The Cough That Doesn’t Go Away

It’s very likely that at some point, you have suffered from an irritating and persistent cough that just didn’t seem to go away. Following a cold, it is common for your cough to stick around for about 2 weeks, sometimes longer. Considering the fact that the majority of upper respiratory infections are caused by viruses (not bacteria!), taking an antibiotic will do nothing for your cough. This annoying cough has probably lead you to venture into the daunting “cough and cold” aisle to face the seemingly endless rows of tablets, capsules, syrups and elixirs that all claim to calm your cough and loosen that awful phlegm and mucus. So how do you decide what to buy?

You grudgingly start to read each box, one-by-one, but run into another problem. Many of these products contain a cough suppressant (dextromethorphan) and/or a decongestant (such as pseudoephedrine). The fine print on almost every box seems to warn against use of the product in patients with various health conditions. This often includes people who are taking antidepressants or people who have diabetes, high blood pressure, a thyroid condition, glaucoma or asthma. Oh, and if you’re trying to find something for your little one, don’t forget that Health Canada warns against the use of most cough and cold products in children under the age of 6. Suddenly the options seem much less plentiful!

A New-ish Option for Cough

The good news is that there is a new-ish (to Canada) natural health product that, according to the manufacturer, is safe for use in people with all the conditions mentioned above as well as in children above the age of one. We say “new-ish to Canada” because the product has been used for more than 20 years in Germany but only about 5 years in Canada. The product is called simply Propsan in Europe, but in Canada it is being marketed under the name Prospan by Helixia.

What is Prospan by Helixia?

Prospan by Helixia is a cough syrup that is naturally sourced from ivy leaf extract. More specifically, ivy leaf is known in the plant world as Hedera helix, an evergreen that belongs to the Araliaceae family of flowering plants^[1] . The makers of this product claim that it will loosen mucus and phlegm and will relieve cough. The product is also free of sucrose, gluten, dye and alcohol. An added bonus is that the syrup tastes like honey^[2].

How Does Ivy Leaf Help Coughs?

Simply put, ivy leaf dissolves thick mucus and helps you to expel it while calming your cough.

For the more technical and curious: a mechanism of action for ivy leaf extract has been identified by in vitro (i.e. “test-tube”) experiments. The active component of ivy leaf extract – called α-hederin – was shown to inhibit intracellular uptake of β₂-receptors which results in increased β₂-adrenergice activity in the cell^[1][3][4]. This in turn relaxes the smooth muscles of the airways and increases the production of mucolytic substances.  

Mucolytics: a term used to describe a substance that dissolves thick mucous, loosens mucous to help clear it out & make it thinner so it’s easier to cough up

Does Helixia for Cough Really Work?

All of the studies done on ivy leaf extract show positive results in terms of decreasing symptoms such as cough, pain on breathing or coughing, thickness of mucus, hoarseness and increasing general well-being and sleep quality^{[1][3][4][5][6]}.

A more recent, placebo-controlled study showed the extracted ivy leaf ingredient in Propsan (EA 575^®) improved cough severity when compared to taking nothing (placebo)^[7]. From the evidence available, it must be noted that some of the studies are not of high quality and have various issues including problems with sample sizes, methods of reporting, selection bias, statistical analysis, reporting of drop-out rates and exclusion criteria^[5][6]. The majority of studies were also not placebo-controlled, but rather, non-interventional^[5][6] (meaning that ivy leaf extract was not compared to placebo or any other product for cough).

So while there is a very plausible mechanism for how ivy leaf extract helps with cough and all studies support its effectiveness, the quality of the data is not enough to allow us to guarantee that this product definitely works.

Is Prospan by Helixia Cough Safe?

As mentioned above, this product has been used in Germany for more than 20 years and there have been no unusual adverse effects that have come to light through post-market surveillance (monitoring done after a drug has made it to the market).  All studies have reported no serious or unexpected side effects. The most common side effects noted in studies were mild nausea, abdominal discomfort and diarrhea^[1][3][4][5].  A systematic review that looked at several studies with a combined total of over 17,000 patients confirms the safety of ivy leaf extract^[5]. In addition, there are no known interactions between ivy leaf extract and other medications, natural products or food^[2].

Bottom Line

This product has been studied in a large number of people of various ages and has been found to be safe (can be used for children over the age of  one). Studies regarding how effective it is are lacking, but the same can be said for many cough and cold products available. Given the often unnecessary and inapplicable use of antibiotics to treat cough, there is a large need for other treatment options. Considering the long-term use and success of ivy leaf extract for cough in Europe, Prospan by Helixia for cough may be worth a shot.

Note: If you do take any over-the-counter cough product and your symptoms worsen, last more than a week, or are accompanied by a fever of greater than 38°C, always consult a doctor for a medical evaluation. Always consult a doctor before taking a new medication if you are pregnant or breastfeeding.

Where Can I Buy Prospan by Helixia In Canada?

In Canada, this product can be bought in-person from any pharmacy or drug store or online from:

Authors: Lisa Ugilini (BSc.Pharm), Aliya Kassamali (PharmD)

Written and Reviewed By The Health Aisle Team

Publication Date: February 9, 2013
Updated: January 7, 2019

References
1. Stauss-Grabo, M, Atiye S, Warnke A, Wedemeyer RS, Donath F, Blume HH (2011). Observational study on the tolerability and safety of film-coated tablets containing ivy extract (Prospan Cough Tablets) in the treatment of colds accompanied by coughing. Phytomedicine, 18(6):433-436.
2. Pendopharm (2011). Helixia Cough. <http:helixia.com/about/helixia-cough/> accessed 06/02/2013.
3. Cwientzek U, Ottillinger B, Arenberger P (2011). Acute bronchitis therapy with ivy leaves extracts in a two-arm study. A double-blind, randomised, study vs. another ivy leaves extract. Phytomedicine, 18(13):1105-1109.
4. Schmidt M, Thomsen M, Schmidt U (2012). Suitability of ivy extract for the treatment of paediatric cough. Phytother Res, 26(12):1942-1947.
5. Hofmann D, Hecker M, Volp A (2003). Efficacy of dry extract of ivy leaves in children with bronchial asthma: a review of randomized controlled trials. Phytomedicine, 10(2-3):213-220.
6. Holzinger F and Chenot, J (2011). 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, Article ID 382789.
7. Schaefer, A., Kehr, M.S. and Giannetti B.M et al. 2016. A randomized, controlled, double-blind, multi-center trial to evaluate the efficacy and safety of a liquid containing ivy leaves dry extract (EA 575 extregistered) vs. placebo in the treatment of adults with acute cough. Die Pharmazie – An International Journal of Pharmaceutical Sciences, 71(9): 504-509