hawthorne

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hawthorne (Crataegus Species)

(haw-thorn) ,

aubepine

(trade name),

cum flore

(trade name),

hagedorn

(trade name),

maybush

(trade name),

whitehorn

(trade name)

Classification

Therapeutic: antihypertensives
HypertensionMild to moderate HFAnginaSpasmolyticSedative

Action

Active compounds in hawthorne include flavonoids and procyanidins.
Increase coronary blood flow.
Positive inotropic and chronotropic effects because of increased permeability to calcium and inhibition of phosphodiesterase.

Therapeutic effects

Increased cardiac output.
Decreased BP, myocardial workload, and oxygen consumption.

Pharmacokinetics

Absorption: Unknown.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: Unknown.

Time/action profile

ROUTEONSETPEAKDURATION
POunknown6-8 wkunknown

Contraindications/Precautions

Contraindicated in: Pregnancy (potential uterine activity); Lactation.
Use Cautiously in: Concurrent use with ACE inhibitors and digoxin; Do not discontinue use abruptly.

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).
Oral (Adults) Heart failure—160–1800 mg standardized hawthorne leaf with flower extract in 2–3 divided doses daily. Hawthorne fluid extract (1:1 in 25% alcohol)—0.5–1 mL tid; hawthorne fruit tincture (1:5 in 45% alcohol)—1–2 mL tid; dried hawthorne berries—300–1000 mg tid.

Availability (generic available)

Dried fruit: OTC
Liquid extract of the fruit or leaf: OTC
Tincture of the fruit or leaf: OTC

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.
References in periodicals archive ?
L'adieu du petit frere au chevreau (dans la version de 1908) est clairement transpose dans l'adieu du heros aux aubepines (dans Swann).
La scene, ou c'est d'ailleurs le comique qui l'emporte, n'est pas sans etrangete, car si l'accoutrement feminin et la conduite colerique et regressive sont relativement vraisemblables dans la version du Contre Sainte-Beuve ou il est precise que Robert Proust est age de cinq ans et demi, leur transposition a un jeune adolescent ou pre-adolescent l'est beaucoup moins : dans << Combray >> en effet la scene se produit l'annee de la rencontre du heros avec Gilberte (4) (rencontre qui, dans l'espace du livre, a eu lieu quatre pages plus haut, l'adieu aux aubepines etant aussi un adieu au parc de Gilberte).
Mais elle a beau dechirer litteralement sa douillette en embrassant les aubepines, pietiner son chapeau et arracher ses papillotes, les scenes de reconnaissance sont differees sine die, le double secret que symbolisent ces << ornements >> dechires ne sera pas enonce, la petite princesse restera muette, sinon dans sa deploration finale qui reitere sa fidelite a son etre veritable (10).
Pour l'adieu aux aubepines proprement dit nous disposons de peu d'avant-textes.
ma mere me trouva en larmes dans le petit chemin en train de dire adieu aux aubepines et comme une princesse de tragedie a qui pesaient ces vains ornements (16) foulant mon chapeau [start strikethrough]neuf[end strikethrough] aux pieds au lieu de l'avoir sur ma tete et [start strikethrough]dechirant ma douillette aux branches[end strikethrough] <et entourant de mes bras les branches> epineuses, [.
Mais j'avais beau rester devant les aubepines a respirer, a porter devant ma pensee qui ne savait ce qu'elle devait en faire, a perdre, a retrouver leur invisible et fixe odeur, a m'unir au rythme qui jetait leurs fleurs, ici et la, avec une allegresse juvenile et a des intervalles inattendus comme certains intervalles musicaux, elles m'offraient indefiniment le meme charme avec une profusion inepuisable, mais sans me le laisser approfondir davantage, comme ces melodies qu'on rejoue cent fois de suite sans descendre plus avant dans leur secret (SWANN, I, I, 136).
Proust plus que quiconque semble avoir saisi le paradoxe de la vie corporelle de l'esprit incarne qui parfois, ne contient pas tout le corps et le plus souvent, contient bien plus que le corps: le monde et ses conditions d'expression puisque l'auteur, dans l'episode des aubepines (comme ailleurs, dans des episodes de meme valeur), fait entrevoir a son personnage une structure d'indivision avec un sens latent aveugle (dont le narrateur pressent la valeur de verite), qui semble s'opposer a un sens manifeste, artificiel et conventionnel.
Place of performance: Taffin City - rue des Aubepines - Cytises street, rue des Eglantines Street and Wisteria Street TamarisNature and scope of work: Construction of improved indoor and outdoor habitat.