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Crataegus monogyna Jacq. (Lindm) (Rosaceae)

Synonyms
Crataegus monogyna Jacq. (Lindm) C. apiifolia Medik. non Michx., C. oxyacantha L. ssp. monogyna Lev., Mespilus elegans Poir., M. monogyna All., M. monogyna Ehrh.

Local names
Aubeline, aubepine, biancospino, calabrice, calavrice, eenarijlige meidorn, eenstijlige meidorn, eingriffeliger Weissdorn, Einkern-Weissdorn, épine blanche, espinero, espino blanco, espino majuelo, galagonya virágzó ágvég, hagdorn, hagedorn, harthorne, haw, hawthorn, hedge thorn, majuelo, may, May thorn, Mehlbeerbaum, Mehldorn, seiyosanzashi, shanzha, sorkh valik, spina, Stumpf gelappter Weissdorn, Weissdorn, whitethorn, za bur, zu’rurr el awdiyah, zweigriffeliger Weissdorn, Zweikern-Weissdorn

Plant material used
dried leaf with flower

Chemical assays
Contains not less than 1.5% of flavonoids, calculated as hyperoside (1), and not less than 0.6% of flavone C-glycosides, calculated as vitexin, determined by spectrophotometry at 410 and 336 nm, respectively (1). A high-performance liquid chromatography method is also available

Major chemical constituents
The major constituents are flavonoids (rutin, hyperoside, vitexin, vitexin-2'' rhamnoside, acetylvitexin-2'' rhamnoside) and related proanthocyanidins. In the inflorescence, flavonol glycosides, mainly in the form of hyperoside, spiraeoside and rutin, are present. The primary flavonoid derivatives in the leaves are epi-catechin (epi-catechol) and/or catechin (catechol), and the related procyanidins formed during condensation of 2–8 monomeric units of the above catechins, together with oligomeric procyanidins. The presence of simple phenolic acids (e.g. chlorogenic and caffeic acids) has also been reported. Of the non-phenolic constituents, pentacyclic triterpenes (e.g. ursolic and oleanolic acids) and the 2-α-hydroxy derivative of oleanolic acid, known as crataegolic acid, are among the characteristic components

Medicinal uses
Uses supported by clinical data
Treatment of chronic congestive heart failure stage II, as defined by the New York Heart Association.

Uses described in pharmacopoeias and well established documents
Support of cardiac and circulatory functions.

Uses described in traditional medicine
As an antispasmodic agent in the treatment of asthma, diarrhoea, gall bladder disease and uterine contractions, and as a sedative for the treatment of insomnia

Proven pharmacological activity
Animal studies
Inotropic positive, Anti-arryhtmic, Increase coronary blood flow, Antihypertensive, Anti-inflammatory, Sedative, Diuretic

Human studies
Cardiac insufficiency, Exercise tolerance

Toxicology
Single-dose toxicity studies have demonstrated that rats and mice tolerate 3g/kg body weight, by gastric lavage, of a standardized hydroalcoholic extract of the leaves with flowers (containing 18.75% oligomeric procyanidins) without any clinical symptoms of toxicity. The intraperitoneal median lethal dose (LD50) was 1.17 g/kg body weight in rats and 750 mg/kg body weight in mice. No toxic effects were observed in a repeat-dose toxicity study in which rats and dogs were given a standardized extract (containing 18.75% oligomeric procyanidins) at doses of 30, 90 and 300 mg/kg body weight daily by the intragastric route for 26 weeks

Contraindications
None.

Warnings
Accurate diagnosis of stage II congestive heart failure should be obtained prior to use of Folium cum Flore Crataegi. Consult a physician if symptoms worsen, remain unchanged for longer than 6 weeks, or if water accumulates in the legs. Medical attention is absolutely necessary if pain occurs in the region of the heart, spreading out to the arms, upper abdomen or neck area, or in cases of respiratory distress (e.g. dyspnoea).

Precautions
Drug interactions
None.

Drug and laboratory test interactions
No effects in laboratory tests (i.e. serum levels of sodium chloride, potassium chloride, calcium chloride, serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, g-glutamyl transpeptidase, total bilirubin, cholesterol and creatinin, and blood glucose levels) were observed.

Carcinogenesis, mutagenesis, impairment of fertility
A standardized extract of Folium cum Flore Crataegi (containing 18.75% oligomeric procyanidins) was not mutagenic or clastogenic in the Salmonella/ microsome assay, mouse lymphoma test, cytogenetic analysis in cultured human lymphocytes or in the mouse bone marrow micronucleus test. A fluidextract was moderately active in the Salmonella/microsome assay in S. typhimurium strain TA98 only after metabolic activation. The mutagenic activity appeared to be due to the quercetin content of the extract; however, the amount of quercetin ingested in a normal daily diet is higher than would be obtained from the extract. Intragastric administration of up to 1.6 g/kg body weight had no effect on the fertility of female and male rats or the F1 generation

Pregnancy: teratogenic effects
Intragastric administration of up to 1.6 g/kg body weight of a standardized extract of Folium cum Flore Crataegi to rats and rabbits was not teratogenic.

Pregnancy: non-teratogenic effects
No peri- or postnatal toxicity was observed in rats treated intragastrically with a standardized extract of Folium cum Flore Crataegi (1.6 g/kg body weight).

Other precautions
No information available on general precautions or precautions concerning nursing mothers or paediatric use. Therefore, Folium cum Flore Crataegi should not be administered during lactation or to children without medical supervision.

Adverse reactions
None.

Dosage forms
Crude drug for infusion and hydroalcoholic extracts. Store in a well-closed container, protected from light and moisture.

Posology
(Unless otherwise indicated)
Daily dosage: 160–900 mg dried 45% ethanol or 70% methanol extract (drug: extract ratio 4–7 : 1) standardized to contain 18.75% oligomeric procyanidins (calculated as epi-catechin) or 2.2% flavonoids (calculated as hyperoside), respectively; 1.0–1.5 g comminuted crude drug as an infusion 3–4 times daily. Therapeutic effects may require 4–6 weeks of continuous therapy

 

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