Ivy Leaf

Hedera helix L. belongs to Araliaceae, the ivy family, which also includes ginseng and eleuthero, and was named by Linnaeus in Species Plantarum in 1753 (Kew’s Plants of the World Online, or POWO). POWO gives its native range as Europe and the Mediterranean to Iran, and Kew’s species page lists native countries from Portugal, Ireland, and Norway to Turkey, Ukraine, and the North Caucasus. It has been introduced to many parts of the world, including several US states, Hawaii, Argentina, Australia, and New Zealand, and POWO notes that it is considered invasive in Australia, New Zealand, and the western United States. Older names include Hedera poetica Salisb. and Hedera communis Gray; POWO names a form, f. poetarum, the “poet’s ivy,” and Grieve linked Virgil’s “golden ivy” to a rare yellow-berried variety. Atlantic ivy, Hedera hibernica, is now treated as a separate species. The IUCN lists common ivy as Least Concern (Kew).

Ivy leads two lives. Kew describes a woody climber, or liana, whose young leaves are leathery, dark green, finely hairy, and three- to five-lobed, and POWO adds that these juvenile shoots carry star-shaped hairs and roots along the stem. Kew explains that the plant climbs smooth walls by pushing minute root hairs into gaps and secreting a glue that hardens; Mrs Grieve’s A Modern Herbal (1931) described the same fibers ending in small disks. Once a stem reaches the top of its support, it switches to a bushy, rootless adult form with unlobed, oval or diamond-shaped leaves, and only these shoots flower, Grieve noted; ivy creeping across the ground never blooms. Rounded clusters of small yellowish-green flowers open in autumn, from September to November according to Kew, and Grieve observed that they give bees abundant nectar when little else is flowering. The berries ripen over winter, turning black and about 8 mm across, and feed birds in hard weather. Grieve believed ivy injured trees by drawing off their sap, but Kew is clear that it is not a parasite.

The medicinal part is the leaf. The European Pharmacopoeia, quoted in EMA’s assessment report, defines ivy leaf as whole or cut dried leaves collected in spring and containing at least 3.0% hederacoside C (PubChem CID 11491905, C59H96O26). The report, citing Wichtl, puts total triterpene saponins at about 2.5–6%, mostly bidesmosidic saponins (with two sugar chains) led by hederacoside C, plus small amounts of monodesmosides such as α-hederin (PubChem CID 73296, C41H66O12), which form when a sugar chain is split off during drying. The balance is lopsided: Gaillard and colleagues (2003, cited by EMA) measured about 21.8 mg of hederacoside C per gram of dried leaf but only 0.41 mg of α-hederin. Ivy leaf also contains flavonoids such as quercetin and kaempferol glycosides, caffeic acid derivatives, phytosterols, and polyacetylenes including falcarinol (indexed by PubChem under its synonym panaxynol, CID 5281149, C17H24O), and fresh leaves hold 0.1–0.3% volatile oil. Older reports of the alkaloid emetine in ivy leaves could not be confirmed, EMA notes.

Ivy was a plant of poets and wine before it was a medicine. Grieve recorded that it was held in high esteem by the ancients: its leaves formed the poet’s crown and the wreath of Bacchus, the god of wine, to whom ivy was dedicated, perhaps because binding the brow with ivy was thought to prevent drunkenness, and the plant was said to grow abundantly at Nyssa, the fabled home of the young Bacchus. Kew notes that wreaths of ivy were awarded to winners of poetry contests in ancient Rome, and that Greeks and Romans wore ivy wreaths in the belief that they would stop them getting drunk. “It did not,” Kew adds. Grieve also wrote that Greek priests gave ivy wreaths to newly married couples as an emblem of fidelity, that an early church council forbade decorating houses and churches with ivy at Christmas because of its pagan associations, and that English taverns once hung an ivy bush over the door to advertise their drink, the origin of the saying “Good wine needs no bush.”

Medical writers were less sure what to make of it. EMA’s assessment report quotes Madaus (1938), who traced ivy leaf back to Dioscorides and Hippocrates, and notes that 16th-century herbals listed uses as varied as jaundice, stones, dysentery, and bringing on menstruation. Mayer (2010, cited by EMA) found that medieval practitioners disagreed about ivy’s value but used it for headaches, toothache, chronic catarrh, diarrhea, ulcers, inflammations, and burns, and that it served as a contraceptive whose abortive effect was also recognized. Grieve preserved Culpeper’s verdict that ivy is “an enemy to the nerves and sinews taken inwardly, but most excellent outwardly,” and a recipe from the Anglo-Saxon Leechbook of Bald for removing sunburn with ivy twigs boiled in butter. External uses lasted longest: Steinmetz (1961) recorded ivy applied for rheumatism, neuralgia, scabies, and lice, and in Italy’s Abruzzo region boiled leaves were applied to ringworm and scabies and as a poultice for boils (EMA).

The cough story is a 20th-century one. Steinmetz recorded that the French physician Leclerc called ivy leaves a “specific” for whooping cough and that Leuret of Bordeaux tested this clinically; Leuret’s report, “Treatment of whooping cough with ivy,” appeared in Le Progrès médical in 1946. In Germany, Engelhard tells how Gloria, the young daughter of its then managing director Karl Engelhard, fell seriously ill with whooping cough in the 1940s, prompting the development of Prospan, launched as drops in 1950. Grieve, writing in 1931, had concluded that the medicinal virtues of ivy were “little regarded nowadays.” Germany’s Commission E monograph of 1988 accepted ivy leaf for catarrh of the airways and symptomatic treatment of chronic inflammatory bronchial conditions at 0.3 g of leaf a day, and EMA records German ivy extracts in medicinal use since at least 1976. EMA’s herbal committee adopted its first European monograph in 2011 and revised it in 2015 and 2017; in 2025 it called for new data for a periodic review, and no updated monograph had been published by October 2026.

Nobody knows exactly how ivy leaf eases a cough, and EMA’s monograph says so plainly: “The mechanism of action is not known.” EMA’s public summary notes that laboratory studies suggest ivy may widen the airways and stimulate glands in the bronchi to produce a more watery secretion, which would make phlegm easier to clear. The most developed theory involves β2-adrenergic receptors, the same receptors that asthma reliever inhalers act on. When these receptors are stimulated, cells pull some of them inside, which damps the response. Sieben and colleagues (Biochemistry 2009) found that α-hederin, but not hederacoside C or the aglycone hederagenin, blocked this internalization in cultured cells after 24 hours, leaving more receptors on the surface, and raised the cells’ cAMP signaling. EMA’s assessment report summarizes related work by Hegener and Runkel, and proposes that this could relax airway muscle and increase surfactant, the slippery film that helps keep small airways open and mucus mobile. All of this comes from cell and tissue experiments, not from people.

Whether enough α-hederin reaches the lungs is doubtful. EMA’s monograph states that no pharmacokinetic data are available, and the assessment report describes small studies in which α-hederin could not be detected in a volunteer given 1 g of extract and was found in only 2 of 16 volunteers given 130 mg, at about 1.4–1.5 nanomolar, far below the concentrations used in the cell experiments. The assessor cited Stauss-Grabo and colleagues (2008), who judged that lung concentrations were probably too low and that the clinical relevance of the receptor effect remains unclear. An older explanation for saponin expectorants is a reflex: a dose just below what causes nausea irritates the stomach lining, and signals carried by the vagus nerve increase watery secretion in the airways. EMA lists this as an alternative hypothesis rather than an established fact. In guinea pigs, an oral ivy extract inhibited airway narrowing triggered by an inhaled allergen (EMA, citing Haen 1996), but animal airway models do not translate directly into cough relief.

EMA’s overall conclusion is cautious: its committee could not identify any single constituent with known therapeutic activity, so ivy medicines are standardized and authorized as whole extracts, each made by its own process. That is why manufacturers stress their own extract codes, such as EA 575, and why Engelhard itself states that its trial data apply only to that extract and not to other ivy medicines. Other compounds in ivy act in different ways. Falcarinol, a polyacetylene concentrated in fresh leaves and sap, is a strong skin sensitizer, and Hausen and colleagues (Contact Dermatitis 1987) identified it and didehydrofalcarinol as the causes of ivy contact dermatitis, noting that falcarinol also occurs in ginseng and Schefflera. EMA does not consider this relevant to dried-leaf extracts taken by mouth. In mice, injected α-hederin suppressed several liver enzymes that break down drugs, but the assessor did not expect this to matter at oral therapeutic doses, given how little α-hederin enters the blood.

Productive cough is ivy leaf’s one accepted use. EMA’s monograph covers ivy leaf extracts “used as an expectorant in case of productive cough,” a cough that brings up phlegm, for adults and children from age 2, and classes this as well-established use based on published data rather than on long use alone. EMA’s public summary explains that, in adults, one study showed reduced cough severity compared with placebo, and that, in children, ivy was comparable to acetylcysteine, a conventional mucus-thinning medicine. In Germany, Prospan products are licensed more broadly, for acute inflammation of the airways with cough and for chronic inflammatory bronchial conditions, reflecting national approvals that predate the European monograph. Ivy is not a cough suppressant, it is not designed for a dry, tickly cough, and it does not treat the infection behind a cough. EMA advises seeing a doctor or pharmacist if symptoms last more than a week while taking it, or sooner if breathlessness, fever, or pus-like phlegm develops.

Two placebo-controlled trials of the same extract carry most of the weight. Schaefer and colleagues (Pharmazie 2016) gave 181 adults with acute cough an EA 575 liquid or placebo three times a day for a week. According to EMA’s summary, cough severity on a 100 mm visual analog scale fell from about 73 to 22 with ivy and from 72 to 40 with placebo, and a bronchitis severity score fell from 11.2 to 2.8 versus 11.3 to 5.5; all adverse events were judged unrelated to treatment. Schaefer and colleagues (ERJ Open Research 2019) then randomized 209 adults with acute bronchitis to EA 575 taken twice or three times a day, or placebo, for a week, and found a significantly greater fall in the bronchitis score with ivy, about 1.9 points on that scale, with both dosing schedules working similarly. A pooled analysis of the two trials by Völp and colleagues (Scientific Reports 2022) found that the placebo groups reached on day 7 the improvement the ivy groups had reached by day 4. All three papers were funded by Engelhard or written with its staff.

Independent reviews have been far more reserved. Holzinger and Chenot (Evidence-Based Complementary and Alternative Medicine 2011) found ten studies with 17,463 participants, mostly uncontrolled observational studies, and noted that the only placebo-controlled trial at the time tested a thyme–ivy combination rather than ivy alone; they concluded there was no convincing evidence of efficacy. Their updated review, led by Sierocinski (European Journal of Clinical Pharmacology 2021), included six randomized trials, one controlled trial, and four observational studies. Only two studies had a low risk of bias, nine were sponsored by or connected to manufacturers, and the reviewers found seven registered trial protocols without published results, raising the possibility that negative results went unpublished. In the 2016 trial, the gap between ivy and placebo was 11.1 mm on day 3 and 17.9 mm at the end of treatment, against a minimal important difference of about 17 mm. They concluded that ivy preparations are safe for acute cough but that the effects are “minimal at best and of uncertain clinical importance.” There is no Cochrane review of ivy leaf.

Several trials compared ivy with other treatments or other ivy products, which makes them harder to interpret. EMA’s assessment report describes a trial in 99 adults with chronic bronchitis that found no significant difference between ivy and the drug ambroxol, an open trial in 50 children comparing ivy with acetylcysteine, and a double-blind trial in 590 patients (Cwientzek and colleagues, Phytomedicine 2011) in which one ivy extract was as effective as another. Ivy is also combined with thyme. In a placebo-controlled trial of 361 adults with acute bronchitis (Kemmerich and colleagues 2006), a thyme–ivy syrup cut coughing fits by 68.7% by days 7 to 9, against 47.6% with placebo; in that syrup, sold as Bronchipret, thyme is the larger component by weight, and the result belongs to that product. Finally, Kardos and colleagues (Pharmaceuticals 2025), an open-label trial funded and partly written by Engelhard, randomized 325 adults with acute bronchitis to ivy drops, thyme–ivy drops, or thyme–primrose drops. Bronchitis scores fell by 9.1, 7.6, and 8.6 points in a week, and ivy alone was judged non-inferior to both. A 2026 commentary by Cho in the same journal criticized the open-label design and unequal group sizes.

Children and asthma are where ivy is most used and least proven. EMA’s summary of a large post-marketing surveillance study in more than 5,000 children (Fazio 2009) and an earlier one in about 52,000 (Kraft 2004) supports tolerability, but these studies had no comparison group and cannot show benefit. Hofmann and colleagues (Phytomedicine 2003) reviewed three trials of ivy in children with asthma and chronic airway obstruction and found that only one, very small, trial had a placebo group, so “more far-reaching conclusions can hardly be drawn.” In a later double-blind crossover trial, Zeil and colleagues (Phytomedicine 2014) added an ivy extract to inhaled steroids in 30 children with mild asthma for four weeks; some lung function measures improved, but the main outcomes showed no treatment effect. Ivy is not a treatment for asthma or a substitute for prescribed inhalers. EMA warns that a persistent or recurring cough in children aged 2 to 4 needs a medical diagnosis before any treatment, because it can signal asthma, a swallowed object, or another condition that a syrup would mask.

EMA’s 2017 monograph lists five extracts, each defined by its drug-to-extract ratio (DER, how many parts of dried leaf go into one part of extract) and extraction solvent: a dry extract (DER 4–8:1, 24–30% ethanol), a dry extract (6–7:1, 40% ethanol), a dry extract (3–6:1, 60% ethanol), a liquid extract (1:1, 70% ethanol), and a soft extract (2.2–2.9:1, 50% ethanol with propylene glycol). Doses are given in milligrams of extract, not leaf. For the most widely used dry extract, adults and adolescents take 15–65 mg one to three times a day, 45–105 mg in total, with a daily maximum of 67 mg (about 420 mg of leaf) in products that contain alcohol; children aged 6 to 11 take 11–35 mg two or three times a day, and children aged 2 to 5 take 8–18 mg two or three times a day. The liquid 1:1 extract is used at 100 mg three times daily in adults and must not be given under age 6 because of its alcohol content. Germany’s Commission E suggested 0.3 g of leaf a day (EMA).

Ivy medicines come as syrups, drops, effervescent tablets, lozenges, and single-dose sachets, and the extract, strength, and alcohol content vary widely, so the dose on one product cannot be transferred to another. Engelhard states that its Prospan cough drops contain 47% alcohol by volume, while its syrup has been sold as an alcohol-free option, and EMA requires ethanol-containing ivy medicines to carry standard alcohol labeling. Anyone avoiding alcohol, and every parent, should read the label carefully. Ivy leaf tea is not a recognized form: EMA’s assessment report notes that textbooks describe tea as rarely made and give no clear dose, that no tea products are on the market, and that the committee therefore did not include tea in the monograph. EMA’s monograph covers oral use only. Its posology is aimed at short courses: if symptoms persist for more than a week, a doctor or pharmacist should be consulted.

Ivy also appears in combination products, which should be judged on their own trials. Thyme–ivy syrups and drops, such as Bronchipret, contain much more thyme than ivy; the syrup tabulated in Sierocinski’s review pairs 1.5 g of thyme liquid extract with 0.15 g of ivy liquid extract per 10 g. The placebo-controlled trial of 361 adults with acute bronchitis described above tested that combination, and a 2015 meta-analysis by Wagner and colleagues (Forschende Komplementärmedizin) reported strong evidence that ivy, primrose, and thyme preparations relieved cough more than placebo, again for specific products rather than ivy alone. Practical points: choose a licensed product that names Hedera helix leaf extract and its ratio, use the measuring device supplied, keep alcoholic drops away from children, and do not combine two ivy products at once. Never make a home remedy from garden ivy, whose fresh sap irritates skin and whose berries are poisonous.