On The Shelf

Mickie Cathers

Bronchitis and upper respiratory tract infections often come with a side of acute cough. A wide range of antitussive agents and expectorants to treat symptomatic cough are available over the counter. Ivy leaf (hoja de hiedra) supplements are among the most popular products for improving symptoms of chronic inflammatory bronchial conditions such as cough and mucus expectoration.

Background

One of the principal symptoms of respiratory tract infections, such as the common cold or bronchitis, includes cough, important for mucociliary clearance and as a defensive mechanism against irritants. A cough may be unproductive (dry, no excretion) or productive (wet, expectoration of mucus). Ivy leaf extract acts as an expectorant, loosening mucus and phlegm, benefiting productive coughs.

Ivy leaf extract is derived from common English Ivy (Hedera helix), the same green climbing plant found on college campus buildings.

Because ivy leaf contains saponins, flavonoids, and phenolic acids, the extract is thought to exert an anti-inflammatory effect linked to inhibition of transcriptional activity of nuclear factor κ-light-chain-enhancer of activated B-cells and a subsequent decrease in the cellular release of cytokine IL-6. Ivy leaf may widen the bronchi and stimulate the bronchial glands.

Is there a benefit?

Results from several interventional and noninterventional studies indicate that patients with acute respiratory tract infections experienced reduced frequency and duration of coughing when treated with ivy leaf extract.

Völp and colleagues published a meta-analysis of double-blind, randomized, placebo-controlled trials on November 21, 2022, in Scientific Reports that studied ivy leaf extract in the treatment of cough during acute respiratory tract infections. Male and female patients between 18 and 75 years old with acute respiratory tract infection received ivy leaf dry extract or placebo for 7 days, followed by a 7-day period without treatment. Efficacy was measured using the Bronchitis Severity Score (BSS), and significant differences between the extract group and placebo group were seen after only 2 days, increasing until treatment end. BSS reduction for the placebo group after 7 days was comparable to 4 days of treatment in the ivy leaf extract group.

In the ivy leaf extract group, the proportion of cough-free patients was 18.1% at treatment end and 56.2% at end of follow up. The placebo group saw 9.3% proportion of cough-free patients at treatment end and 25.6% at end of follow up. The authors concluded that ivy leaf dry extract may reduce the intensity of acute cough associated with acute respiratory tract infections and lead to a significant acceleration of recovery.

Dosage and availability

Available products on store shelves and through online retailers offer relief from cough, respiratory support, or even a “lung cleanse.” Ivy leaf extract is sold as a syrup or drop (often combined with thyme, licorice, honey, and lemon) but is also available as a tincture, tablets (50 mg), and tea. Options are also available for children and infants 2 months and older. As supplements are not FDA-approved, there is no recommended dosage, but clinical trials typically used a dosage of 105 mg/day for 7 days.

What to tell your patients

Generally considered safe, ivy leaf supplements may be effective for treating coughs and early symptoms of respiratory tract infections. Adverse effects are rare but may include stomach upset, diarrhea, nausea, and vomiting. Exercise caution using any supplement.   ■