Hawthorn is a flowering shrub of the  rose family grown throughout North and South American, Europe, and Asia  (113113).  Multiple species are commonly found in Hawthorn preparations,  including: C. laevigata, C. oxyacantha, C. monogyna and C. mexicana (54659, 54662, 54665, 113112, 113113).  Traditionally, hawthorn has been used orally to improve digestion and  blood circulation, and for asthma, diarrhea, parasitic infections, and  kidney and bladder disorders. Topically, hawthorn has traditionally been  used as a poultice or wash for boils, sores, ulcers, itching, and frost  bite.                                 

   In January  2024, the FDA issued a warning to the public to avoid some hawthorn root  extract supplements derived from Mexican Hawthorn root, also known as  tejocote (Crataegus mexicana), because they may be contaminated or  adulterated with toxic yellow oleander which can lead to  gastrointestinal, neurological, and cardiovascular adverse effects that  may be severe, or even fatal. The FDA further advises anyone who has  taken the tejocote Hawthorn root extract products listed in their  warning letter to contact their health care provider immediately for  health evaluation (113114).

   Possibly Safe when  used orally and appropriately, short-term. Hawthorn preparations in  doses of up to 1800 mg daily seem to be safe when used for up to 16  weeks. Although hawthorn might be safe for long-term use, current  studies have not evaluated safety past 16 weeks (8279, 8280, 8281, 10144, 17203, 104689).                                                             

There is  insufficient reliable information available about the safety of  hawthorn when used topically.                                                             

PREGNANCY AND LACTATION: Insufficient reliable information available; avoid using.                                                             

Scientific Name Crataegus cuneata (synonyms:  Crataegus kulingensis, Crataegus mexicana, Crataegus pentagyna,  Crataegus pinnatifida, Crataegus rhipidophylla), Crataegus laevigata  (synonyms: Crataegus oxyacantha, Mespilus laevigata), Crataegus monogyna                                          Family Rosaceae Other Common Names Aubepine, Aubépine,  Aubépine Blanche, Aubépine Épineuse, Bianco Spino, Bois de Mai,  Cenellier, Chinese Hawthorn, Crataegi Flos, Crataegi Folium,          

Orally,  hawthorn seems to be well tolerated when used appropriately. Topically,  no adverse effects have been reported, although a thorough evaluation  of safety outcomes has not been conducted. 

Orally: Multiorgan hypersensitivity reactions resulting in acute renal failure have been reported rarely.

Cardiovascular 

Orally, tachycardia (with facial pains) of uncertain relationship to hawthorn was reported in a multicenter clinical trial (54640). Palpitations (19244) were reported in three patients in a large surveillance trial of 3,664 patients with cardiac failure (54692) and in 11 patients with congestive heart failure (CHF) in a literature review of 5,577 patients (19247). Circulation failure has been reported in two patients with CHF in a literature review of 5,577 patients (19247).  Incidences of hospitalization, hospitalization due to CHF, worsening of  CHF, angina, and atrial fibrillation have also been reported with the  use of hawthorn extract WS 1442 (Crataegutt forte), although it is  unclear if these events are related to hawthorn supplementation or  existing CHF (19222). In clinical trials, chest pain (8281), short-term increases in blood pressure (19240), and other non-specific heart problems (17203) have also been reported following the use of various hawthorn preparations (e.g. WS 1442, Korodin).

Orally,  severe bradycardia, bradypnea, and Mobitz type 1 second degree heart  block have been reported in a 16-year-old female who consumed Hawthorn  root extract. Blood tests indicated plasma digoxin levels in the  therapeutic range, despite no history of digoxin use. Medical treatment  for digoxin cardiotoxicity did not improve symptoms. Symptoms gradually  normalized over 3 days after discontinuation of the product (113112).  Similarly, a 40-year-old female presented with bradycardia and elevated  plasma digoxin levels after taking hawthorn root extract 196 mg daily  for 2 days with no history of digoxin use. Symptoms resolved within 24  hours (113113).

                                                                                                                                                                                                                                                                                      Insufficient Reliable Evidence to Rate                                                                       

It is unclear if oral hawthorn is beneficial in patients with angina.

Oral hawthorn has only been evaluated in combination with other ingredients; its effect when used alone is unclear.

Although  there has been interest in using oral hawthorn for arrhythmia, there is  insufficient reliable information about the clinical effects of  arrhythmia for this condition.

Although  there has been interest in using oral hawthorn for atherosclerosis,  there is insufficient reliable information about the clinical effects of  arrhythmia for this condition.

Although  there has been interest in using oral hawthorn for CVD, there is  insufficient reliable information about the clinical effects of  arrhythmia for this condition.

Oral hawthorn has only been evaluated in combination with other ingredients; its effect when used alone is unclear.

The  evidence on the effects of oral hawthorn in patients with CHF is  conflicting. Although some older research suggests it may be beneficial,  more recent, larger studies suggest it may actually increase the risk  for complications.

Although  there has been interest in using oral hawthorn for hyperlipidemia,  there is insufficient reliable information about the clinical effects of  arrhythmia for this condition.

It is unclear if oral hawthorn is beneficial for lowering blood pressure.

Oral hawthorn has only been evaluated in combination with other ingredients; its effect when used alone is unclear.

Oral hawthorn has only been evaluated in combination with other ingredients; its effect when used alone is unclear.

More evidence is needed to rate hawthorn for these uses.

Hawthorn extract has most often been used as 160-1200 mg daily in divided doses. See Effectiveness section for condition-specific information.
Hawthorn extract used in clinical trials has commonly been standardized to a range of 17.3% to 20.1% oligomeric procyanidins (17203, 19226, 8280, 8281, 104689).

Research is limited; typical dosing is unavailable.

Hawthorn extract WS 1442 (Crataegutt forte) has been standardized to a range of 17.3% to 20.1% oligomeric procyanidins (17203, 19226, 104689), while some studies have reported specific standardization to 18.75% (8280, 8281) or 84.3 mg oligomeric procyanidins (16824). The U.S. brand HeartCare (Nature's'Way) is also standardized in this fashion.

Hawthorn extract LI 132 (Faros 600) has been standardized to 2.2% flavonoids (19245). Crataesor has been standardized to 5% procyanidins and 2% flavonoids (19241). Hawthorn Supreme System Support liquid phyto-caps (250 mg) has been standardized to 50 mg oligomeric procyanidins (19244).  Korodin has been standardized to contain 97.3 gram fluid extract from  fresh hawthorn berries, 2.5 grams natural D-camphor, and 0.2 grams  menthol as an aromatic ingredient per 100 grams (91504).

  Interaction Rating Moderate Be cautious with this combination.     Severity HIGH   Occurrence POSSIBLE   Level of Evidence                                                                                 D (Theoretical based on pharmacology)    Theoretically, hawthorn may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
 

  Interaction Rating Moderate Be cautious with this combination.     Severity MODERATE   Occurrence POSSIBLE   Level of Evidence                                                                                 D (Theoretical based on pharmacology)    Theoretically, concomitant use might cause additive effects on blood pressure and heart rate.
 

  Interaction Rating Moderate Be cautious with this combination.     Severity MODERATE   Occurrence POSSIBLE   Level of Evidence                                                                                 D (Theoretical based on pharmacology)    Theoretically, concomitant use might cause additive coronary vasodilation and hypotensive effects.
 

  Interaction Rating Moderate Be cautious with this combination.     Severity MODERATE   Occurrence POSSIBLE   Level of Evidence                                                                                 D (Theoretical based on pharmacology)    Theoretically, hawthorn might potentiate the effects and adverse effects of digoxin.
 

  Interaction Rating Major Do not take this combination.     Severity HIGH   Occurrence PROBABLE   Level of Evidence D (Theoretical based on pharmacology)    Theoretically, concomitant use might cause additive coronary vasodilatory effects.
 

  Interaction Rating Major Do not take this combination.     Severity HIGH   Occurrence PROBABLE   Level of Evidence D (Theoretical based on pharmacology)    Theoretically, concomitant use might result in additive vasodilation and hypotension.
                                                                                                                                                                                                          

Theoretically, hawthorn may have antiplatelet effects in some people.
 

Hawthorn might have hypotensive effects (12595).  Theoretically, concomitant use of hawthorn with other herbs and  supplements that decrease blood pressure might increase the risk of  hypotension.

There is insufficient reliable information available about the presentation or treatment of overdose with hawthorn.

There is insufficient reliable information available about the pharmacokinetics of hawthorn.

The  applicable parts of hawthorn are the leaves, berries, flowers, and  roots. Major pharmacologically active components are believed to be  flavonoids, particularly the oligomeric proanthocyanidins (OPCs) such as  procyanidin B2, procyanidin clusters (DP 4, 5, 6), catechin, and  epicatechin (54659, 54662, 54665).  Other known constituents include caffeic acid, chlorogenic acid,  hesperidin, hyperoside, myricitrin, oleanolic acid,  O-methyoxyphenethylamine, phenylethylamine, quercitrin, rutin,  tocopherols, tyramine, ursolic avid, vitamin C, isovitexin, vitexin,  vitexin-2-O-rhamnoside, and vitexin rhamnoside (19241, 54657, 54662).

Hawthorn  may exhibit antineoplastic activity and collagen stabilizing actions.  Two triterpenes, uvaol and ursolic acid, were isolated from hawthorn and  suggested to be responsible for cytotoxicity against human and murine  cancer cell lines (54641).  Triterpene-enriched fractions of hawthorn extract have demonstrated  almost complete inhibition of cultured larynx cancer cell growth and  stronger in vitro activity than 6-mercaptopurine solution(54695). The exact mechanism of action is not well understood.

Free radical properties have been demonstrated in vivo (54682, 54699), and may depend on the phenol (54681) or flavonoid content of the extract.

In  vitro and animal research shows that hawthorn extract can inhibit ADP-  and epinephrine-induced platelet aggregation and prolong bleeding time (95528, 95529, 95530, 95531).  The extracts inhibit synthesis of thromboxane A2, a stimulator of  platelet aggregation. The active constituents are thought to include  flavonoids and sesquiterpenes (95529, 95531).  However, the effect of hawthorn on platelet aggregation in humans is  conflicting. One observational study shows that taking hawthorn shortly  before undergoing cardiovascular surgery is associated with a 9% higher  incidence of postoperative bleeding compared with never consuming  hawthorn (95527).  However, clinical research shows that taking a specific preparation of  dried hawthorn leaves and flowers (Crataesor, Soria Natural Lab) 800 mg  three times daily for 15 days does not affect platelet aggregation or  levels of thromboxane B2, the metabolite of thromboxane A2, in healthy  humans (54664). These conflicting results may be due to the use of different hawthorn species, extracts, and doses.

Hawthorn preparations have been traditionally used for cardiovascular conditions (98380).  Hawthorn acts on the myocardium by increasing force of contraction and  lengthening the refractory period, increasing coronary blood flow and  cardiac output, and reducing oxygen consumption (10144, 11450, 12595). Hawthorn's cardiotrophic properties are attributed to increased membrane permeability for calcium (11450),  and phosphodiesterase inhibition, which increases intracellular cAMP.  Increased cAMP leads to increased coronary blood flow, vasodilation, and  positive inotropic effects (11450, 12595).  Hawthorn seems to have hypotensive and vasodilatory activity. In a  human study, hawthorn extract had beneficial effects on endothelial  function (104689).  In animals, it seems to cause peripheral vasodilation and to induce  endothelium-dependent arterial relaxation. The proantocyanidin  constituents seem to be responsible for this effect (12595).

There is also interest in using hawthorn for reducing arrhythmic events (12595).  One theory is that hawthorn might reduce arrhythmias by reducing  adrenergic stimulation. In vitro, hawthorn leaf extract had a  dose-dependent negative chronotropic effect on cardiac muscle cells.  This effect is thought to be due to beta-adrenergic receptor blockade  similar to propranolol (98380).  However, this effect has not been confirmed in humans. Another theory  is that hawthorn might block potassium channels, prolong action  potential repolarization, and prolong the QT interval similarly to class  III antiarrhythmic agents. Preliminary studies in animal models support  this theory. However, a small clinical trial in healthy adults shows  that a single dose of hawthorn 160 mg orally has no effect on  electrocardiographic measures such as QT, PR and QRS intervals (98381).

Finally,  some preliminary research in humans and animals suggests hawthorn might  lower serum cholesterol, low-density lipoprotein (LDL) cholesterol,  and/or triglycerides (12595, 104689).  In an animal model, hawthorn seems to lower accumulation of lipids in  the liver and aorta. The fruit extract may lower cholesterol by  increasing bile acid excretion, reducing cholesterol synthesis by the  liver, and enhancing LDL-receptor activity. Hawthorn also seems to have  antioxidant activity (12595).

Skin  aging is caused by exposure to ultraviolet (UV) A and B rays from  sunlight. There is interest in using polyphenols from hawthorn to  protect from UVB radiation damage to slow skin aging. Preliminary  research in human skin cell lines and in animal models shows that  hawthorn polyphenol extract increases activity of antioxidant enzymes  and reverses oxidative stress caused by UVB irradiation. Hawthorn  extract also seems to reduce epidermal thickening and increase collagen  production, which might help to reduce wrinkles and skin damage from UVB  radiation (98379).

Antiplatelet Agents,                                     Phosphodiesterase Inhibitors,                                     Vasodilators  

See Monograph References  

Literature Review Current Through: 3/23/2026, Last Updated: 7/6/2026

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