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HAWTHORN














Botanical Names: Crataegus monogyna, Crataegus laevigata+ (Crataegus oxyacantha#)
Family: Rosaceae
Plant Parts Used: Leaf, berry

+ Medicinally interchangeable species.


# Alternative name.



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:

• Cardiac insufficiency, particularly corresponding to New York Heart Association (NYHA) stages I and II (1,4,5)

• Other mild heart conditions, such as minor angina pectoris (2,5)

• Low heart rate variability (2)

• Hypertension (3,5)

• Cardiac arrhythmias, tachycardia, nervous heart complaints, circulatory support (4)

• Arteriosclerosis, Buerger’s disease (5)
Contraindications None known.
Warnings and Precautions None required.
Interactions Hawthorn may act in synergy with digitalis glycosides, beta-blockers, and other hypotensive drugs. Modification of drug dosage may be required.
Use in Pregnancy and Lactation No adverse effects expected.
Side Effects
None expected if taken within the recommended dose range.

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%).

Reported side effects included gastrointestinal disorders, palpitations, headache, dizziness, circulatory disturbances, sleeplessness, and inner agitation.
Dosage Hawthorn berry:
  Dose per day* Dose per week*
  3-7 ml of 1:2 liquid extract 20-50 ml of 1:2 liquid extract
  Extracts providing quantified levels of oligomeric procyanidins (OPCs) are recommended. Ideally, aqueous ethanol extracts should contain not less than 4 mg/ml of OPCs.
  Hawthorn leaf:
  Dose per day** Dose per week**
  3-6 ml of 1:2 liquid extract 20-40 ml of 1:2 liquid extract
  Extracts providing quantified levels of OPCs are recommended. Ideally, aqueous ethanol extracts should contain not less than 10 mg/ml of OPCs.
  Higher doses than those outlined here may be necessary for effective control of hypertension.

* This dose range is extrapolated from British Herbal Pharmacopoeia 1983 and the author’s education and experience.


** This dose range is extrapolated from clinical studies.



SUPPORTING INFORMATION














Traditional Prescribing
Traditional Western herbal medicine uses of hawthorn berry include myocardial weakness, hypertension, angina pectoris, tachycardia, and other circulatory disorders, such as arteriosclerosis and Buerger’s disease.1

Traditional Western herbal medicine uses of hawthorn leaf include as an astringent and tonic.2

Native Americans used Hawthorn fruit and bark for women’s medicine, and the chewed leaves were used as a poultice for swellings.3 Eclectic physicians used hawthorn fruit and bark for cardiac problems, particularly those of a functional nature, and as a general tonic as well.2
Pharmacologic Research
Key constituents of hawthorn include OPCs, especially procyanidin B-2, and flavonoids. The levels vary with the species of hawthorn and also within the plant part. The flowers contain the highest levels of flavonoids, and the leaves contain the highest levels of OPCs. The ripe berries are the lowest in OPCs and flavonoids. Therefore a fair assumption would be that the leaf is more active than the traditionally preferred berry.

• Studies have shown (many in vitro) hawthorn extracts or fractions to increase coronary blood flow, to be positively inotropic (increasing the force of contraction), negatively chronotropic (decreasing the heart rate), and cardioprotective. Oral administration also found an increase in coronary blood flow in an experimental model.

• Purified flavonoids from hawthorn leaf produced a smaller necrotic focus and improved revascularization of finer vessels (after myocardial infarction) when compared with controls.

• In experimental models, the following has been observed:
• Improved myocardial performance (OPCs, by injection)

• Increased coronary blood flow (OPCs, by both oral and injected routes)

• Decreased blood pressure (extract, OPCs, by both oral and injected routes)

• Antiarrhythmic effect (extract, oral route)

• In laboratory studies, when compared with a digoxin preparation, hawthorn extract increased the erythrocyte flow rate in all the vascular networks examined and reduced both leukocyte endothelial adhesion and diapedesis in the venular network of mesenteric vessels.

• Hawthorn leaf and berry extracts exhibited antioxidant activity in vitro. Hawthorn tincture inhibited in vitro oxidation of LDL and VLDL from the plasma of patients with non-insulin–dependent diabetes mellitus.4

• Although studies have not been conducted specifically on the OPCs found in hawthorn, hawthorn OPCs will likely share many of the known pharmacological properties of OPCs. These indications might include prevention of cancer, atheroma, and any cell damage occurring under hypoxic conditions. Hawthorn OPCs have also stabilized collagen in vitro.
Clinical Studies
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

• ESCOP recommends hawthorn leaf and flower extract for treating declining cardiac performance corresponding to NYHA stage II.

Other preparations, including herbal teas, are indicated for nervous heart complaints and circulatory support.7


REFERENCES



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
Based on appropriate evaluation of the patient, practitioners should consider prescribing Hemidesmus in formulations in the context of:

• Autoimmune diseases such as rheumatoid arthritis (7)

• Diseases of the genitourinary tract (5)

• Skin diseases, fever (5)
Contraindications None known.
Warnings and Precautions None required.
Interactions None known.
Use in Pregnancy and Lactation No adverse effects expected.
Side Effects None expected if taken within the recommended dose range.
Dosage Dose per day* Dose per week*
  3.5-8.5 ml of 1:2 liquid extract 25-60 ml of 1:2 liquid extract

* This dose range is extrapolated from traditional Ayurvedic medicine1 and the author’s education and experience.



SUPPORTING INFORMATION














Traditional Prescribing
Traditional Ayurvedic uses include:

• Diseases of the genitourinary system2

• Loss of appetite, fever, skin diseases, chronic cough1

• Topically as an antiinflammatory remedy2

Hemidesmus is regarded in Ayurvedic medicine as a depurative and tonic and is used as a substitute for sarsaparilla (Smilax spp.).3
Pharmacologic Research
• Hemidesmus has demonstrated antifungal activity in vitro.4

• Oral administration of Hemidesmus has been found to depress both the cell-mediated and humoral components of the immune system.5

• An inhibiting effect on leprosy was found in an experimental model (dose route unknown).6

• 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

• Oral administration of Hemidesmus extract prevented experimentally induced hepatotoxicity in two models.10
Clinical Studies No clinical studies using Hemidesmus have been found.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on H

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