Hawthorn (Crataegus monogyna and Crataegus laevigata): Uses, Evidence and Safety
Hawthorn (Crataegus): what a Cochrane review and EMA say about heart failure and "nervous" heart complaints, digoxin and blood pressure medicine cautions, and a toxic look-alike product warning.
Content last updated . This page has not been medically reviewed.
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What is Hawthorn good for?
What the body uses it for, and how strong the evidence is. A normal job in the body is not proof that extra supplements add benefit; each card says which.
Added to usual care in chronic heart failure
Clinically supportedA Cochrane review of placebo-controlled trials found that hawthorn leaf-and-flower extract, added to usual treatment, improved exercise tolerance and symptoms such as breathlessness and tiredness in adults with chronic heart failure. NCCIH calls the overall evidence conflicting.
Supplements: Possible add-on symptom benefit in diagnosed heart failure under medical care; not a substitute for treatment, and results depend on the extract.
Traditional use for nervous heart complaints (palpitations)
Not enough evidenceIn the EU, hawthorn leaf and flower is registered as a traditional herbal medicine for temporary heart complaints linked to nervousness, such as palpitations, once a doctor has ruled out serious conditions.
Supplements: Traditional use only; no clinical-trial proof.
Traditional use for mild mental stress and sleep
Not enough evidenceEMA lists hawthorn leaf and flower as a traditional herbal medicine for mild symptoms of mental stress and to aid sleep, for adults and adolescents over 12.
Supplements: Traditional use only; no clinical-trial proof.
Heart disease, angina, irregular heartbeat, artery plaque
Not enough evidenceNCCIH says there is not enough evidence to know whether hawthorn helps heart disease, angina, irregular heartbeat or plaque in the arteries.
Supplements: No verified benefit.
Anxiety
Not enough evidenceNCCIH says it is unclear whether hawthorn helps anxiety.
Supplements: No verified benefit.
Weight loss
Not enough evidenceNCCIH says there is no evidence that hawthorn affects weight loss.
Supplements: No evidence of an effect.
Connected topics
Open a group to see how each topic connects and how strong the evidence is.
Health goals (1)
- Heart HealthClinically supported
Hawthorn leaf-and-flower extract has been studied as an add-on to usual care in chronic heart failure, with a Cochrane review reporting better exercise tolerance and symptoms; NCCIH calls the overall evidence conflicting, and there is no data on deaths. It is not a substitute for heart treatment.
Body systems (2)
- Cardiovascular SystemClinically supported
Hawthorn leaf-and-flower extract has been studied as an add-on to usual care in chronic heart failure, with a Cochrane review reporting better exercise tolerance and symptoms; NCCIH calls the overall evidence conflicting, and there is no data on deaths.
- Heart & CirculationClinically supported
Hawthorn leaf-and-flower extract has been studied as an add-on to usual care in chronic heart failure, with a Cochrane review reporting better exercise tolerance and symptoms; NCCIH calls the overall evidence conflicting, and there is no data on deaths.
Body parts (1)
- HeartClinically supported
Hawthorn leaf-and-flower extract has been studied as an add-on to usual care in chronic heart failure, with a Cochrane review reporting better exercise tolerance and symptoms; NCCIH calls the overall evidence conflicting, and there is no data on deaths.
Functional actions (1)
- Cardiovascular SupportClinically supported
Hawthorn leaf-and-flower extract has been studied as an add-on to usual care in chronic heart failure, with a Cochrane review reporting better exercise tolerance and symptoms; NCCIH calls the overall evidence conflicting, and there is no data on deaths. For other heart uses (angina, rhythm, plaque) NCCIH says there is not enough evidence.
Root causes (1)
- Medication Side EffectsDocumented risk
Hawthorn may interact with digoxin and other heart medicines. One small trial found no change in digoxin levels, but a lab study found test interference and advised people on digoxin to avoid it; ask a pharmacist first.
Conditions & symptoms (2)
- Congestive Heart FailureClinically supported
Same evidence as heart failure: symptom and exercise-tolerance benefit as an add-on in Cochrane, with conflicting overall evidence per NCCIH.
- Heart FailureClinically supported
Studied as an add-on to usual care in chronic heart failure; a Cochrane review found better exercise capacity and symptoms but no data on deaths, and NCCIH calls the evidence conflicting. NCCIH also describes one study where a preparation may have been linked to earlier progression.
Documented risks and interactions (4)
- Possible interaction with digoxin and heart or blood-pressure medicines. Ask a pharmacist or prescriber before combining hawthorn with digoxin or other heart medicines. A small trial in 8 healthy people found no significant change in digoxin levels after 3 weeks, but a laboratory study found hawthorn interfered with one digoxin blood test and advised people on digoxin to avoid it.
- Side effects. NCCIH lists dizziness, nausea, vomiting, diarrhea and muscle pain. Cochrane reported adverse events as infrequent, mild and transient in the heart-failure trials.
- Pregnancy and breastfeeding. NCCIH says little is known about the safety of hawthorn in pregnancy or breastfeeding.
- Toxic look-alike products sold as tejocote root. In January 2024 the FDA warned that some products labeled tejocote root (Mexican hawthorn) contained yellow oleander, a toxic plant that can cause serious harm or death, and some people took them for weight loss.
Hawthorn is not a replacement for heart treatment. Heart failure, chest pain and irregular heartbeat need a clinician. If you take digoxin, a blood thinner or a blood pressure medicine, ask your pharmacist or prescriber before using hawthorn: LactMed says it can possibly increase the effect of anticoagulants, digoxin and blood-pressure-lowering medicines. [1] And be aware of a poisoning warning: FDA (alert first issued January 2024 and still being updated in 2026) warned that some products labeled "tejocote root" (Mexican hawthorn, Crataegus mexicana) actually contain yellow oleander, a toxic plant that can cause serious or fatal harm. [2][3] If someone has taken such a product and feels unwell, call 911 or Poison Help at 1-800-222-1222 (US). [3]
What hawthorn is
Hawthorn is a flowering shrub or tree of the rose family that grows in temperate regions. [2] The two species in this page's title are Crataegus monogyna Jacq. and Crataegus laevigata (Poir.) DC., both accepted names in GBIF. [4][5] NCCIH also lists C. mexicana and C. pinnatifida under hawthorn, so a label saying only "hawthorn" or "tejocote" does not tell you which plant is inside. [2] The EU assessment covers only leaf and flower preparations of several Crataegus species, so it does not speak to berries or roots. [6] Read the label for species and plant part. See Botanical Names and Plant Parts on Labels.Traditional use
This is tradition, not proof. NCCIH says hawthorn was traditionally used for heart disease, digestion, blood circulation, and kidney and bladder problems, and on the skin for sores, itching and frostbite. [2] EMA's herbal committee (EU, 2016) accepted hawthorn leaf and flower for "traditional use" only, meaning long-standing use rather than clinical-trial proof. [6]What research shows
NCCIH (US, April 2025) says there is little or no quality evidence on hawthorn for most health conditions; heart failure is the main condition studied. [2]| Use | What the source found | Strength of evidence | Population and form studied |
|---|---|---|---|
| Chronic heart failure (added to usual care) | A Cochrane review of 14 placebo-controlled trials found benefit in exercise capacity and symptoms such as breathlessness and fatigue. [7] It reported no usable data on deaths or cardiac events. [7] NCCIH calls the overall evidence conflicting. [2] | Mixed; the review searched only to 2006 | Adults with chronic heart failure (NYHA classes I to III); leaf-and-flower extracts, mostly as an add-on to conventional treatment [7] |
| Heart disease, angina, abnormal heartbeat, plaque in arteries | Not enough evidence to know. [2] | Insufficient evidence | Not established |
| Weight loss | No evidence that hawthorn affects weight loss. [2] | No good evidence of benefit | None identified |
| Anxiety | Unclear. [2] | Insufficient evidence | Not established |
| Palpitations related to nervousness, mild stress, sleep (traditional use in the EU) | EMA's committee noted a lack of clinical studies and accepted these uses on long-standing use only, after a doctor has excluded serious conditions. [6] | Traditional use only | Adults (heart complaints); adults and adolescents over 12 (stress and sleep) [6] |
A review that searched literature only up to 2006 may miss newer trials. Newer heart-failure results were not read for this page, so we do not describe them.
Safety
- Heart medicines: LactMed says hawthorn can possibly increase the effect of anticoagulants, digoxin and blood-pressure-lowering medicines. [1] In a small crossover trial in 8 healthy volunteers, a leaf-and-flower extract taken for 3 weeks did not significantly change digoxin levels. [8] A separate laboratory study found hawthorn extract interfered with one of two digoxin blood tests it checked, and its authors concluded a person on digoxin should avoid hawthorn (the pharmacology part used rat heart cells). [9] NCCIH describes one study in which a specific preparation may have been linked to earlier heart failure progression; the cause is unclear, and drug interactions are one possibility. [2] Read Supplements and Blood Pressure and Heart Medicines and How Interactions Work. Never stop or change a heart medicine without the prescriber.
- Side effects: NCCIH lists dizziness, nausea, vomiting, diarrhea and muscle pain. [2]
- How long: no studies have tested hawthorn beyond 16 weeks. [2]
- Pregnancy and breastfeeding: NCCIH says little is known about safety. [2] LactMed found no data on hawthorn in breast milk; it notes that a German expert commission saw no reason to avoid flowers or leaves while breastfeeding but advised avoiding the fruit, and that other sources advise avoiding hawthorn for lack of studies. [1] See Pregnancy and Breastfeeding.
- Children: EMA's summary limits the heart-complaint use to adults and the stress and sleep use to adults and adolescents over 12. [6]
- Liver, kidney, bleeding, surgery, allergy: not described in the sources we read. Because LactMed raises possible effects on anticoagulants, tell the surgical team about any herbal product. See Supplements Before Surgery.
Quality and adulteration
FDA analysis found certain products labeled as tejocote root or "Brazil seed" were adulterated with yellow oleander (Thevetia peruviana). [3] FDA's advice is to stop using and dispose of products on its alert list, and to contact a health care provider right away if you took one, even if not recently. [3] Yellow oleander is known to harm the nervous system, heart, stomach and intestines. [2] This page gives no foraging or plant-identification help. See Product Quality and Contamination and Hawthorn Tea for the tea product.We give no amounts. A clinician or pharmacist decides what suits a person.
Frequently asked questions
Does hawthorn help heart failure?
A Cochrane review found benefit in symptoms and exercise capacity when hawthorn leaf-and-flower extract was added to usual care, but no data on deaths or cardiac events, and it searched only to 2006. [7] NCCIH calls the evidence conflicting. [2] Decisions belong with your cardiology team.
Can I take hawthorn with digoxin?
Ask your pharmacist or prescriber first. LactMed says hawthorn can possibly increase the effect of digoxin. [1] One lab study advised people on digoxin to avoid hawthorn. [9]
Is tejocote root the same as hawthorn?
Tejocote refers to Crataegus mexicana, but FDA found products labeled tejocote root that contained toxic yellow oleander instead. [3]
Is hawthorn safe in pregnancy?
Little is known about safety in pregnancy or breastfeeding. [2] Ask your clinician.
Does hawthorn help with anxiety or weight loss?
For anxiety, NCCIH says it is unclear. For weight loss, it says there is no evidence of an effect. [2]
References
- LactMed, NIH (US), Hawthorn, record updated February 2021. Read 2026-10-23.
- NCCIH (US), Hawthorn, last updated April 2025. Read 2026-10-23.
- US Food and Drug Administration, FDA issues warning about certain supplements substituted with toxic yellow oleander, alert first issued January 2024 and updated through 2026. Read 2026-10-23.
- GBIF Backbone Taxonomy, Crataegus monogyna match record. Read 2026-10-23.
- GBIF Backbone Taxonomy, Crataegus laevigata match record. Read 2026-10-23.
- European Medicines Agency (EMA, EU), Committee on Herbal Medicinal Products, Hawthorn leaf and flower: summary of conclusions, published 2016. Read 2026-10-23.
- Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database of Systematic Reviews, 2008. Read 2026-10-23.
- Tankanow R et al. Interaction study between digoxin and a preparation of hawthorn. Journal of Clinical Pharmacology, 2003. Read 2026-10-23.
- Dasgupta A et al. Interference of hawthorn on serum digoxin measurements by immunoassays and pharmacodynamic interaction with digoxin. Archives of Pathology and Laboratory Medicine, 2010. Read 2026-10-23.