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Moderate evidenceHeart & metabolic

Hawthorn

Standardised hawthorn extract modestly improves exercise tolerance and symptoms in chronic heart failure as an add-on, but the largest properly powered trial found no survival benefit. It is a symptom aid at best, never a substitute for heart failure medication.

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What the science says

  • Improves symptoms and exercise capacity in chronic heart failure Moderate evidence

    A Cochrane review of 14 randomised, double-blind, placebo-controlled trials (855 patients) found hawthorn extract as adjunctive therapy improved maximal workload (weighted mean difference about 5.4 watts), pressure-heart rate product, and shortness of breath and fatigue scores. Trials were mostly short (4-16 weeks), used mildly-to-moderately symptomatic NYHA II-III patients, and predate current guideline therapy.

  • Reduces mortality in heart failure Limited evidence

    The SPICE trial randomised 2,681 patients with NYHA II-III heart failure and reduced ejection fraction to WS 1442 hawthorn extract 900 mg/day or placebo for 24 months on top of standard therapy. It found no significant reduction in the primary composite cardiac endpoint or in all-cause mortality, though a prespecified subgroup with ejection fraction of 25-35% showed a signal for reduced sudden cardiac death that was hypothesis-generating only.

  • Lowers blood pressure Limited evidence

    Small trials in mild hypertension and type 2 diabetes report diastolic reductions of roughly 2-3 mmHg with 1,200 mg/day over 16 weeks. The effect is inconsistent across studies and too small to be clinically useful on its own.

Dosage & safety

Studied doseTrials used 160-1,800 mg/day of standardised leaf-and-flower extract, most commonly the WS 1442 preparation (standardised to 18.75% oligomeric procyanidins) at 900 mg/day in divided doses, or LI 132 (standardised to 2.2% flavonoids). Benefits on exercise capacity took 4-16 weeks. Berry-only preparations and unstandardised teas were not what the trials tested.
SafetyGenerally well tolerated; dizziness, vertigo, nausea, headache and palpitations are the most reported effects and occurred at rates close to placebo in controlled trials. The critical caution is interaction and substitution risk: hawthorn has cardioactive properties and may potentiate digoxin (both increase contractility and slow heart rate), nitrates and other antihypertensives, and beta-blockers. Anyone with heart failure must treat it strictly as an add-on to prescribed therapy — self-medicating with hawthorn while delaying evidence-based treatment is dangerous. Avoid in pregnancy and breastfeeding. Stop before surgery due to cardiovascular effects.

How to take it

TimingIn divided doses through the day; exercise-capacity benefits took 4-16 weeks to appear.
With food?With food, which reduces the nausea some people get.
Worth knowingOnly standardised leaf-and-flower extracts such as WS 1442 were tested — berry preparations and teas were not.

Interactions

With medications

  • digoxin

    A human pharmacokinetic study found no change in digoxin levels, but both slow heart rate and increase contractility, so the pharmacodynamic effects stack. do not combine without medical supervision

  • blood-pressure medication, nitrates and beta-blockers

    Hawthorn is vasodilating and can add to the drop in blood pressure and heart rate. monitor blood pressure and pulse when starting

Well-established interactions only — this is not a complete list. Always tell your doctor and pharmacist what you take.

Frequently asked questions

Does hawthorn help heart failure?

Hawthorn has moderate evidence as an add-on for heart failure symptoms: a Cochrane review of 14 trials found it improved exercise capacity, shortness of breath and fatigue. But the SPICE trial in 2,681 patients found no reduction in cardiac events or mortality, and hawthorn never replaces heart failure medication.

Does hawthorn lower blood pressure?

Only slightly and inconsistently: small trials report diastolic reductions of roughly 2-3 mmHg with 1,200 mg/day of hawthorn over 16 weeks. That limited effect is too small to be clinically useful on its own.

Can I take hawthorn with heart medications?

Not without medical supervision: hawthorn's effects on heart rate and contractility stack with digoxin, and it can add to blood pressure drugs, nitrates and beta-blockers. Monitor blood pressure and pulse, and stop hawthorn before surgery.

How much hawthorn extract should I take?

Hawthorn trials most commonly used the WS 1442 leaf-and-flower extract at 900 mg/day in divided doses, with benefits taking 4-16 weeks. Berry-only preparations and unstandardised teas were not what the trials tested.

Scientific references

Where to buy

California Gold Nutrition, Magnesium & Hawthorn Extract Complex with Taurine, Coleus Forskohlii Extract, and Hops, 180 Tablets

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