Hawthorn Tea

• Do not treat heart failure, chest pain or palpitations on your own with hawthorn tea. The biggest risk is delay. Heart failure, angina and chest pain need a diagnosis and proven treatment. The EU monograph allows hawthorn leaf and flower, including as a herbal tea, only as a traditional medicine for temporary nervous heart complaints such as palpitations, and only after a doctor has ruled out serious conditions. It says to see a doctor immediately for swollen ankles or legs, pain in the heart area that may spread to the arms, upper belly or neck, or breathlessness, and to see a doctor if symptoms last more than 2 weeks. NCCIH says the evidence in heart failure is conflicting and that there is not enough evidence for heart disease, angina or abnormal heartbeat. The best trials were of extracts: SPICE (2,681 people) found no difference in the main outcome (HR 0.95, 95% CI 0.82 to 1.10) and HERB CHF (120 people) found no gain in walking distance. No study measured the harm of delaying care, so that risk comes from medical guidance, not a trial. Authoritative guidance ^{27 26 9 25 4}
• Heart and blood-pressure medicines: digoxin, beta-blockers, nitrates and others. Hawthorn compounds raise heart-cell calcium and relax blood vessels in lab work, so doctors worry about added effects with digoxin, beta-blockers, calcium-channel blockers, nitrates, other blood-pressure medicines and antiarrhythmic drugs. The EU monograph lists interactions as none reported. In trials of extracts, many patients took several heart medicines and no interactions were reported, but those trials did not test interactions on purpose, and none tested tea. For digoxin, a small study in 8 healthy volunteers found no change in digoxin levels with an extract, while a laboratory study found hawthorn can disturb one digoxin blood test and advised people on digoxin to avoid hawthorn. Hawthorn may also lower blood pressure a little, so dizziness on standing is plausible with blood-pressure medicines. Ask your prescriber or pharmacist before drinking it regularly. Mixed ^{27 17 6 20 16 9 5}
• Pregnancy, breastfeeding and children. The EU monograph says safety in pregnancy and breastfeeding has not been established and use is not recommended. It does not recommend use under 18 for the heart indication, and says use under 12 for the stress and sleep indication has not been established. NCCIH says little is known about pregnancy and breastfeeding. Animal findings conflict: one rat study at 56 times the human dose found no harm to embryo development, while another found the water leaf extract had a teratogenic effect and both extracts caused short-term genetic damage. These are animal results at high doses. No human pregnancy study was found. Authoritative guidance ^{27 26 22 1}
• Everyday side effects are mild in trials. A review of 24 studies of single-ingredient hawthorn products (5,577 patients analysed) counted 166 adverse events, mostly mild to moderate. The most frequent were stomach complaints, dizziness or vertigo, palpitation, headache and migraine. Eight severe events were all with one extract (LI 132). The Cochrane review describes events as infrequent, mild and temporary. NCCIH lists dizziness, nausea, vomiting, diarrhoea and muscle pain. The EU monograph says undesirable effects are none known. The counts are not rates, and the trials were mostly in heart-failure patients taking extracts, not tea drinkers. Systematic review ^{5 14 26 27}
• A small signal of faster heart-failure worsening in one trial (extract). A look back at the HERB CHF data found early heart-failure progression was 3.9 times more likely on the extract (95% CI 1.1 to 13.7), and 3.2 times in people whose heart pumped out 35% or less of its blood per beat (CI 1.3 to 8.3), although overall progression was similar (46.6% versus 43.3%). HERB CHF also had significantly more total adverse events on hawthorn (P=0.02), most not heart-related. The analysis was not planned in advance, the numbers were small, and the much larger SPICE trial did not show harm. NCCIH cites this signal. Both trials used extracts, so they say nothing certain about tea. Controlled trial ^{24 25 9 26}
• Products sold as tejocote root for weight loss have been poisonous: yellow oleander, not hawthorn tea. Tests of 10 online products labelled tejocote (Crataegus mexicana) root found 9 were yellow oleander, a heart poison, and none was tejocote root. Case reports describe a 16-year-old with a heart rate of 38 and heart block, a 30-year-old woman with heart block, and a 42-year-old woman in Europe whose supplement tested as yellow oleander with no Crataegus. NCCIH says the FDA published a list in January 2024 of such products and warned they may be fatal. A tea of true hawthorn leaf, flower or berry is a different product, but a label alone does not prove which plant is inside. Do not use any product sold as tejocote root, Nuez de la India or a weight-loss root. Case series ^{3 12 2 19 26}
• Tea, extract and tincture are not the same product. The heart-failure trials used standardised leaf-and-flower extracts. The EU monograph lists a herbal tea of the leaf with flower, several extracts and a tincture as separate traditional-use forms. No trial of the tea was found, so extract results should not be carried over to a cup of tea, and a tea's strength depends on the plant parts and how it is made. The safety signals above come from extract trials and case reports. Authoritative guidance ^{27 9 25}
• Surgery, bleeding and long use. No regulator advice and no human study on hawthorn before surgery or with blood thinners was found. A rat study found a low dose of a hawthorn water extract reduced platelet clumping and a very high dose did the opposite. Tell the surgeon and anaesthetist about any hawthorn product. NCCIH says no research has tested use beyond 16 weeks, although SPICE followed people for 24 months. Pharmacological theory ^{15 26 9}

No published human case of liver injury from hawthorn was found in the sources read. The NIH LiverTox entry could not be opened, so no likelihood score is given. Not finding reports is not proof of safety. ^{5 21}

How often. No frequency was found.

Monitoring. No agency monitoring advice was found. Stop and get care for yellow skin or eyes, dark urine, pale stools or severe itching.

This is a safety connection. It is not evidence that Hawthorn Tea supports liver health.

Summary. True hawthorn leaf, flower and berry preparations have mild side effects in trials, and the EU reports no overdose. The serious poisonings in the literature are from products sold as tejocote root that tested as yellow oleander. Cancer and reproduction tests are largely missing.

Animal. Pregnant-rat studies conflict (see pregnancy). A rat study found the water extract of C. oxyacantha leaf cytotoxic and genotoxic in the short term.

Human doses studied. Trials used standardised extracts for 3 to 24 weeks (24 months in SPICE). None used tea.

High dose or long term signals. The EU monograph says no overdose has been reported. NCCIH says no research has tested use beyond 16 weeks.

Overdose response. For true hawthorn, no overdose case was found.

Genotoxicity. Short-term genetic damage in rats with leaf extracts (one study).

Toxic or hazardous parts. Leaf, flower and berry are the parts used. Seeds and root were not assessed in the sources read. 'Tejocote root' products are a separate problem (yellow oleander).

The proven quality problem is substitution, not dirt: products sold as tejocote root were mostly yellow oleander. For ordinary hawthorn teas we found no survey of adulteration, heavy metals or pesticides, so quality is unknown rather than known to be good.

Tejocote root products replaced by yellow oleander. Of 10 online products labelled tejocote root bought in December 2022 and tested, 9 were yellow oleander and none was tejocote root. ³

Laboratory-confirmed poisoning. A 42-year-old woman with a slow heart rate and heart block took a 'Tejocote root' supplement bought in the USA. Mass spectrometry and DNA barcoding found yellow oleander and no Crataegus. Standard toxicology screens do not look for plant heart poisons. ¹⁹

Blood tests for digoxin can be fooled. Hawthorn extracts and plant heart poisons can cross-react with some digoxin blood tests. A tejocote case showed a digoxin reading of 0.7 ng/mL in a person who took no digoxin. ^{12 6}

Heavy metals, pesticides, tea bag quality. Not found for hawthorn tea in the sources read.

• Chest pain or pressure, especially spreading to the arm, upper belly or neck, or sudden breathlessness: call emergency services now. Do not drink hawthorn tea instead of getting care.
• Swollen ankles or legs, new tiredness or breathlessness: see a doctor soon. Heart failure needs proper assessment and treatment.
• Fainting, a very slow pulse, vomiting, drowsiness or confusion after any product sold as tejocote root, Nuez de la India or a weight-loss root: go to the emergency department or call a poison centre now. Bring the packet.
• Palpitations that are new, worse, or come with dizziness, fainting or chest discomfort: get a doctor to check your heart rhythm.
• Dizziness or faintness on standing after adding hawthorn to blood-pressure or heart medicines: sit or lie down, avoid driving, and call your doctor the same day.
• Swelling of the face or throat, trouble breathing or widespread hives: get emergency help.
• Heart-failure symptoms getting worse after you started hawthorn: stop it and see your doctor.

Stop using the product and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.