Significant Interactions

Controlled studies are not available; therefore, interactions are based on evidence of activity and are largely theoretical and speculative. CARDIAC GLYCOSIDES

Hawthorn may theoretically potentiate the effects of cardiac glycosides, as both in vitro and in vivo studies indicate that it has positive inotropic activity. Furthermore, the flavonoid components of hawthorn may also affect P-glycoprotein function and cause interactions with drugs that are P-glycoprotein substrates, such as digoxin. In practice, however, a randomised crossover trial with eight healthy volunteers evaluating digoxin 0.25 mg alone for 10 days and digoxin 0.25 mg with Crataegus special extract WS 1442 (hawthorn leaves with flowers) 450 mg twice daily for 21 days found no significant difference to any measured pharmacokinetic parameters, suggesting that hawthorn and digoxin in these doses may be coadministered safely (Tankanow et al 2003). Caution — use under professional supervision and monitor drug requirements.

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