Safety of Prospan Helixia (Ivy Leaf Extract) Before Surgery
Prospan Helixia (ivy leaf extract) should be discontinued at least 2 weeks before surgery due to potential perioperative risks.
Understanding Prospan Helixia
Prospan Helixia contains ivy leaf extract (EA 575), which is primarily used as an expectorant for productive cough. While it has shown good efficacy and safety profile for respiratory conditions 1, 2, 3, 4, 5, its perioperative safety requires careful consideration.
Perioperative Risks and Recommendations
Bleeding Risk Considerations
According to the Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement, herbal supplements with unknown pharmacokinetics should be discontinued before surgery 6. While ivy leaf extract is not specifically mentioned in the list of supplements that affect bleeding risk, the SPAQI recommends a cautious approach with herbal preparations that have limited perioperative safety data.
General Perioperative Management of Supplements
The SPAQI consensus provides clear guidance on supplement management before surgery:
- Supplements with unknown pharmacokinetics should ideally be held for 2 weeks before surgery 6
- For lower-risk procedures, cautiously proceeding with surgery may be reasonable if the supplement cannot be discontinued 6
Decision Algorithm for Prospan Helixia
- High-risk or major surgery: Discontinue Prospan Helixia 2 weeks before surgery
- Low-risk or minor surgery: Consider proceeding with caution if unable to discontinue, but still preferable to hold for 2 weeks
Postoperative Considerations
Resuming Prospan Helixia after surgery should follow the general principle for supplements: restart only once the risk of postoperative bleeding is minimal 6. For cough medications like Prospan, this is particularly important to avoid strain on surgical incisions.
Important Caveats
- The recommendation to discontinue Prospan Helixia is based on the general precautionary principle for herbal supplements rather than specific evidence of harm
- If the patient has been using Prospan for managing productive cough, discuss alternative management strategies during the perioperative period
- If the patient has already taken Prospan close to surgery time, inform the anesthesia team
Conclusion
While Prospan Helixia has demonstrated safety for its intended use in treating cough, the perioperative setting presents unique risks. Following the SPAQI consensus guidelines, discontinuing Prospan Helixia for 2 weeks before surgery represents the safest approach to minimize any potential unknown risks during the perioperative period.