Hawthorn
Summary
Hawthorn leaf-and-flower extract was studied as an add-on for chronic heart failure. Older small trials pooled by Cochrane showed better exercise capacity and symptoms, but the large 2-year SPICE trial found no fewer cardiac events, and HERB-CHF found no functional benefit with more adverse events. FDA warns that some "tejocote root" products contain toxic yellow oleander.
Key facts
- 10 trials (855 patients): better maximal workload and fewer symptoms such as breathlessness and fatigue than placebo[2]
- 2,681 patients, 900 mg/day for 2 years: time to first cardiac event no different from placebo[3]
- 120 patients, 450 mg twice daily for 6 months: no gain in walking distance or quality of life; more adverse events[4]
- FDA found products labelled "tejocote root" (Mexican hawthorn) that contained toxic yellow oleander[1]
- 3 graded human outcomes on this page
- October 11, 2026
How it works
ProposedHow hawthorn extract might act on the heart is not established in the sources cited here.[1]
What the human research says
Human trials only, one row per outcome. The form column shows what each trial actually tested. Grades follow our evidence-grading policy.
| Outcome | Effect | Grade | Best evidence | PMID |
|---|---|---|---|---|
| Exercise capacity and symptoms in chronic heart failure | Improved | Grade C | Systematic review · n = 855 · 2008 Patients with NYHA class I–III heart failure, mostly on conventional treatment Form: Hawthorn leaf-and-flower extract · Dose: Varied across trials · Duration: Varied across trials Maximal workload rose 5.35 W and breathlessness and fatigue scores improved versus placebo; mortality and cardiac events were not reported. | 18254076 (opens PubMed)Source [2] |
| Time to first cardiac event in heart failure | No effect | No effect | RCT · n = 2,681 · 2008 Adults with NYHA class II–III heart failure and ejection fraction ≤35% on standard therapy Form: Crataegus extract WS 1442 · Dose: 900 mg/day · Duration: 24 months Cardiac events occurred in 27.9% versus 28.9% on placebo (hazard ratio 0.95, not significant); cardiac death trended lower but not significantly; adverse events were similar. | 19019730 (opens PubMed)Source [3] |
| Walking distance and quality of life in heart failure | No effect | No effect | RCT · n = 120 · 2009 Ambulatory adults with NYHA class II–III heart failure on standard therapy Form: Hawthorn extract · Dose: 450 mg twice daily · Duration: 6 months No difference in 6-minute walk, quality of life or functional capacity; ejection fraction differed slightly in favour of hawthorn, and adverse events were more frequent on hawthorn. | 19789403 (opens PubMed)Source [4] |
Forms
| Form | Elemental % | Absorption (human data) | GI tolerance | Studied for |
|---|---|---|---|---|
| Hawthorn leaf-and-flower extract | Varies | No head-to-head human absorption data in the sources cited here. | Dizziness, nausea, vomiting, diarrhoea and muscle pain reported.[1] | Heart-failure trials |
| Tejocote root (Mexican hawthorn) products | Varies | Not studied. | FDA found some products contained toxic yellow oleander.[1] | Not studied; marketed for weight loss |
Studied doses
Doses studied in human trials ranged from 900 mg of hawthorn extract per day (WS 1442, or 450 mg twice daily) for 6 to 24 months in the large trials cited here.[3][4]
Interactions
Published interactions only: each row cites a source. No row means none was found in our sources, not that a combination is safe.
None found in our sources.
Who should be careful
- People with heart failure
- Hawthorn has been tested as an add-on to heart medicines; one trial raised concern about early heart-failure progression, possibly from interactions, so use belongs with a cardiologist.[1][4]
- Tejocote root products
- FDA warned some contain yellow oleander, which can cause severe harm or death.[1]
- Use beyond 16 weeks
- NCCIH notes no studies have tested safety beyond 16 weeks.[1]
- Pregnancy and breastfeeding
- Little is known about safety in these groups.[1]
Talk to your pharmacist or clinician before starting a supplement, especially if you take prescription medicines.
Frequently asked questions
Does hawthorn help heart failure?
Small older trials showed better exercise capacity, but the large SPICE trial found no fewer cardiac events and HERB-CHF found no functional benefit.[2][3][4]
Is hawthorn safe with heart medicines?
HERB-CHF reported more adverse events on hawthorn, and NCCIH notes possible interactions with heart drugs.[4][1]
What is tejocote root?
A product sold as Mexican hawthorn; FDA found some contained toxic yellow oleander.[1]
Does hawthorn help weight loss?
NCCIH says there is no evidence that it does.[1]
Sources
- [1]Hawthorn (last updated April 2025). National Center for Complementary and Integrative Health, 2025. fact-sheet
- [2]Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev, 2008. systematic-review
- [3]The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial. Eur J Heart Fail, 2008. RCT
- [4]Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial. Eur J Heart Fail, 2009. RCT
What changed
- New monograph. Every PMID checked against NCBI E-utilities (title, journal and year from the PubMed record); each evidence row written from its abstract; intake and safety facts from the cited fact sheets.