Hawthorn, the heart and palpitations: forms, evidence and safety

The EMA covers a traditional use of leaf-and-flower preparations for palpitations linked to mild nervousness, only after a doctor has ruled out a serious cause. It also covers traditional use for mild stress and sleep support. “Traditional” describes the basis of the indication; it does not prove treatment of heart disease.

Chest pain, breathlessness, fainting, marked weakness, a very fast rhythm or symptoms that do not stop require urgent medical help. A first episode, worsening symptoms or known heart disease also warrants professional advice.

The European monograph concerns defined leaf-and-flower preparations, including herbal substance, powder, juice and extracts. Tea, tincture, standardised capsule, fruit product and root product do not necessarily have the same composition or evidence. An extract dose cannot simply be transferred to a home infusion.

Trials in heart failure have produced conflicting results across heterogeneous extracts and populations. Current evidence is insufficient or discordant to recommend hawthorn as a treatment for heart failure or an arrhythmia. There is no sound basis for a universal blood-pressure or palpitation dose.

Dizziness and digestive symptoms are possible. Long-term safety and use during pregnancy or breastfeeding remain insufficiently documented. People taking cardiovascular, blood-pressure, rhythm or sedating medicines should ask a clinician or pharmacist before use. Never replace or stop prescribed treatment.