Evidence review
Ivy Leaf for Cough
Hedera helix
The short answer
Promising clinical evidencePossibly, for a chesty cough in adults, but expect a small effect. In two placebo-controlled trials of EA 575, the ivy extract in Prospan, coughs in 181 and 209 adults eased a few days faster than with placebo, and the European Medicines Agency accepts ivy leaf as an expectorant for productive cough. Both trials were run with the manufacturer, and an independent review judged the benefit minimal at best. Never give it to children under 2, and see a doctor for breathing trouble, coughing blood, or a cough lasting over 3 weeks.
8 key studies reviewed
Updated October 22, 2026
Key points
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01
A slightly faster recovery in trials
In placebo-controlled trials of the extract EA 575 in 181 and 209 adults, cough scores fell faster over a week. In pooled data, placebo groups reached on day 7 the improvement ivy groups had reached by day 4.
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02
Mostly manufacturer research
Both placebo trials and the pooled analysis were sponsored or co-written by Engelhard, Prospan’s maker. An independent 2021 review found a high risk of bias and judged the effects minimal at best.
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03
Made for a chesty cough
EMA accepts ivy leaf as an expectorant for productive (chesty) cough, one that brings up phlegm. It is not a cough suppressant and is not accepted for a dry, tickly cough.
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04
Never under age 2
EMA contraindicates ivy medicines under 2 because loosening mucus can worsen breathing in infants. Some brand labels are looser, so follow the stricter rule and ask a doctor first.
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05
Do not mix with cough suppressants
EMA’s assessors advise against combining ivy with codeine or dextromethorphan without medical advice. Stomach upset is the main side effect, and allergic reactions are rare.
Ivy leaf extract may help a chesty cough clear up a little faster, but the benefit is small and most of the evidence comes from the company that makes the best-known product. In two placebo-controlled trials of EA 575, the ivy extract in Prospan syrups and drops, adults with acute cough or bronchitis improved faster over a week than adults given a placebo (dummy syrup). The European Medicines Agency (EMA) accepts ivy leaf as a well-established expectorant, a medicine that helps bring up phlegm, for productive cough. Independent reviewers point out that both trials were run with the manufacturer, that much of the wider research is at high risk of bias, and that the effects are “minimal at best.” England’s National Institute for Health and Care Excellence (NICE) reviewed ivy-containing products for its cough guideline and made no recommendation either way.
A cough that comes with a cold or chest infection usually clears up on its own within three to four weeks, according to the UK National Health Service (NHS) and NICE. Some coughs are dry and tickly; others are chesty and bring up mucus, which may be yellow or green. Ivy leaf medicines are made from the dried leaves of common ivy (Hedera helix), extracted with alcohol and water and sold as syrups, drops, and tablets. Well-known single-herb brands include Prospan, made by Engelhard Arzneimittel, and Hedelix, made by Krewel Meuselbach, both German companies. Ivy is also an ingredient in combination products, notably thyme–ivy syrups and drops such as Bronchipret, which have trials of their own. The leaves contain saponins, soap-like compounds believed to help loosen mucus, but exactly how ivy works in people is not known.
This page goes through the placebo-controlled trials and who ran them, what independent reviewers and guideline groups concluded, why the type of cough matters, which products and doses were tested, and who should avoid ivy, especially young children. Nothing here is medical advice. A cough with breathing difficulty, chest pain, or coughing up blood, or one that lasts more than three weeks, needs a doctor, and a child who is struggling to breathe needs emergency care.
02 The trials
Key studies
The trials and reviews that carry the most weight for this question, with the product and dose each one tested. Results apply to the preparation studied.
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Schaefer et al., 2016
Randomized, double-blind, placebo-controlled, multicenter trial; listed by independent reviewers as industry-sponsored
- Who
- 181 adults with acute cough of 2–3 days (89 ivy, 92 placebo)
- What and how much
- Cough liquid with EA 575 (35 mg dry extract per 5 ml), 5 ml three times daily, versus matching placebo
- How long
- 7 days of treatment plus 7 days of follow-up
Cough severity on a 100 mm scale fell from 72.8 to 22.4 mm with ivy and from 72.3 to 40.3 mm with placebo over the study; the Bronchitis Severity Score fell from 11.2 to 2.8 versus 11.3 to 5.5. The gap 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. Adverse events were non-serious and judged unrelated to treatment.
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Schaefer et al., 2019
Randomized, double-blind, placebo-controlled, multicenter trial; authors employed or paid by Engelhard
- Who
- 209 adults aged 18–73 with acute bronchitis at 3 general practices and 2 ENT practices in Germany
- What and how much
- Liquid identical to Prospan Cough Liquid, EA 575 105 mg a day as 5 ml three times or 7.5 ml twice daily, versus placebo
- How long
- 7 days of treatment plus 7 days of follow-up
The Bronchitis Severity Score (0–20) fell from 11.8 to 3.2 with ivy and from 11.8 to 5.1 with placebo by day 7, a difference of 1.9 points (p < 0.0001), significant from day 3. Both dosing schedules performed alike. Adverse events occurred in 14.4% on ivy and 12.9% on placebo, mostly recorded worsening of cough; one case of upper abdominal pain was possibly related. Two authors were Engelhard employees and three received fees or grants from it.
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Völp et al., 2022
Individual patient data meta-analysis of the two placebo-controlled EA 575 trials; funded by Engelhard
- Who
- 390 adults with acute respiratory infections (228 EA 575, 162 placebo)
- What and how much
- EA 575 liquid versus placebo
- How long
- 7 days of treatment plus 7 days without treatment
The Bronchitis Severity Score fell by 8.6 points with EA 575 and 6.2 with placebo by the end of treatment (p < 0.001); the placebo group reached on day 7 the improvement the ivy group had reached by day 4. Cough-free: 18.1% versus 9.3% at the end of treatment and 56.2% versus 25.6% a week later. Engelhard supplied the data, and four of six authors reported fees or grants from it.
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Sierocinski et al., 2021
Independent systematic review of 6 randomized trials, 1 controlled trial, and 4 observational studies
- Who
- 3,592 adults and children with acute upper respiratory infections or bronchitis
- What and how much
- Ivy leaf extracts alone or combined with other herbs
- How long
- Literature searched from December 2009 to January 2020
Three trials reported faster reduction in cough severity or frequency, but the effects were judged minimal at best and of uncertain clinical importance. Only two studies were at low risk of bias, nine had manufacturer sponsorship or affiliation, and seven registered trials had no published results, suggesting publication bias. No serious adverse effects were reported.
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Holzinger and Chenot, 2011
Independent systematic review of randomized, nonrandomized, and observational studies
- Who
- 10 studies with 17,463 participants with acute upper respiratory infections
- What and how much
- Ivy leaf alone (7 studies) or ivy combined with thyme (3 studies)
- How long
- Varied across included studies
Only one randomized trial used a placebo, and it tested a thyme–ivy combination. Every other study lacked a placebo and had serious methodological flaws, so the authors found no convincing evidence that ivy extracts work, even though all the studies reported benefit.
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Cwientzek et al., 2011
Randomized, double-blind non-inferiority trial comparing two ivy extracts; no placebo group
- Who
- 590 children aged 2 and over and adults with acute bronchitis
- What and how much
- Ivy soft extract drops (ratio 2.2–2.9:1) versus an ivy dry extract (ratio 5–7.5:1, 30% ethanol)
- How long
- 7 days (±1)
The Bronchitis Severity Score fell by about 4.7–4.9 points in both groups, from 6.2–6.3 to 1.4–1.6, meeting the non-inferiority goal. Adverse events, mostly diarrhea, nausea, and heartburn, affected 2.7% of each group, none serious. The lead author worked for Krewel Meuselbach, maker of the soft-extract product; without a placebo the trial shows the extracts are similar, not that either works.
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Kardos et al., 2025
Randomized, open-label, three-arm non-inferiority trial; three of five authors Engelhard employees
- Who
- 325 adults with acute bronchitis analyzed, randomized 3:2:2
- What and how much
- Prospan Cough Drops (EA 575) versus Bronchipret thyme–ivy drops or Bronchicum thyme–primrose drops, as labeled
- How long
- 7 days
The Bronchitis Severity Score fell by 9.11 points with ivy alone, 7.64 with thyme–ivy, and 8.59 with thyme–primrose. Ivy was non-inferior to both combinations and statistically superior to thyme–ivy. Adverse events were infrequent and non-serious. A 2026 letter by Cho argued that the open-label design, patient-reported outcomes, and unequal group sizes may have biased the results.
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Schmidt et al., 2012
Two open, non-interventional studies with identical design; no comparison group
- Who
- 268 children aged 0–12 with cough or bronchitis
- What and how much
- An ivy leaf extract as syrup or cough drops
- How long
- Up to 14 days
By the end, rhinitis, cough, and viscous mucus were mild or absent in 93%, 94.2%, and 97.7% of children, and five mild adverse events (1.9%) were reported. Without a comparison group, the study cannot separate the effect of the extract from natural recovery, and it included infants under 2, an age group EMA now excludes.
03 Evidence
What the research shows
Our rating for Ivy Leaf for Cough, based on the studies below.
The case for ivy leaf rests mainly on two placebo-controlled trials of one extract, EA 575, which Engelhard sells as Prospan. In the first, Schaefer and colleagues (Die Pharmazie 2016) gave 181 adults whose cough had started two to three days earlier either an EA 575 cough liquid (89 people) or a matching placebo (92 people), 5 ml three times a day for a week. According to EMA’s assessment report, cough severity on a 100 mm visual analog scale, a line patients mark from no cough to extreme cough, fell from 72.8 to 22.4 mm with ivy and from 72.3 to 40.3 mm with placebo over the study. The Bronchitis Severity Score (BSS), a doctor-rated score from 0 to 20 covering cough, phlegm, rattling chest sounds, chest pain, and breathlessness, fell from 11.2 to 2.8 points with ivy and from 11.3 to 5.5 with placebo. All adverse events were judged unrelated to the extract. In the second trial, Schaefer and colleagues (ERJ Open Research 2019) randomized 209 adults with acute bronchitis, at three general practices and two ear, nose, and throat practices in Germany, to 105 mg of EA 575 a day, taken as 5 ml three times or 7.5 ml twice daily, or to placebo. By day 7 the BSS had fallen from 11.8 to 3.2 with ivy and from 11.8 to 5.1 with placebo, a difference of 1.9 points, and the two dosing schedules worked alike. Two of the five authors were Engelhard employees and the other three received fees or grants from the company, and an independent review by Sierocinski and colleagues lists the 2016 trial among studies sponsored by industry.
These results are statistically clear but modest, and the placebo groups show how much an acute cough improves on its own. A pooled analysis of both trials by Völp and colleagues (Scientific Reports 2022), funded by Engelhard, which also supplied the patient data, found that the BSS fell by 8.6 points with EA 575 and 6.2 with placebo over a week. Put another way, people taking placebo reached on day 7 the level of improvement the ivy groups had reached by day 4. At the end of treatment, 18.1% of people on ivy and 9.3% on placebo were free of cough, and a week later 56.2% versus 25.6%. Sierocinski and colleagues compared the 2016 results with the smallest change patients notice on the 100 mm cough scale, about 17 mm. The difference between ivy and placebo was 11.1 mm on day 3, probably too small to notice, and 17.9 mm at the end of treatment, potentially noticeable. The trial populations were also narrow. Both excluded people with allergic asthma or other chronic lung disease, and the 2019 trial excluded anyone with a temperature above 38.3°C (about 101°F), a history of chronic gastritis or stomach ulcers, or recent use of other cough medicines, antibiotics, or anti-inflammatory painkillers. The findings describe adults with an uncomplicated cough of a few days, not children, people with chronic lung disease, or people with a high fever.
Independent reviewers have been consistently unimpressed. Holzinger and Chenot, general practice researchers at University Medicine Göttingen (Evidence-Based Complementary and Alternative Medicine 2011), found 10 studies with 17,463 participants; only one randomized trial used a placebo, and it tested a thyme–ivy combination, so they concluded there was no convincing evidence that ivy extracts work. Their update, led by Sierocinski (European Journal of Clinical Pharmacology 2021), covered six randomized trials, one controlled trial, and four observational studies with 3,592 patients. Only two studies were at low risk of bias, nine had financial links to manufacturers, and seven registered trials had never published results, which the authors took as evidence of publication bias, since unfavorable results are less likely to appear in print. They concluded that ivy preparations are safe for acute cough but that their effects are “minimal at best and of uncertain clinical importance,” and that large, high-quality trials seem unlikely to establish clinically important effects. NICE reviewed ivy, primrose, and thyme products, alone or combined, for its acute cough guideline and found very low-quality evidence that they reduced cough (77.4% versus 54.9% with placebo), but made no recommendation because the clinical significance was unclear and safety data were lacking. NICE’s self-care list names honey, pelargonium, and some over-the-counter cough medicines, not ivy, and it advises doctors not to offer mucolytics, medicines that thin mucus such as acetylcysteine, for an acute cough.
The remaining trials compare ivy with something other than placebo, which limits what they can show. In a double-blind trial of 590 children aged 2 and over and adults with acute bronchitis, Cwientzek and colleagues (Phytomedicine 2011) found that an ivy soft extract and an ivy dry extract lowered the BSS by similar amounts, about 4.7 to 4.9 points, in a week. The lead author worked for Krewel Meuselbach, maker of the soft-extract product, and without a placebo group such a trial shows only that two products are similar, not that either works. In Switzerland, Kruttschnitt and colleagues (Evidence-Based Complementary and Alternative Medicine 2020) followed 139 patients aged 6 to 95 in an open observational study, 118 given an EA 575 syrup and 21 given acetylcysteine at their doctors’ discretion, and reported similar improvement in both groups; two of the four authors worked for the Swiss company Max Zeller Söhne. Kardos and colleagues (Pharmaceuticals 2025), with three of five authors employed by Engelhard, randomized adults with acute bronchitis to Prospan drops, Bronchipret thyme–ivy drops, or Bronchicum thyme–primrose drops without blinding; among 325 analyzed, the BSS fell by 9.11, 7.64, and 8.59 points, and ivy alone was judged non-inferior to both. Cho, a London respiratory physician, argued in a 2026 letter that the open design, reliance on patient-reported outcomes, and unequal group sizes may have biased the result. Evidence in children is mostly observational. Schmidt and colleagues (Phytotherapy Research 2012) reported that most of 268 children aged 0 to 12 given an ivy syrup or drops for up to 14 days had mild or no symptoms by the end, with five mild adverse events, but without a comparison group the study cannot separate the effect of the extract from natural recovery. EMA’s assessment report summarizes surveillance studies in more than 5,000 children (Fazio 2009) and about 52,000 children (Kraft 2004) that support tolerability but cannot show benefit.
Whether a cough is chesty or dry matters for ivy. EMA’s herbal committee accepts ivy leaf as well-established use only as an expectorant for productive cough, a chesty cough that brings up phlegm. How it works in people is not known, and EMA’s assessor noted that acute bronchitis, which often starts as a dry cough and becomes productive later, does not exactly reflect the benefit shown for ivy. Neither placebo trial was limited to chesty coughs, but both required a high BSS, which counts phlegm among its five symptoms. Ivy is not a cough suppressant, so it is not designed to quiet a dry, tickly cough. Results also belong to the extract tested: the authors of the 2019 trial stress that different ivy extracts are not interchangeable, EMA lists five extract types with different doses, and nearly all of the placebo-controlled data come from EA 575. Open questions remain, including whether any ivy product helps children, whether a few days’ faster recovery matters to patients, and what the unpublished trials found. In 2025 EMA called for new data for a periodic review of its ivy leaf monograph.
04 In practice
How it was taken in studies
The tested product is EA 575, a dry extract made with 30% ethanol at a drug-to-extract ratio of 5–7.5:1, meaning 5 to 7.5 parts of dried leaf for each part of extract. In both placebo trials, adults took 105 mg of it a day for a week, as 5 ml of a liquid containing 7 mg per ml three times daily (or 7.5 ml twice daily in one arm of the 2019 trial); the 2019 trial product was identical to Prospan Cough Liquid. That is the top of EMA’s adult range for this type of extract, 45–105 mg a day in one to three doses, with a lower maximum of 67 mg a day for products that still contain alcohol. For the same extract type, EMA gives 33–70 mg a day for children aged 6 to 11 and 24–36 mg a day for children aged 2 to 5, again with lower ceilings for alcoholic products. Other extracts use different numbers. Hedelix syrup, for example, contains 0.8 g of an ivy soft extract (ratio 2.2–2.9:1) per 100 ml, so doses cannot be swapped between brands. Follow the leaflet and use the measuring device that comes with the product.
Ivy is meant for a short course for an ordinary chesty cough. EMA advises seeing a doctor or pharmacist if symptoms last more than a week while taking it, and straight away if breathlessness, fever, or pus-like phlegm develops. The trials measured change over seven days, so any benefit beyond that is unproven. Ivy can sit alongside the self-care the NHS recommends: rest, plenty of fluids, paracetamol (acetaminophen) or ibuprofen for aches, and hot lemon and honey for anyone over 1 year old. For a chest infection, the NHS also suggests propping your head up on extra pillows at night. Antibiotics do not help a viral cough, and NICE advises against routinely offering them for acute bronchitis. Do not take two ivy products at once, including an ivy syrup together with a thyme–ivy combination, which already contains ivy.
Match the product to the cough. Ivy is an expectorant for a chesty cough; for a dry, tickly cough, honey in a warm drink for anyone over 1, or demulcent herbs that coat the throat, such as marshmallow root and mullein, are the traditional choices. Read the label for age limits, alcohol, and sweeteners. Hedelix syrup is labeled alcohol-free; Prospan syrup sold in Austria contains 963 mg of sorbitol in every 2.5 ml, which people with hereditary fructose intolerance should discuss with a doctor; and EMA says its 70% alcohol liquid extract should not be given to children under 6. Brand labels for young children also differ, as the safety section explains. Choose a licensed medicine that names Hedera helix leaf extract and its strength, rather than an unlabeled blend or a homemade preparation, since only standardized extracts have been tested.
05 Caution
Before you try ivy leaf
Ivy leaf medicines are usually well tolerated in short courses. EMA lists nausea, vomiting, and diarrhea, and allergic reactions including hives, rash, breathlessness, and anaphylaxis, all of unknown frequency, and advises caution in people with gastritis or a stomach ulcer. In trials, adverse events were similar to placebo: 14.4% versus 12.9% in the 2019 trial, mostly recorded worsening of cough, with a single case of upper abdominal pain possibly caused by the extract; and 2.7% in each group of the 590-patient comparison of two ivy extracts, mainly diarrhea, nausea, and heartburn. Sierocinski’s review found no serious adverse effects in the included studies but noted published case reports of anaphylaxis after ivy syrup. Stop the product and get urgent help for swelling of the face or throat, widespread hives, or difficulty breathing. According to EMA, an overdose can cause nausea, vomiting, diarrhea, and agitation.
Children under 2 must not take ivy medicines, according to EMA. The reason applies to all medicines that loosen mucus: in 2010 the French and Italian medicines agencies contraindicated mucolytics in children under 2 after a French pharmacovigilance survey found a risk of worsening chest congestion and bronchiolitis, because infants’ narrow airways cannot clear the extra mucus well, and EMA’s herbal committee adopted the same limit for ivy as a precaution. For children aged 2 to 4, EMA requires a doctor’s diagnosis before a persistent or recurring cough is treated. Brand labels can be looser: Prospan syrup’s Austrian leaflet allows use from 1 month of age, with a doctor’s advice under age 1, and Hedelix syrup is marketed in Germany for children from birth. The NHS, meanwhile, says cough medicines are not suitable for children under 6. Given these differences, talk to a doctor before giving any cough medicine to a child under 2. EMA also contraindicates ivy in people allergic to plants of the ivy family (Araliaceae), which includes ginseng, and does not recommend it in pregnancy or breastfeeding because safety has not been established.
No drug interactions have been established, and EMA’s monograph lists none, but no interaction studies have been done. One caution comes from EMA’s assessment report, which reviewed two case reports in young children who had taken ivy alongside opioid cough medicines, including a 3-year-old who died after inhaling vomit, having taken a codeine syrup, ibuprofen, and Prospan drops; codeine was judged the probable cause. The assessor nonetheless treated an interaction as a signal and advised that combining ivy with opioid cough suppressants such as codeine or dextromethorphan is not recommended without medical advice, and Prospan’s Austrian leaflet carries the same warning. Taking a medicine meant to help you cough up mucus together with one meant to stop the cough also works against itself. Many multi-ingredient cough products already contain ivy, thyme, or a cough suppressant, so check every label and avoid doubling up.
Most coughs settle on their own, but some signs call for a doctor rather than a syrup. The NHS advises seeing a GP for a cough lasting more than 3 weeks, unexplained weight loss, or a weakened immune system, and asking for an urgent appointment if the cough is very bad or quickly getting worse, you feel very unwell, you have chest pain, you find it hard to breathe, or you are coughing up blood. For a chest infection, it also advises seeing a GP if you are pregnant, over 65, or have a long-term health condition. MedlinePlus, from the US National Library of Medicine, adds fever, a high-pitched sound when breathing in (stridor), thick foul-smelling phlegm, night sweats, and any cough in a baby younger than 3 months. For children, the NHS says to call emergency services (911 in the US, 999 in the UK) if a child is struggling to breathe, with grunting or the tummy sucking in under the ribs, has blue, gray, or pale skin or lips, is unusually sleepy, floppy, or hard to wake, or is drooling and finding it hard to swallow. It notes that wheezing, rapid breathing, and not feeding in a baby with a cold can be bronchiolitis rather than an ordinary cough. NICE adds that children under 5 with a cough and fever should be assessed under its fever guideline.
06 Questions
Frequently Asked Questions
It may help a chesty cough clear slightly faster in adults. In two placebo-controlled trials of the extract EA 575, sold as Prospan, cough and bronchitis scores in 181 and 209 adults improved faster over a week, and pooled data showed placebo groups reaching on day 7 the improvement the ivy leaf groups had reached by day 4. Both trials were run with the manufacturer, and an independent 2021 review judged the effects “minimal at best and of uncertain clinical importance.” Our guide to herbs for cough compares other options.
A chesty one. EMA accepts ivy leaf only as an expectorant for productive cough, one that brings up phlegm. It is not a cough suppressant, so it is not designed to quiet a cough. For a dry, tickly cough, honey in a warm drink (for anyone over 1) or demulcent herbs that coat the throat, such as marshmallow root and mullein, are the traditional choices. A dry cough that started after beginning an ACE inhibitor blood pressure medicine should be checked by a doctor.
Follow the leaflet of your product, because ivy extracts differ in strength. The placebo trials gave adults 105 mg a day of EA 575, the Prospan extract, as 5 ml of a 7 mg per ml liquid three times daily for a week, the top of EMA’s adult range for that extract type. EMA’s doses for children aged 2 to 11 are lower, and products containing alcohol have lower maximum doses. If your cough is no better after a week, or you develop breathlessness, fever, or pus-like phlegm, see a doctor or pharmacist.
Not under age 2 without a doctor. EMA contraindicates ivy medicines under 2 because medicines that loosen mucus can worsen breathing in infants, whose narrow airways cannot clear it well, even though some brand labels allow use in babies. For children aged 2 to 4, a persistent or recurring cough needs a diagnosis first, and the NHS says cough medicines are not suitable for children under 6. Honey is an option only after age 1. A child who is struggling to breathe, grunting, or has blue or gray lips needs emergency care.
No blinded trial has shown either to be better. Thyme and ivy syrup (Bronchipret) has its own placebo-controlled trial, in which 361 adults with acute bronchitis had 68.7% fewer daytime coughing fits by days 7 to 9, against 47.6% fewer on placebo. In a 2025 open-label trial in which three of five authors worked for Prospan’s maker, ivy drops alone did at least as well as thyme–ivy drops and thyme–primrose drops (primrose root comes from cowslip), but patients and doctors knew which product was used. Each product’s results belong to that product.
Not without medical advice. EMA’s assessors reviewed two case reports in young children who took ivy alongside opioid cough medicines and advised against combining ivy with cough suppressants such as codeine or dextromethorphan unless a doctor recommends it; Prospan’s Austrian leaflet carries the same warning. A medicine that helps you cough up mucus also works against one that stops you coughing. Many cough products already combine ivy with thyme or other ingredients, so check labels and avoid doubling up.
See a doctor if a cough lasts more than 3 weeks, if you are losing weight for no reason, or if you have a weakened immune system. Get urgent help for chest pain, difficulty breathing, coughing up blood, a cough that is quickly getting worse, or feeling very unwell, and for a high-pitched noise when breathing in (stridor) or any cough in a baby under 3 months. EMA advises seeing a doctor or pharmacist if a cough lasts more than a week despite an ivy medicine. For people 12 and over, NICE lists pelargonium among self-care options, alongside honey.
07 References
Sources
These references support the claims on this page. They are not an endorsement of any product. The ivy leaf monograph carries its own full source list.
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Ivy leaf (Hedera helix) for acute upper respiratory tract infections: an updated systematic review
European Journal of Clinical Pharmacology (PubMed 33523253), 2021
Sierocinski, Holzinger, and Chenot (full text): 6 RCTs, 1 CCT, and 4 observational studies with 3,592 patients; 2 at low risk of bias; 9 with manufacturer sponsorship or affiliation; 7 registered trials unpublished; VAS gap 11.1 mm on day 3 and 17.9 mm at end of treatment against a 17 mm minimal important difference; effects minimal at best.
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Systematic review of clinical trials assessing the effectiveness of ivy leaf (hedera helix) for acute upper respiratory tract infections
Evidence-Based Complementary and Alternative Medicine (PubMed 20976077), 2011
Holzinger and Chenot: 10 studies, 17,463 subjects; the only placebo-controlled RCT tested an ivy–thyme combination; all other studies lacked placebo controls and had serious flaws; no convincing evidence of efficacy.
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A randomized, controlled, double-blind, multi-center trial to evaluate the efficacy and safety of a liquid containing ivy leaves dry extract (EA 575) vs. placebo in the treatment of adults with acute cough
Die Pharmazie (PubMed 29441845), 2016
Schaefer et al.: 181 adults with acute cough, EA 575 liquid or placebo three times daily for one week; faster fall in cough severity from 48 hours; adverse events non-serious and not drug-related.
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Efficacy of two dosing schemes of a liquid containing ivy leaves dry extract EA 575 versus placebo in the treatment of acute bronchitis in adults
ERJ Open Research (PubMed 31832428), 2019
Schaefer et al. (full text): 209 adults; 105 mg EA 575 daily as 3 × 5 ml or 2 × 7.5 ml versus placebo for 7 days; BSS 3.2 versus 5.1 at day 7, difference 1.9 points; adverse events 14.4% versus 12.9%; exclusion criteria; two Engelhard employees among authors.
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Ivy leaves extract EA 575 in the treatment of cough during acute respiratory tract infections: meta-analysis of double-blind, randomized, placebo-controlled trials
Scientific Reports (PubMed 36414647), 2022
Völp et al.: pooled 228 EA 575 and 162 placebo patients; BSS reductions 8.6 versus 6.2; placebo at day 7 comparable to EA 575 at day 4; cough-free 18.1% versus 9.3% and 56.2% versus 25.6%; funded by Engelhard, which provided the data.
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Acute bronchitis therapy with ivy leaves extracts in a two-arm study. A double-blind, randomised study vs. an other ivy leaves extract
Phytomedicine (PubMed 21802921), 2011
Cwientzek et al. (Krewel Meuselbach): 590 patients with acute bronchitis; ivy soft extract non-inferior to another ivy extract over 7 days; BSS down about 4.7–4.9 points; 2.7% adverse events per group, all non-serious.
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Assessment of the Efficacy and Safety of Ivy Leaf (Hedera helix) Cough Syrup Compared with Acetylcysteine in Adults and Children with Acute Bronchitis
Evidence-Based Complementary and Alternative Medicine (PubMed 32454850), 2020
Kruttschnitt et al. (full text): open, noninterventional study at 25 Swiss practices; 139 patients aged 6–95, 118 on EA 575 syrup (35 mg per 5 ml) and 21 on acetylcysteine; comparable improvement; two authors employed by Max Zeller Söhne AG.
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Efficacy and Safety of a Single Ivy Extract Versus Two Herbal Extract Combinations in Patients with Acute Bronchitis: A Multi-Center, Randomized, Open-Label Clinical Trial
Pharmaceuticals (PubMed 40430571), 2025
Kardos et al. (full text): 325 adults; Prospan drops, Bronchipret thyme–ivy drops, or Bronchicum thyme–primrose drops for 7 days; BSS change −9.11, −7.64, and −8.59; ivy non-inferior to both; three authors Engelhard employees.
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Comment on Kardos et al. Efficacy and Safety of a Single Ivy Extract Versus Two Herbal Extract Combinations in Patients with Acute Bronchitis
Pharmaceuticals (PubMed 42075848), 2026
Cho (King’s College Hospital): the open-label design, reliance on patient-reported outcomes, unequal group sizes, and an unvalidated threshold for a meaningful change in the Bronchitis Severity Score may have biased the trial and led to overinterpretation.
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Suitability of ivy extract for the treatment of paediatric cough
Phytotherapy Research (PubMed 22532491), 2012
Schmidt, Thomsen, and Schmidt: two open, non-interventional studies in 268 children aged 0–12 given ivy syrup or drops for up to 14 days; symptoms mild or absent in most at the end; five mild adverse events (1.9%).
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Efficacy and tolerability of a fluid extract combination of thyme herb and ivy leaves and matched placebo in adults suffering from acute bronchitis with productive cough
Arzneimittelforschung (PubMed 17063641), 2006
Kemmerich, Eberhardt, and Stammer: 361 adults, Bronchipret thyme–ivy syrup 5.4 ml three times daily or placebo for 11 days; coughing fits down 68.7% versus 47.6% on days 7–9.
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European Union herbal monograph on Hedera helix L., folium (Revision 2)
European Medicines Agency (EMA/HMPC/325716/2017), 2017
Well-established use as an expectorant in productive cough; five extract types with adult and child doses and lower maximums for ethanol-containing products; contraindicated under 2 and with Araliaceae allergy; diagnosis needed at 2–4 years; caution with gastritis; not recommended in pregnancy; no interactions reported; mechanism unknown.
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Assessment report on Hedera helix L., folium (Revision 2)
European Medicines Agency (EMA/HMPC/325715/2017), 2017
Schaefer 2016 details (VAS 72.8 to 22.4 versus 72.3 to 40.3 mm; BSS 11.2 to 2.8 versus 11.3 to 5.5); Cwientzek and pediatric surveillance data; French and Italian 2010 mucolytic decisions behind the under-2 contraindication; codeine and dextromethorphan signal.
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Cough (acute): antimicrobial prescribing (NG120): recommendations
National Institute for Health and Care Excellence (NICE), 2019
Acute cough usually lasts 3–4 weeks; do not offer mucolytics; antibiotics not routinely offered for acute bronchitis; self-care options are honey, pelargonium, guaifenesin, and non-codeine cough suppressants; children under 5 with cough and fever follow the fever guideline.
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Cough (acute): antimicrobial prescribing (NG120): summary of the evidence
National Institute for Health and Care Excellence (NICE), 2019
Ivy, primrose, or thyme products reduced cough versus placebo (77.4% versus 54.9%, very low quality); no recommendation made because clinical significance was unclear and safety data were lacking.
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Cough
NHS, 2023
Coughs usually clear within 3–4 weeks; rest, fluids, pain relief, and hot lemon and honey (not under 1); see a GP for a cough over 3 weeks, weight loss, or weak immunity; urgent help for chest pain, breathing difficulty, or coughing blood.
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Chest infection
NHS, 2026
Chesty cough with yellow or green mucus; raising the head with pillows; cough medicines not suitable for children under 6; see a GP if pregnant, over 65, or with a long-term condition or weakened immunity.
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Croup
NHS, 2026
High-pitched sound when breathing in; emergency signs in children including struggling to breathe, grunting, the tummy sucking under the ribs, blue or gray skin or lips, floppiness, and drooling; bronchiolitis signs.
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Cough
MedlinePlus, National Library of Medicine (NIH), 2025
ACE inhibitors as a cause of cough; call 911 for shortness of breath or a swollen face or throat; seek care for stridor, coughing blood, fever, foul-smelling phlegm, night sweats, or any cough in an infant under 3 months.
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Prospan-Hustensaft: Gebrauchsinformation (Austria)
Engelhard Arzneimittel (package leaflet), 2025
For use from 1 month, under 1 year only after consulting a doctor; Araliaceae allergy; no combination with codeine or dextromethorphan without medical advice; not recommended in pregnancy; 963 mg sorbitol per 2.5 ml.
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Hedelix Hustensaft
Krewel Meuselbach (product information), 2020
Ivy soft extract (2.2–2.9:1), 0.8 g per 100 ml; alcohol-free; marketed for adults and children from birth.