaraj SN. Indian J Exp Biol. 2000;38(5):509-511.
5 Zapfe Jun. G. Phytomed. 2001;8(4):262-266.
6 Blumenthal M, et al, editors. The complete German Commission E monographs: therapeutic guide to herbal medicines. Austin: American Botanical Council, 1998.
7 Scientific Committee of the European Scientific Cooperative on Phytotherapy [ESCOP]. ESCOP monographs: Crataegi folium cum flore. Argyle House, Gandy Street, Exeter, Devon, EX4 3LS, United Kingdom: European Scientific Cooperative on Phytotherapy, ESCOP Secretariat, October 1999.
HEMIDESMUS
| Other Common Name: | Indian sarsaparilla |
| Botanical Name: | Hemidesmus indicus |
| Family: | Asclepiadaceae |
| Plant Part Used: | Root |
PRESCRIBING INFORMATION
| Actions | Depurative, diaphoretic, immune depressant | |
| Potential Indications | ||
* This dose range is extrapolated from traditional Ayurvedic medicine1 and the author’s education and experience.
SUPPORTING INFORMATION
| Traditional Prescribing | |
| Pharmacologic Research |
• Oral administration of Hemidesmus has been found to depress both the cell-mediated and humoral components of the immune system.5
• An organic acid isolated from the root of Hemidesmus inhibited the activity of snake venom in experimental models (by injection). The acid inhibited the lethal hemorrhagic, coagulant, and anticoagulant activities that the viper venom induced.7,8 The same compound demonstrated antiinflammatory activity in an experimental model (most likely by injection) and in vitro antioxidant activity.9
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| Clinical Studies |
