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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]" /><meta name="citation_title" content="Hawthorn" /><meta name="citation_publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="citation_date" content="2023/01/28" /><meta name="citation_pmid" content="36753600" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK589114/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Hawthorn" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="DC.Date" content="2023/01/28" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK589114/" /><meta name="description" content="Hawthorn is a flowering shrub or tree of several Crataegus species, which has been used in traditional medicine for digestive complaints and heart disease including hypertension and heart failure. Oral forms of hawthorn extracts have not been linked to elevations in serum aminotransferase levels or to instances of clinically apparent liver injury with jaundice." /><meta name="og:title" content="Hawthorn" /><meta name="og:type" content="book" /><meta name="og:description" content="Hawthorn is a flowering shrub or tree of several Crataegus species, which has been used in traditional medicine for digestive complaints and heart disease including hypertension and heart failure. Oral forms of hawthorn extracts have not been linked to elevations in serum aminotransferase levels or to instances of clinically apparent liver injury with jaundice." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK589114/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/livertox/Hawthorn/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK589114/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="All Drug Records" href="/books/n/livertox/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" alt="Cover of LiverTox" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK589114_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK589114_dtls__"><div>Bethesda (MD): <a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>; 2012-.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/livertox/">Drug Records</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/livertox/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/livertox/Halothane/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/livertox/HematologicGrowthFac/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK589114_"><span class="title" itemprop="name">Hawthorn</span></h1><p class="small">Last Update: <span itemprop="dateModified">January 28, 2023</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="Hawthorn.OVERVIEW"><h2 id="_Hawthorn_OVERVIEW_">OVERVIEW</h2><div id="Hawthorn.Introduction"><h3>Introduction</h3><p>Hawthorn is a flowering shrub or tree of several <i>Crataegus species, w</i>hich has been used in traditional medicine for digestive complaints and heart disease including hypertension and heart failure. Oral forms of hawthorn extracts have not been linked to elevations in serum aminotransferase levels or to instances of clinically apparent liver injury with jaundice.</p></div><div id="Hawthorn.Background"><h3>Background</h3><p>Hawthorn is bulky shrub or small tree of several species of the genus <i>Crataegus (pinnatifida</i>, <i>laevigata, monogyna, oxyacantha</i>), which is found throughout most of Asia, Europe and North America. Extracts of the dried ripe berries and leaves were used in ancient traditional Chinese medicine to treat indigestion, chest pain, and hernia. More recently it has been used largely to treat cardiovascular disease such as angina pectoris, hypertension, and congestive heart failure. The hawthorn berry is also used as a food, prepared as jam or jelly, and made into a fruit drink. Extracts of hawthorn berries and leaves contain multiple flavonoids, phenylpropanoids, lignans, triterpenoids and glycosides. The ingredient responsible for the purported activity of hawthorn in heart disease is unknown, but is suspected to be a flavonoid antioxidant. Studies in vitro and in vivo have shown that hawthorn extracts have multiple pharmacological actions, including cardiovascular protection and antioxidant, antibacterial, lipid lowering, and hepatoprotective activity. Clinical trials of hawthorn, however, have not consistently substantiated these medicinal properties. Hawthorn is found in multiple commercial forms, the recommended daily dose ranging widely from 120 to as high as 1800 mg of extract daily. Hawthorn is generally well tolerated without adverse events; minor side effects may include diarrhea, abdominal discomfort and nausea. Rare instances of hypersensitivity reactions, skin rash and allergic dermatitis have been described.</p></div><div id="Hawthorn.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>In several prospective clinical trials, hawthorn in conventional oral doses was typically described as having no serious, drug related adverse side effects and serum enzyme elevations were not mentioned. In most studies, adverse events with hawthorn occurred at rates similar to or less than that with placebo, and no instances of serum enzyme elevations or clinically apparent liver injury were mentioned. Despite widespread use as an herbal supplement, hawthorn has not been implicated in cases of drug induced liver injury.</p><p><a class="def" href="/books/n/livertox/glossary/def-item/glossary.likelihood-score/">Likelihood score</a>: E (unlikely cause of clinically apparent liver injury).</p></div><div id="Hawthorn.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>The mechanism by which hawthorn might cause liver injury is unknown. Hawthorn is a widely used food, and liver injury arising while taking a multiingredient, hawthorn containing product might be due to a contaminant or another herbal component in the dietary supplement.</p><p>Drug Class: <a href="/books/n/livertox/HerbalDietarySuppl/">Herbal and Dietary Supplements</a></p><p>Other names: English Hawthorn, Hawthorne, Haw.</p></div></div><div id="Hawthorn.PRODUCT_INFORMATION"><h2 id="_Hawthorn_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Hawthorn – Generic</p><p>
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<b>DRUG CLASS</b>
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</p><p>Herbal and <a class="def" href="/books/n/livertox/glossary/def-item/glossary.dietary-supplements/">Dietary Supplements</a></p><p>
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<b>SUMMARY INFORMATION</b>
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</p><p>
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<a href="https://www.nccih.nih.gov/health/hawthorn" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Fact Sheet at National Center for Complementary and Integrative Health, NIH</a>
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</p></div><div id="Hawthorn.CHEMICAL_FORMULA_AND_STRUCTURE"><h2 id="_Hawthorn_CHEMICAL_FORMULA_AND_STRUCTURE_">CHEMICAL FORMULA AND STRUCTURE</h2><div id="Hawthorn.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK589114/table/Hawthorn.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Hawthorn.Tc_lrgtbl__"><table><thead><tr><th id="hd_h_Hawthorn.Tc_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DRUG</th><th id="hd_h_Hawthorn.Tc_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CAS REGISTRY NUMBER</th><th id="hd_h_Hawthorn.Tc_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Hawthorn.Tc_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Hawthorn.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hawthorn</td><td headers="hd_h_Hawthorn.Tc_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/135318819" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">90045-52-6</a>
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</td><td headers="hd_h_Hawthorn.Tc_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Herbal</td><td headers="hd_h_Hawthorn.Tc_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not Applicable</td></tr></tbody></table></div></div></div><div id="Hawthorn.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Hawthorn_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 28 January 2023</p><p>Abbreviations: HDS, herbal and dietary supplements.</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Hawthorn.REF.zimmerman.1999">Zimmerman HJ. Unconventional drugs. Miscellaneous drugs and diagnostic chemicals. In, Zimmerman, HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott,1999: pp. 731-4.<div><i>(Expert review of hepatotoxicity published in 1999; several herbal medications are discussed, but not hawthorn).</i></div></div></li><li><div class="bk_ref" id="Hawthorn.REF.liu.2007">Liu LU, Schiano TD. Hepatotoxicity of herbal medicines, vitamins and natural hepatotoxins. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 2nd ed. New York: Informa Healthcare USA, 2007, pp. 733-54.<div><i>(Review of hepatotoxicity of herbal and dietary supplements [HDS] published in 2007; no mention of Hawthorn).</i></div></div></li><li><div class="bk_ref" id="Hawthorn.REF3">English Hawthorn. In, PDR for Herbal Medicines. 4th ed. Montvale, New Jersey: Thomson Healthcare Inc. 2007: pp. 279-84.<div><i>(Compilation of short monographs on herbal medications and dietary supplements).</i></div></div></li><li><div class="bk_ref" id="Hawthorn.REF.stedman.2002.195">Stedman C. Herbal hepatotoxicity. <span><span class="ref-journal">Semin Liver Dis. </span>2002;<span class="ref-vol">22</span>:195–206.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12016550" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12016550</span></a>]<div>
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<i>(Review and description of patterns of liver injury due to herbals, including discussion of potential risk factors, and herb-drug interactions).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.holubarsch.2008.1255">Holubarsch CJ, Colucci WS, Meinertz T, Gaus W, Tendera M. Survival and prognosis: investigation of Crataegus Extract WS 1442 in CHF (SPICE) trial study group. The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial. <span><span class="ref-journal">Eur J Heart Fail. </span>2008;<span class="ref-vol">10</span>:1255–63.</span><div>
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<i>(Among 2681 adults with heart failure treated with a hawthorn extract or placebo for 24 months, the mean times to first cardiovascular event, rates of death from heart failure and hospitalizations for heart failure were the same in both groups as were total [67% vs 68] and severe adverse event rates [39% vs 41%]; no mention of ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.zick.2009.990">Zick SM, Vautaw BM, Gillespie B, Aaronson KD. Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial. <span><span class="ref-journal">Eur J Heart Fail. </span>2009;<span class="ref-vol">11</span>:990–9.</span> [<a href="/pmc/articles/PMC2754502/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2754502</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19789403" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19789403</span></a>]<div>
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<i>(Among 120 adults with chronic heart failure treated with a hawthorn extract [450 mg] or placebo twice daily for 6 months, there were no differences in rates of deaths or hospitalizations, or changes of symptoms and signs of heart failure while adverse events were more frequent with hawthorn [60% vs 38%], no mention of ALT elevations or hepatoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.jacobsson.2009.1039">Jacobsson I, Jönsson AK, Gerdén B, Hägg S. Spontaneously reported adverse reactions in association with complementary and alternative medicine substances in Sweden. <span><span class="ref-journal">Pharmacoepidemiol Drug Saf. </span>2009;<span class="ref-vol">18</span>:1039–47.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19650152" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19650152</span></a>]<div>
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<i>(Review of 778 spontaneous reports of adverse reactions to herbals to Swedish Registry found no reports attributed to Hawthorn).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.reuben.2010.2065">Reuben A, Koch DG, Lee WM., Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. <span><span class="ref-journal">Hepatology. </span>2010;<span class="ref-vol">52</span>:2065–76.</span> [<a href="/pmc/articles/PMC3992250/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3992250</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20949552" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20949552</span></a>]<div>
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<i>(Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 [11%] were attributed to drug induced liver injury of which 12 [9%] were due to herbals, including several herbal mixtures, usnic acid, Ma Huang, black cohosh, and Hydroxycut, but not Hawthorn).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.stickel.2011.595">Stickel F, Kessebohm K, Weimann R, Seitz HK. Review of liver injury associated with dietary supplements. <span><span class="ref-journal">Liver Int. </span>2011;<span class="ref-vol">31</span>:595–605.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21457433" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21457433</span></a>]<div>
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<i>(Review of current understanding of liver injury from herbals and dietary supplements focusing upon Herbalife and Hydroxycut products, green tea, usnic acid, noni juice, Chinese herbs, vitamin A and anabolic steroids; Hawthorn is not discussed).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.teschke.2012.1543">Teschke R, Wolff A, Frenzel C, Schulze J, Eickhoff A. Herbal hepatotoxicity: a tabular compilation of reported cases. <span><span class="ref-journal">Liver Int. </span>2012;<span class="ref-vol">32</span>:1543–56.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22928722" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22928722</span></a>]<div>
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<i>(A systematic compilation of all publications on the hepatotoxicity of specific herbals identified 185 publications on 60 different herbs, herbal drugs and supplements, but does not list or mention Hawthorn).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.bj_rnsson.2013.1419">Björnsson ES, Bergmann OM, Björnsson HK, Kvaran RB, Olafsson S. Incidence, presentation and outcomes in patients with drug-induced liver injury in the general population of Iceland. <span><span class="ref-journal">Gastroenterology. </span>2013;<span class="ref-vol">144</span>:1419–25.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23419359" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23419359</span></a>]<div>
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<i>(In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2 year period, 15 of which [16%] were attributed to HDS products, but none were listed as containing Hawthorn).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.bunchorntavakul.2013.3">Bunchorntavakul C, Reddy KR. Review article: herbal and dietary supplement hepatotoxicity. <span><span class="ref-journal">Aliment Pharmacol Ther. </span>2013;<span class="ref-vol">37</span>:3–17.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23121117" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23121117</span></a>]<div>
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<i>(Systematic review of literature on HDS associated liver injury does not mention Hawthorn).</i>
|
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.navarro.2013.715">Navarro VJ, Seeff LB. Liver injury induced by herbal complementary and alternative medicine. <span><span class="ref-journal">Clin Liver Dis. </span>2013;<span class="ref-vol">17</span>:715–35.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24099027" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24099027</span></a>]<div>
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<i>(Review of the epidemiology, regulatory status, diagnosis, pathogenesis and causes of liver injury from herbal products with specific discussion of conjugated linoleic acid, ephedra, germander, green tea, usnic acid, flavocoxid, aloe vera, chaparral, greater celandine, black cohosh, comfrey, kava, skullcap, valerian, noni juice, pennyroyal and traditional herbal remedies).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.navarro.2014.1399">Navarro VJ, Barnhart H, Bonkovsky HL, Davern T, Fontana RJ, Grant L, Reddy KR, et al. Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. <span><span class="ref-journal">Hepatology. </span>2014;<span class="ref-vol">60</span>:1399–408.</span> [<a href="/pmc/articles/PMC4293199/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4293199</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25043597" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25043597</span></a>]<div>
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<i>(Among 839 cases of liver injury from drugs collected in the US between 2004 and 2013, 130 were due to HDS products, including 45 from body building agents [probably anabolic steroids] and 85 from diverse HDS products, but no case was attributed specifically to Hawthorn).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.brown.2017.472">Brown AC. Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 series. <span><span class="ref-journal">Food Chem Toxicol. </span>2017;<span class="ref-vol">107</span>:472–501.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27402097" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27402097</span></a>]<div>
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<i>(Description of an online compendium of cases of liver toxicity attributed to HDS products, does not list or discuss Hawthorn).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.medinacaliz.2018.1495">Medina-Caliz I, Garcia-Cortes M, Gonzalez-Jimenez A, Cabello MR, Robles-Diaz M, Sanabria-Cabrera J, Sanjuan-Jimenez R, et al. Spanish DILI Registry. Herbal and dietary supplement-induced liver injuries in the Spanish DILI Registry. <span><span class="ref-journal">Clin Gastroenterol Hepatol. </span>2018;<span class="ref-vol">16</span>:1495–1502.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29307848" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29307848</span></a>]<div>
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<i>(Among 856 cases of hepatotoxicity enrolled in the Spanish DILI Registry between 1994 and 2016, 32 were attributed to herbal products, the most frequent cause being green tea [n=8] and Herbalife products [n=6], while one anicteric, self-limited hepatocellular case was scored as probably due to Hawthorn).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.holubarsch.2018.25">Holubarsch CJF, Colucci WS, Eha J. Benefit-risk assessment of Crataegus Extract WS 1442: an evidence-based review. <span><span class="ref-journal">Am J Cardiovasc Drugs. </span>2018;<span class="ref-vol">18</span>:25–36.</span> [<a href="/pmc/articles/PMC5772138/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5772138</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29080984" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29080984</span></a>]<div>
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<i>(Summary of the effects of a hawthorn extract [WS 1442] reporting evidence from post-hoc sub-analyses of large clinical trials in chronic heart failure mentions that in most studies adverse events were no greater than with placebo and in some instances were less frequent, indicating excellent safety and tolerance).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.ballotin.2021.5490">Ballotin VR, Bigarella LG, Brandão ABM, Balbinot RA, Balbinot SS, Soldera J. Herb-induced liver injury: Systematic review and meta-analysis. <span><span class="ref-journal">World J Clin Cases. </span>2021;<span class="ref-vol">9</span>:5490–5513.</span> [<a href="/pmc/articles/PMC8281430/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8281430</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34307603" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34307603</span></a>]<div>
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<i>(Systematic review of the literature on herb induced liver injury identified 446 references describing 936 cases due to 79 different herbal products, the most common being He Shou Wu [91], green tea [90] Herbalife products [64], kava kava [62] and greater celandine [48]; hawthorn was not implicated in any cases).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.bessone.2022.e548">Bessone F, García-Cortés M, Medina-Caliz I, Hernandez N, Parana R, Mendizabal M, Schinoni MI, et al. Herbal and dietary supplements-induced liver injury in Latin America: experience from the LATINDILI Network. <span><span class="ref-journal">Clin Gastroenterol Hepatol. </span>2022;<span class="ref-vol">20</span>:e548–e563.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33434654" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33434654</span></a>]<div>
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<i>(Among 367 cases of hepatotoxicity enrolled in the Latin American DILI Network between 2011 and 2019, 29 [8%] were attributed to herbal products, the most frequent being green tea [n=7], Herbalife products [n=5] and garcinia [n=3], while no case was attributed to hawthorn).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.kim.2022.867">Kim E, Jang E, Lee JH. Potential roles and key mechanisms of hawthorn extract against various liver diseases. <span><span class="ref-journal">Nutrients. </span>2022;<span class="ref-vol">14</span>:867.</span> [<a href="/pmc/articles/PMC8879000/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8879000</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35215517" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35215517</span></a>]<div>
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<i>(Review of the possible roles of hawthorn in treating liver disease it having been found to have antioxidant activity and to decrease lipid accumulation in animal models of nonalcoholic fatty liver).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.zhang.2022.2861">Zhang J, Chai X, Zhao F, Hou G, Meng Q. Food applications and potential health benefits of hawthorn. <span><span class="ref-journal">Foods. </span>2022;<span class="ref-vol">11</span>:2861.</span> [<a href="/pmc/articles/PMC9498108/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9498108</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36140986" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36140986</span></a>]<div>
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<i>(Description of the numerous components of hawthorn, which is rich in vitamins A, C, B1 and B2 as well as aminoacids calcium and carotene and has more than 60 flavonoids).</i>
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</div></div></li><li><div class="bk_ref" id="Hawthorn.REF.li.2023.115819">Li R, Luan F, Zhao Y, Wu M, Lu Y, Tao C, Zhu L, Zhang C, Wan L. Crataegus pinnatifida: A botanical, ethnopharmacological, phytochemical, and pharmacological overview. <span><span class="ref-journal">J Ethnopharmacol. </span>2023;<span class="ref-vol">301</span>:115819. </span> [<a href="https://pubmed.ncbi.nlm.nih.gov/36228891" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36228891</span></a>]<div>
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<i>(Review of the botanical features, traditional usage, chemical composition, pharmacological actions, clinical efficacy and safety of Crataegus pinnatifida, mentions that C. pinnatifida has over 250 phytochemical components, causes liver injury when given in high doses to dogs, but has been used safely for centuries in China).</i>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK589114/?report=reader">PubReader</a></li><li><a href="/books/NBK589114/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK589114" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK589114" style="display:none" title="Cite this Page"><div class="bk_tt">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Hawthorn. [Updated 2023 Jan 28].<span class="bk_cite_avail"></span></div></div></li><li><a href="/books/NBK589114/pdf/Bookshelf_NBK589114.pdf">PDF version of this page</a> (100K)</li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>New and Updated</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22LiverTox%22+AND+pmcbook&sort=date&size=200" ref="pagearea=source-links&targetsite=external&targetcat=link&targettype=uri">In PubMed</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Bulk Download</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="https://ftp.ncbi.nlm.nih.gov/pub/litarch/29/31/" ref="pagearea=source-links&targetsite=external&targetcat=link&targettype=uri">Bulk download LiverTox data from FTP</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Overviews</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/livertox/intro/">Introduction</a></li><li><a href="/books/n/livertox/ClinicalCourse/">Clinical Course</a></li><li><a href="/books/n/livertox/ClinicalOutcome/">Clinical Outcomes</a></li><li><a href="/books/n/livertox/ImmuneFeatures/">Immune Features</a></li><li><a href="/books/n/livertox/Phenotypes_intro/">Phenotypes</a></li><li><a href="/books/n/livertox/Causality/">Causality</a></li><li><a href="/books/n/livertox/DrugCategory/">Likelihood Scale</a></li><li><a href="/books/n/livertox/Severity/">Severity Grading</a></li><li><a href="/books/n/livertox/CaseReport/">Writing a Case Report</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Support Links</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/livertox/">LiverTox Homepage</a></li><li><a href="/books/n/livertox/masterlistintro/">Master List of LiverTox Drugs [with Metadata]</a></li><li><a href="/books/n/livertox/drugliverinjury/">LiverTox Drugs by Drug Class</a></li><li><a href="/books/n/livertox/aboutus/">About LiverTox</a></li><li><a href="/books/n/livertox/editorsandreviewers/">Editors and Review Committee</a></li><li><a href="/books/n/livertox/alert/">Meetings and News</a></li><li><a href="/books/n/livertox/abbreviation/">Abbreviations Used</a></li><li><a href="/books/n/livertox/glossary/">Glossary</a></li><li><a href="/books/n/livertox/resource/">Information Resources</a></li><li><a href="/books/n/livertox/disclaimer/">User/Medical Advice Disclaimer</a></li><li><a href="/books/n/livertox/Contactus/">Contact Us</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>OTHER REFERENCE LINKS</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li>
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<a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&pubmedfilters=true&term=Hawthorn+AND+Human%5BMH%5D+AND+(drug+induced+liver+injury+OR+jaundice/CI+OR+bile+duct+diseases/CI+OR+liver/DE+OR+liver+diseases/CI)+AND+(%221900/1/1%22%5BEDat%5D:%222999/12/31%22%5BEDat%5D)" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Recent References on Hawthorn: from PubMed.gov</a>
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Epub 2022 Feb 18.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/37788786" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Traditional uses, phytochemistry, pharmacology, and safety concerns of hawthorn (Crataegus genus): A comprehensive review.</a><span class="source">[J Ethnopharmacol. 2024]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Traditional uses, phytochemistry, pharmacology, and safety concerns of hawthorn (Crataegus genus): A comprehensive review.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Cui M, Cheng L, Zhou Z, Zhu Z, Liu Y, Li C, Liao B, Fan M, Duan B. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">J Ethnopharmacol. 2024 Jan 30; 319(Pt 2):117229. Epub 2023 Oct 1.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/11887407" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hawthorn: pharmacology and therapeutic uses.</a><span class="source">[Am J Health Syst Pharm. 2002]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hawthorn: pharmacology and therapeutic uses.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Rigelsky JM, Sweet BV. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Am J Health Syst Pharm. 2002 Mar 1; 59(5):417-22. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/33232307" ref="ordinalpos=1&linkpos=4&log$=relatedarticles&logdbfrom=pubmed">Ethanol Extract of Chinese Hawthorn (Crataegus pinnatifida) Fruit Reduces Inflammation and Oxidative Stress in Rats with Doxorubicin-Induced Chronic Heart Failure.</a><span class="source">[Med Sci Monit. 2020]</span><div class="brieflinkpop offscreen_noflow">Ethanol Extract of Chinese Hawthorn (Crataegus pinnatifida) Fruit Reduces Inflammation and Oxidative Stress in Rats with Doxorubicin-Induced Chronic Heart Failure.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Cheng F, Jiang W, Xiong X, Chen J, Xiong Y, Li Y. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Med Sci Monit. 2020 Nov 24; 26:e926654. Epub 2020 Nov 24.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/21359265" ref="ordinalpos=1&linkpos=5&log$=relatedarticles&logdbfrom=pubmed">Hawthorn--Crataegus monogyna (common hawthorn) or Crataegus laevigata (midland hawthorn; Crataegus oxyacantha); also known as haw, thornapple, maythorn, whitethorn.</a><span class="source">[J Prim Health Care. 2011]</span><div class="brieflinkpop offscreen_noflow">Hawthorn--Crataegus monogyna (common hawthorn) or Crataegus laevigata (midland hawthorn; Crataegus oxyacantha); also known as haw, thornapple, maythorn, whitethorn.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Rasmussen P. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">J Prim Health Care. 2011 Mar 1; 3(1):63-4. Epub 2011 Mar 1.</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=36753600" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=36753600" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67c8dfb4b15b832ebc0af94e">Hawthorn - LiverTox</a><div class="ralinkpop offscreen_noflow">Hawthorn - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67c8dfb3f4a390645e2cc8d8">Halothane - LiverTox</a><div class="ralinkpop offscreen_noflow">Halothane - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67c8dfb2b15b832ebc0aed0d">Haloperidol - LiverTox</a><div class="ralinkpop offscreen_noflow">Haloperidol - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67c8dfb1f4a390645e2cb6d0">Halogenated Anesthetics - LiverTox</a><div class="ralinkpop offscreen_noflow">Halogenated Anesthetics - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=5" href="/portal/utils/pageresolver.fcgi?recordid=67c8dfb0ab82281a8037b348">Gymnema - LiverTox</a><div class="ralinkpop offscreen_noflow">Gymnema - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
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