Bronchial Clear Liquid [Discontinued] by Terry Naturally

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Bronchitis. It is unclear if oral English ivy leaf extract is beneficial in patients with acute or chronic bronchitis. Details: Observational, low-quality research in adults and children with acute or chronic bronchitis has found that taking a specific product containing English ivy leaf extract (Prospan, PendoPharm) three times daily for 7 days is associated with improvement of respiratory symptoms when compared with baseline. However, the validity of this study is limited by the lack of a comparator group and it is unclear if improvements are associated with English ivy extract, other concomitant treatments, or the natural course of the disease (29903). Another small observational study in children and adults with acute bronchitis has found that taking a specific product containing English ivy leaf extract (Prospanex, Engelhard Arzneimittel GmbH and Co. KG) three times daily for approximately 7 days is not associated with a difference in respiratory symptoms, such as coughing, when compared with taking acetylcysteine 300-600 mg daily (106055). In these studies, English ivy extract 7 mg/mL was dosed as 2.5 mL three times daily in children less than 5 years of age, 5 mL three times daily in children 6-12 years of age, and 5-7.5 mL three times daily in those at least 12 years of age (29903,106055). English ivy has also been evaluated in combination with thyme. A large clinical study in patients with acute bronchitis shows that taking a specific syrup (Bronchipret Saft, Bionorica AG) containing English ivy leaf and thyme extracts as 5.4 mL three times daily for 11 days reduces the frequency and duration of cough when compared with placebo (78152). Additionally, an observational study in children with acute bronchitis has found that taking this combination product in an age-specific dosing schema is associated with reduced bronchitis severity and coughing fits when compared to baseline (78181). However, due to the lack of a comparator group, it is unclear if these changes are due to the product or to the natural resolution of the condition.
• Burns. Although there has been interest in using topical English ivy for burns, there is insufficient reliable information about the clinical effects of English ivy for this purpose.
• Cough. Oral English ivy has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large open-label, uncontrolled study in adults with acute cough due to an upper respiratory tract infection who purchased a specific syrup (Bronchipret drops, Bionorica AG) containing English ivy leaf and thyme extracts suggests that taking this product as 2.6 mL three times daily for at least 4 days may improve patient-reported bronchitis-symptom severity, cough severity, and quality of life, with over 90% of patients reporting overall satisfaction and product tolerability (110401). However, due to the lack of a comparator group, it is unclear if these changes are due to the product or the natural resolution of the condition. Additionally, the validity of these findings is limited by poor study methodology.
• Gout. Although there has been interest in using oral English ivy for gout, there is insufficient reliable information about the clinical effects of English ivy for this purpose.
• Neuropathic pain. Although there has been interest in using topical English ivy for neuropathic pain, there is insufficient reliable information about the clinical effects of English ivy for this purpose.
• Respiratory tract infections. Although there has been interest in using oral English ivy for respiratory tract infections, there is insufficient reliable information about the clinical effects of English ivy for this purpose.
• Rheumatoid arthritis (RA). Although there has been interest in using oral and topical English ivy for RA, there is insufficient reliable information about the clinical effects of English ivy for this purpose.
• Spasticity. Although there has been interest in using oral English ivy for spasticity, there is insufficient reliable information about the clinical effects of English ivy for this purpose. More evidence is needed to rate English ivy for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. It is unclear if a topical thyme flower and leaf extract reduces wrinkles. Details: A small clinical trial in healthy females aged 40-60 years with wrinkles shows that applying a specific gel preparation (ThymLec 2%, PhytoPharmaTech) containing thyme flower and leaf 1-3% extract in lecithin on the face twice daily for 60 days reduces facial wrinkles when compared with inactive control gel, but not when compared with an active comparator gel containing propanediol, ornithine, phospholipids, and glycolipids (105909).
• Alopecia areata. Topical thyme oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical study shows that applying a combination of the essential oils from thyme, rosemary, lavender, and cedarwood improves hair growth in up to 44% of patients after 7 months of treatment when compared with baseline (5177). The validity of this finding is limited by the lack of a comparator group. Additionally, it is unclear if this effect is due to thyme, other ingredients, or the combination.
• Bronchitis. Oral thyme has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Some research has evaluated thyme in combination with cowslip. One observational study in adults and children has found that taking a specific product (Bronchipret) containing thyme and cowslip relieves symptoms of bronchitis and increases production of sputum (13557). A clinical study in patients with acute bronchitis shows that taking a similar combination extract (Bronchicum Tropfen) containing thyme and cowslip root 1 mL five times daily for 7-9 days seems to reduce severity and duration of coughing when compared with placebo (49219). Other thyme and cowslip preparations such as Bronchicum Elixir S and Bronchcium Tropfen seem to be similarly beneficial for bronchitis (49223). Thyme has also been studied in combination with other ingredients. A large clinical study in patients with acute bronchitis shows that taking a specific syrup (Bronchipret Saft, Bionorica AG) containing thyme and English ivy leaf 5.4 mL three times daily for 11 days reduces the frequency and duration of cough when compared with placebo (78152). Additionally, an observational study in children with acute bronchitis has found that taking this combination product in an age-specific dosing schema is associated with reduced bronchitis severity and coughing fits when compared to baseline (78181). However, due to the lack of a comparator group, it is unclear if these changes are due to the product or to the natural resolution of the condition.
• Colic. Although there is interest in using oral thyme for colic, there is insufficient reliable information about the clinical effects of thyme for this condition.
• Cough. Oral thyme has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large open-label, uncontrolled study in adults with acute cough due to an upper respiratory tract infection who purchased a specific syrup (Bronchipret drops, Bionorica AG) containing thyme and English ivy leaf extracts suggests that taking this product as 2.6 mL three times daily for at least 4 days may improve patient-reported bronchitis symptom severity, cough severity, and quality of life, with over 90% of patients reporting overall satisfaction and product tolerability (110401). However, due to the lack of a comparator group, it is unclear if these changes are due to the product or the natural resolution of the condition. Additionally, the validity of these findings is limited by poor study methodology.
• Common cold. Although there is interest in using oral thyme for the common cold, there is insufficient reliable information about the clinical effects of thyme for this condition.
• Dementia. It is unclear if aromatherapy with thyme oil is beneficial in patients with dementia. Details: One very small clinical study in patients with advanced dementia shows that attaching a pad containing thyme oil to the collar area of the shirt does not reduce agitation when compared with lavender oil or unscented grapeseed oil (12213).
• Developmental coordination disorder (DCD). Oral thyme oil has only been evaluated in combination with other oils; its effect when used alone is unclear. Details: One very small clinical study in children with DCD shows that taking thyme oil, in combination with evening primrose oil, fish oil, and vitamin E (Efalex, Efamol Ltd.), seems to modestly improve movement disorders when compared with baseline (5708). The validity of this finding is limited by the lack of a comparator group. Additionally, it is unclear if this effect is due to thyme, other ingredients, or the combination.
• Dyspepsia. Although there is interest in using oral thyme for dyspepsia, there is insufficient reliable information about the clinical effects of thyme for this condition.
• Dysmenorrhea. It is unclear if drinking thyme tea is beneficial for the prevention of dysmenorrhea. Details: One small observational study in adolescents living in Ethiopia has found that drinking thyme tea is associated with a lower occurrence of primary dysmenorrhea when compared with those who did not drink thyme tea (105910).
• Halitosis. It is unclear whether oral thyme is beneficial for halitosis. Details: One small retrospective study in adults with gingival halitosis who received periodontal treatment and oral hygiene instructions suggests that drinking thyme tea twice daily for 1 week is associated with a reduction in volatile sulfur compounds, which is a marker for halitosis, when compared with chlorhexidine or oral hygiene alone (111716). However, the interpretation of this finding is limited by the lack of thyme dosing information and the narrow focus on intraoral halitosis, excluding most extraoral halitosis-associated conditions.
• Laryngitis. Although there is interest in using oral and topical thyme for laryngitis, there is insufficient reliable information about the clinical effects of thyme for this condition.
• Oral mucositis. Although there is interest in using oral and topical thyme for oral mucositis, there is insufficient reliable information about the clinical effects of thyme for this condition.
• Tonsillitis. Although there is interest in using oral and topical thyme for tonsillitis, there is insufficient reliable information about the clinical effects of thyme for this condition. More evidence is needed to rate thyme for these uses.

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POSSIBLY SAFE ...when the leaf extract is used orally and appropriately, short-term. Two specific products containing dried English ivy leaf extract 7 mg/mL (Prospan, PendoPharm; Prospanex, Engelhard Arzneimittel GmbH and Co. KG), taken in doses of 7.5 mL three times daily, have been used with apparent safety for up to 7 days (29903,106055). There is insufficient reliable information available about the safety of topical English ivy.

CHILDREN: POSSIBLY SAFE
when the leaf extract is used orally and appropriately, short-term. Two specific products containing dried English ivy leaf extract 7 mg/mL (Prospan, PendoPharm; Prospanex, Engelhard Arzneimittel GmbH and Co. KG), taken in doses of 2.5-7.5 mL three times daily, has been used with apparent safety for up to 7 days in infants and children up to 18 years of age (29903,106055).

PREGNANCY:
Insufficient reliable information available; avoid using. A small retrospective study suggests that taking English ivy leaf extract at an unknown dose or duration during pregnancy is not associated with changes in pregnancy duration, the rate of preterm birth, infant health complications, or infant deaths (110402). However, due to its small size, retrospective design, and insufficient information regarding dose and duration, further research is needed to determine the safety of English ivy during pregnancy.

LACTATION:
Insufficient reliable information available; avoid using.

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LIKELY SAFE ...when used in amounts commonly found in foods. Thyme has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when thyme is used orally and appropriately in supplemental amounts. Orally, thyme, in combination with other herbs, has been used safely for up to 23 days (13557,49219,49223,78133). ...when diluted thyme oil is used topically, short-term. Diluted thyme oil has been used with apparent safety for up to 7 months (5177). There is insufficient reliable information available about the safety of thyme oil when used orally or when inhaled.

CHILDREN: LIKELY SAFE
when used in amounts commonly found in foods. Thyme has Generally Recognized as Safe (GRAS) status in the US (4912).

CHILDREN: POSSIBLY SAFE
when thyme is used orally in medicinal amounts in combination with English ivy. Thyme has been used with apparent safety in combination with English ivy for up to 10 days (78181). There is insufficient reliable information available about the safety of thyme oil when used orally or topically in children.

PREGNANCY AND LACTATION: LIKELY SAFE
when used in amounts commonly found in foods. Thyme has Generally Recognized as Safe (GRAS) status in the US (4912). There is insufficient reliable information available about the safety of thyme when used in medicinal amounts during pregnancy and breast-feeding; avoid using.

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CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, English ivy might increase the levels of drugs metabolized by CYP2C19.  Details In vitro research shows that English ivy inhibits CYP2C19 enzymes (96682). So far, this interaction has not been reported in humans.

CYTOCHROME P450 2C8 (CYP2C8) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, English ivy might increase the levels of drugs metabolized by CYP2C8.  Details In vitro research shows that English ivy inhibits CYP2C8 enzymes (96682). So far, this interaction has not been reported in humans.

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, English ivy might increase the levels of drugs metabolized by CYP2D6.  Details In vitro research shows that English ivy inhibits CYP2D6 enzymes (96682). So far, this interaction has not been reported in humans.

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ANTICHOLINERGIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concurrent use of anticholinergic drugs and thyme essential oil might reduce the effects of anticholinergic drugs.  Details In vitro evidence suggests that thyme essential oil and specific essential oil constituents like thymohydroquinone and carvacrol can inhibit acetylcholinesterase (AChE) (78155). However, this effect has not been observed in humans.

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, thyme leaf extract might have additive effects with anticoagulant or antiplatelet drugs.  Details In vitro and animal research suggests that thyme leaf extract has antiplatelet effects (13457,18335,49445). However, this effect has not been observed in humans.

CHOLINERGIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concurrent use of cholinergic drugs and thyme essential oil might cause additive cholinergic effects.  Details In vitro evidence suggests that thyme essential oil and specific essential oil constituents like thymohydroquinone and carvacrol can inhibit acetylcholinesterase (AChE) (78155). However, this effect has not been observed in humans.

ESTROGENS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, thyme might competitively inhibit the effects of estrogen replacement therapy.  Details In vitro research shows that thyme has estrogen receptor-binding activity and phytoestrogen content (3701). However, this effect has not been observed in humans.

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General ...Orally and topically, English ivy leaf extract seems to be generally well tolerated.
Most Common Adverse Effects:
Orally: Abdominal pain, diarrhea, nausea, skin irritation, vomiting.
Topically: Allergic reactions, contact dermatitis.

Dermatologic ...Orally, English ivy and fresh English ivy leaves can cause skin irritation (7,29903).
Topically, fresh English ivy leaves can cause contact dermatitis and rash, with frequent exposure increasing the risk of sensitization (29910,29912,29913,29914,91301,96620,96636,96681). Occupational airborne exposure to English ivy can also cause contact dermatitis (96600).

Gastrointestinal ...Orally, English ivy can cause abdominal pain, diarrhea, nausea, and vomiting (29903,106055). The saponin constituents of English ivy can produce an acrid and/or bitter taste (7).

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General ...Orally, thyme is well tolerated when used in food and seems to be well tolerated when used medicinally. Topically, thyme seems to be generally well tolerated.
Most Common Adverse Effects:
Orally: Allergic reactions, diarrhea, dizziness, headache, heartburn, nausea, or vomiting.
Topically: Contact dermatitis and skin irritation.

Dermatologic ...Topically, thyme, thyme oil, or the constituent thymol can cause contact dermatitis and skin irritation (13463,78252,78362,78384,77982,78154,78310,78313,78384). In one study of 100 patients with contact allergies, 5% were attributed to thyme oil as an allergen contained in wound dressings (78362). Toothpastes containing thymol have been associated with cheilitis and glossitis (13463).

Gastrointestinal ...Orally, thyme and thyme oil may cause heartburn, nausea, vomiting, stomach upset, or diarrhea (13557,94033). In a clinical study, two patients using extracts of thyme herb and ivy leaves experienced temporary stomach ache and mild nausea (78181).
Intravaginally, cream containing thyme and garlic has been associated with reports of nausea and vomiting in one clinical study (88387). It is not clear if these adverse effects were associated with thyme, garlic, or the combination.

Genitourinary ...Intravaginally, cream containing thyme and garlic has been associated with reports of vaginal dryness and vaginal irritation in one clinical study (88387). It is not clear if these adverse effects were associated with thyme, garlic, or the combination.

Immunologic ...Orally, thyme can cause allergic reactions; however, this is uncommon (13463). Allergic reactions to thyme might be more common in people who are also allergic to oregano and other Lamiaceae species (3808).

Neurologic/CNS ...Orally, thyme may case headache or dizziness (94033).

Pulmonary/Respiratory ...By inhalation, occupational exposure to thyme dust can cause acute airway obstruction (783,13463,13464,77982,78098).

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