Ivy Leaf vs Thyme and Other Cough Herbs

Table of Contents

1. How Cough Herbs Can Be Compared
2. Thyme
3. The Thyme and Ivy Combination
4. Pelargonium: The Children's Evidence Leader
5. Marshmallow and Other Mucilage Herbs
6. Shirazi Thyme (Zataria multiflora)
7. Honey and the Non-Herbal Options
8. A Benefit–Risk Ranking
9. The Few Head-to-Head Trials
10. The Comparison in Summary
11. Key Research Papers
12. Connections

How Cough Herbs Can Be Compared

There are three ways the evidence for two cough herbs can be compared, from strongest to weakest:

1. A head-to-head randomised trial, in which patients are randomly assigned to one herb or the other under the same conditions. For ivy, such trials are almost entirely missing; where ivy is a comparator, it is usually against a new combination product.
2. Separate placebo-controlled trials of each herb, which can be compared through their effect sizes. This works only if the trials enrolled similar patients and measured similar outcomes, which cough trials rarely do.
3. Reviews that grade each herb's evidence, such as "sufficient", "some evidence" or "further research needed". This is the level at which most ivy comparisons sit.

Two complications run through everything below. First, many products combine herbs, so a trial of "thyme and ivy" cannot say which herb did what. Second, results belong to a specific extract made in a specific way; a finding for one ivy extract does not automatically apply to another, and a finding for a thyme fluid extract says nothing about thyme tea.

Thyme

Thyme (Thymus vulgaris) is ivy's closest competitor and most frequent partner. Like ivy, it is used in Europe for productive cough, and a 2021 review of non-drug remedies for post-viral acute cough lists both thyme and ivy among the agents with "some evidence", while stating that "further rigorous studies should confirm natural products' efficacy and safety" for all of them (Ciprandi 2021).

The two herbs are thought to work differently. Thyme's main active components are aromatic oils such as thymol, while ivy's are saponins. The site's Thyme: Respiratory Health and Cough deep-dive covers its traditional and modern respiratory use, including the combination trials described below.

The Thyme and Ivy Combination

Thyme and ivy are often sold together, as fluid extracts combined in syrups and drops. The site's Thyme deep-dive describes placebo-controlled bronchitis trials of thyme–ivy combinations; those trials are outside the citation set reviewed for this page.

For children, a 2025 systematically conducted review of herbal medicines for acute respiratory infections included "thyme herb and ivy leaf extracts" among the fixed combinations it examined, alongside ivy leaf dry extract on its own. It concluded that only one product, Pelargonium extract EPs 7630, had sufficient evidence to be regarded as an appropriate treatment in children, and that for the other herbal products in the review "further research is needed to close existing evidence gaps" (Kamin 2025).

What a combination trial cannot tell you is how much each herb contributes. A positive result for thyme-plus-ivy is not evidence for ivy alone, nor for thyme alone.

Pelargonium: The Children's Evidence Leader

Pelargonium sidoides, a South African geranium, is used as a root extract coded EPs 7630 for acute bronchitis and other respiratory infections. In the 2025 paediatric review, it was the clear leader: six double-blind placebo-controlled trials, eight meta-analyses, four prospective open-label studies and two observational studies, "demonstrating efficacy and good tolerability". On that basis the review regarded it as an appropriate treatment to reduce the severity and duration of upper and lower respiratory infections in children (Kamin 2025).

Ivy leaf extract, by comparison, was placed among the products for which more research is needed. One point of context: the review declares funding from a herbal-medicine manufacturer and reports that the funder was not involved in the literature search. Readers can weigh the funding as they see fit; the independent 2021 review of ivy specifically reached a similarly cautious conclusion about ivy's effect size (Sierocinski 2021).

Marshmallow and Other Mucilage Herbs

Marshmallow root (Althaea officinalis) works on a different principle from ivy. Instead of loosening mucus, its slippery plant gums (mucilage) coat the irritated lining of the throat, which is thought to calm the urge to cough. It is used more for dry, irritating cough, where ivy is aimed at productive cough.

The two are sometimes combined. A 2019 comparative phase II trial tested chewable tablets made from marshmallow root, ivy leaf and Sisymbrium irio seed against another multi-herb product in 70 patients for 15 days, and reported better cough quality-of-life scores in the test group with no side effects reported (Khan 2019). The trial had no placebo arm and analysed changes within groups, so it does not show what any single herb contributes.

The 2021 post-viral cough review lists marshmallow alongside ivy as having "some evidence" (Ciprandi 2021), and the 2020 benefit–risk assessment described below rated both as "positive" (Silveira 2020). Plantain and mullein, both on this site, are other mucilage-rich traditional cough herbs.

Shirazi Thyme (Zataria multiflora)

Zataria multiflora, sometimes called Shirazi or Persian thyme, is a thymol-rich relative of thyme widely used for cough in Iranian traditional medicine. A 2018 review found five clinical studies testing it for acute cough — alone in one, combined with marshmallow in two and with fennel oil in one — against placebo or the cough drugs bromhexine, dextromethorphan and clobutinol. All five reported benefit in adults or children without adverse effects. The review's author suggested that future trials could combine Zataria with ivy leaf or primrose root extract (Mahboubi 2018).

No such Zataria–ivy combination trial is in the record reviewed for this page.

Honey and the Non-Herbal Options

The 2021 post-viral cough review placed several non-herbal remedies on the same "some evidence" footing as ivy: honey, glycerol, hyaluronic acid and saline solutions, along with herbs including marshmallow, sundew (Drosera rotundifolia), Grindelia, Pelargonium, elder (Sambucus nigra) and thyme (Ciprandi 2021). The review noted that the market for cough relievers is very large, that a well-established tradition regards natural remedies as effective and safe, and that few studies have actually investigated them.

Honey is the non-herbal comparator most familiar to families; the site's Honey: Cough Suppressant Evidence page covers its trials. Health authorities advise against honey for infants under one year because of the risk of infant botulism, a different age limit from ivy's under-two contraindication.

A Benefit–Risk Ranking

In 2020, a group of researchers assessed 39 herbal medicines likely to appeal to people with early, mild flu-like symptoms in the context of COVID-19, weighing preclinical and clinical evidence of benefit against risk, using paracetamol, ibuprofen and codeine as reference drugs. The plant selection was based mainly on species listed by the World Health Organization and the European Medicines Agency (Silveira 2020).

• Positive benefit–risk balance (5): marshmallow (Althaea officinalis), myrrh (Commiphora molmol), licorice (Glycyrrhiza glabra), ivy (Hedera helix) and elder (Sambucus nigra).
• Promising (12): including garlic, Andrographis, two Echinacea species, eucalyptus oil, Pelargonium sidoides, aniseed, willow and ginger.
• Unknown: the rest.

Among the reference drugs, only ibuprofen came out as "promising". The authors were explicit that these herbs "will not cure or prevent the flu"; the assessment concerns symptom relief and safety margins. Note that this is a ranking of benefit against risk, in which ivy's favourable tolerability counts heavily, not a ranking of how well each herb relieves cough. It also places Pelargonium lower than the paediatric review did, a reminder that such rankings depend on the population, question and method.

The Few Head-to-Head Trials

Where ivy has been tested directly against something else, it has usually been as the established comparator for a new combination product.

• Ivy plus Coptis versus ivy alone. In a 2026 Korean randomised, double-blind phase 3 trial in 236 patients aged 2 to 70, a combination of ivy leaf and Coptis chinensis rhizome extracts was non-inferior to a widely prescribed ivy leaf extract over five days. Cough cleared in 43.0% versus 40.0%, and adverse events were 11.0% versus 11.1% (Cho 2026).
• Ivy-containing chewable tablet versus another multi-herb product. The 70-patient marshmallow–ivy–Sisymbrium trial described above (Khan 2019).

A non-inferiority result against ivy says the new product is not meaningfully worse than ivy. It says nothing about how either compares with placebo. No trial in the record reviewed for this page tests ivy alone directly against thyme alone, Pelargonium, marshmallow or honey.

The Comparison in Summary

• Regulatory standing: ivy leaf extract holds EU well-established use status for productive cough (EMA: Hederae helicis folium), a stronger regulatory footing than many herbs on the cough shelf.
• Volume of research: large, including very big observational studies and reviews (Pawłowska 2026; Seifert 2023).
• Quality of the efficacy evidence: rated low with high risk of bias in an independent review, with minimal effects (Sierocinski 2021).
• Children: one paediatric review placed Pelargonium EPs 7630 ahead of ivy on the strength of placebo-controlled evidence (Kamin 2025).
• Grouped reviews: ivy sits in the same "some evidence" tier as thyme, honey, marshmallow and others (Ciprandi 2021), and in the top "positive" tier of one benefit–risk ranking, largely on safety (Silveira 2020).
• Direct comparisons: essentially absent for single herbs.

The research does not single out a "best" cough herb. It shows several with small, uncertain effects and generally good short-term tolerability, of which Pelargonium has the most placebo-controlled evidence in children and ivy one of the strongest regulatory and safety records. Most acute coughs resolve on their own whichever, if any, is used.

Key Research Papers

1. Ciprandi G, Tosca MA. Non-pharmacological remedies for post-viral acute cough. Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace. 2021;92(1). PubMed PMID: 34461702
2. Kamin W, Seifert G, Zwiauer K, et al. Phytotherapy for acute respiratory tract infections in children: a systematically conducted, comprehensive review. Frontiers in pediatrics. 2025;13:1423250. PubMed PMID: 40376625
3. Silveira D, Prieto-Garcia JM, Boylan F, et al. COVID-19: Is There Evidence for the Use of Herbal Medicines as Adjuvant Symptomatic Therapy? Frontiers in pharmacology. 2020;11:581840. PubMed PMID: 33071794
4. Mahboubi M. Management of acute cough by Zataria multiflora Boiss as an alternative treatment. Journal of integrative medicine. 2018;16(1):20-25. PubMed PMID: 29397088
5. Khan M, Rehman H, Naveed S, et al. Chewable cough tablets with improved palatability: A comparative phase II clinical trial. Pakistan journal of pharmaceutical sciences. 2019;32(1(Supplementary)):339-343. PubMed PMID: 30829213
6. Cho YJ, Yoon HJ, Lim DH, et al. Randomized, Double-Blind, Multicenter, Phase 3 Study of AG NPP709 Compared With Ivy Leaf Extract in Patients With Acute or Chronic Respiratory Symptoms. Journal of Korean medical science. 2026;41(9):e97. PubMed PMID: 41807028
7. Sierocinski E, Holzinger F, Chenot JF. Ivy leaf (Hedera helix) for acute upper respiratory tract infections: an updated systematic review. European journal of clinical pharmacology. 2021;77(8):1113-1122. PubMed PMID: 33523253
8. Pawłowska AM. From Traditional Remedy to Evidence-Based Phytotherapeutic Agent: Hedera helix L. in Respiratory Medicine. Plants (Basel, Switzerland). 2026;15(17). PubMed PMID: 42739377
9. Seifert G, Upstone L, Watling CP, et al. Ivy leaf dry extract EA 575 for the treatment of acute and chronic cough in pediatric patients: review and expert survey. Current medical research and opinion. 2023;39(10):1407-1417. PubMed PMID: 37731370
10. Baharara H, Moghadam AT, Sahebkar A, et al. The Effects of Ivy (Hedera helix) on Respiratory Problems and Cough in Humans: A Review. Advances in experimental medicine and biology. 2021;1328:361-376. PubMed PMID: 34981489

PubMed Topic Searches

1. PubMed: thyme ivy bronchitis
2. PubMed: Pelargonium sidoides bronchitis children
3. PubMed: herbal medicine acute cough systematic review

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Connections

• Respiratory and Lung Herbs — the category hub
• Ivy Leaf (Hedera helix) — the main topic page
• Ivy Leaf: Benefits Deep Dive — the evidence ledger
• Cough Trials in Adults and Children — ivy's own trials
• Alpha-Hederin and the Beta2 Mechanism — how ivy is thought to work
• Safety in Children and Allergy — the safety record
• Thyme — ivy's most common partner
• Thyme: Respiratory Health and Cough — the thyme deep-dive
• Marshmallow Root: Cough and Sore Throat — the mucilage approach
• Honey: Cough Suppressant Evidence — the food comparator
• Licorice — rated "positive" in the benefit–risk ranking
• Elderberry — elder, also rated "positive"
• Echinacea — rated "promising"
• Mullein — a traditional cough herb
• Coltsfoot: Safer Alternatives for Cough — another comparison of cough herbs
• Cold and Flu Treatments — the wider remedy picture

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