hag

hawthorne (Crataegus Species)

(haw-thorn) ,

aubepine

(trade name),

cum flore

(trade name),

hagedorn

(trade name),

maybush

(trade name),

whitehorn

(trade name) HypertensionMild to moderate HFAnginaSpasmolyticSedative

Action

Pharmacokinetics

Time/action profile

ROUTE	ONSET	PEAK	DURATION
PO	unknown	6-8 wk	unknown

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• agitation
• dizziness
• fatigue
• vertigo
• headache
• sedation (high dose)
• sleeplessness
• sweating

Cardiovascular

• hypotension (high dose)
• palpitations

Dermatologic

• rash

Gastrointestinal

• nausea

Interactions

May potentiate effects of digoxin, calcium channel blockers, and beta blockers.Concurrent use with phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil ) and nitrates may potentiate vasodilatory effects.May cause additive CNS depression when used with other CNS depressants.Additive effect with other cardiac glycoside–containing herbs (digitalis leaf, black hellebore, oleander leaf, and others).Additive hypotensive effects with herbs than lower BP such as ginger, panax ginseng, coenzyme Q-10and valerian.Additive effect with other cardioactive herbs (devil’s claw, fenugreek, and others).

Availability (generic available)

Nursing implications

Nursing assessment

• Monitor intake and output rations and daily weight. Assess for peripheral edema, auscultate lungs for rales and crackles during therapy.
• Assess BP and pulse periodically during therapy.

Potential Nursing Diagnoses

Decreased cardiac output (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

• Administered as 2–3 divided doses daily at the same time.
• May be taken without regard to food.

Patient/Family Teaching

• Advise patients that there are other proven therapies available for treatment of heart failure. These therapies should be employed prior to initiating treatment with hawthorne.
• Tell patient not to take hawthorne without the advice of health care professional.
• Instruct patients in the symptoms of a heart attack (pain in the region of the heart, jaw, arm, or upper abdomen; sweating; chest tightness) and heart failure (shortness of breath, chest tightness, dizziness, sweating) and to promptly contact health care professional if they occur.
• Advise patient to report weight gain or persistent swelling of the feet to health care professional.
• May cause dizziness and fatigue. Patients should avoid driving or other activities that require mental alertness until response to herb is known.
• Avoid alcohol and other CNS depressants while taking hawthorne without consulting health care professional.
• Profuse sweating and dehydration under extreme heat may increase the BP-lowering properties of hawthorne, leading to severe hypotension. Warn patients to avoid exertion in hot weather to minimize the risk of side effects.
• Instruct patients that hawthorne helps control the symptoms of heart failure but does not cure the disease. Lifestyle changes (salt restriction, weight management, exercise as tolerated, adherence to medication regimens) still need to be followed.
• Instruct patient to consult health care professional before taking Rx, OTC, or other herbal products concurrently with hawthorne.
• Advise female patients to use contraception during therapy and to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

• Decrease in symptoms of HF. Effects may not be seen for 6 wks.
• Improved cardiac output as evidenced by improved activity tolerance.