What is the recommended dose of Syr Prospan (Ivy leaf extract) for adults and children with a history of respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD)?

Prospan (Ivy Leaf Extract) Dosing for Respiratory Conditions

Prospan syrup should be dosed at 5 mL (approximately 35 mg ivy leaf dry extract) three times daily for adults, and 2.5 mL three times daily for children aged 6-12 years, or 2.5 mL twice daily for children aged 1-5 years, based on manufacturer recommendations and clinical study protocols. 1, 2, 3

Standard Dosing Regimens by Age

Adults and Adolescents (≥12 years)

• Standard dose: 5-7.5 mL (approximately 35-52.5 mg ivy leaf dry extract) three times daily 2
• Alternative formulation: 1.5-2 effervescent tablets daily (97.5-130 mg dried ivy leaf extract) for chronic bronchitis 2
• Treatment duration: Typically 7-14 days, though chronic conditions may require up to 4 weeks 2

School-Age Children (6-12 years)

• Standard dose: 2.5 mL twice daily or three times daily depending on severity 4, 3
• This corresponds to approximately 17.5 mg ivy leaf dry extract per dose 3
• Treatment duration: Up to 14 days for acute cough 3

Preschool Children (1-5 years)

• Standard dose: 2.5 mL twice daily 4, 3
• Lower frequency compared to older children due to smaller body size and metabolic considerations 3

Infants (<1 year)

• Prospan has been studied in children under 1 year with favorable safety profiles 1
• Specific dosing should follow manufacturer guidelines, typically 2.5 mL twice daily under medical supervision 3

Special Considerations for Asthma and COPD Patients

Critical Safety Caveat

Ivy leaf extract is NOT a substitute for standard asthma or COPD controller medications. Patients with these conditions should continue their prescribed inhaled corticosteroids, bronchodilators, or other maintenance therapies as directed. 5

Appropriate Use Context

• Prospan may be used as adjunctive symptomatic treatment for productive cough in patients with well-controlled asthma or COPD 1, 2
• It should NOT replace step-wise asthma therapy (inhaled corticosteroids remain first-line for persistent asthma) 5
• For children with asthma and recurrent wheezing, inhaled corticosteroids at appropriate doses (e.g., budesonide 0.25-0.5 mg twice daily for ages 5-11 years) remain the evidence-based standard 5, 6

When Prospan May Be Considered

• Productive cough associated with acute bronchitis superimposed on chronic respiratory disease 2, 4
• Symptomatic relief when standard therapies adequately control underlying disease but residual cough persists 1
• Patients seeking complementary approaches alongside evidence-based treatments 1

Clinical Evidence and Efficacy

Symptom Improvement Rates

Studies demonstrate the following improvement rates after 7-14 days of treatment:

• Cough improvement: 92-94% of patients 2, 3
• Expectoration improvement: 94% of patients 2
• Dyspnea reduction: 83% of patients with chronic bronchitis 2
• Complete symptom resolution: 38% or more for each respiratory symptom 2

Quality of Life Benefits

• Expert consensus suggests Prospan may improve sleep quality in children with nocturnal cough 1
• High guardian satisfaction (68% very satisfied) with twice-daily dosing regimens 4
• Reduction in cough frequency from "several times per hour" to occasional in most patients 4

Safety Profile and Tolerability

Adverse Event Rates

• Overall incidence: 0.2-1.9% across large studies 2, 3
• Most common side effects: Mild gastrointestinal symptoms (eructation, nausea) 2
• Serious adverse events: None reported in pediatric populations including infants 1, 3
• Compliance and tolerability: Rated "good to very good" in 99-100% of patients 3

Age-Specific Safety

Prospan has demonstrated favorable safety even in children under 1 year of age, though this population requires closer monitoring and medical supervision. 1

Administration Technique

Practical Dosing Tips

• Administer doses before meals to optimize absorption and minimize gastrointestinal effects 3
• Use the provided measuring device (oral syringe or dosing cup) for accurate measurement 7
• For young children unable to swallow syrup directly, mixing with small amounts of water or juice is acceptable 3
• Shake bottle well before each use to ensure uniform distribution of active extract 3

Common Pitfalls to Avoid

Critical Errors in Management

1. Never discontinue prescribed asthma controllers (inhaled corticosteroids, LABAs) to use Prospan alone—this can lead to loss of disease control and exacerbations 5
2. Do not use Prospan as monotherapy for moderate-to-severe asthma or COPD—these conditions require evidence-based pharmacotherapy 5
3. Avoid exceeding recommended doses—higher doses have not been studied and may increase adverse event risk 2, 3
4. Do not continue beyond 4 weeks without medical reassessment if symptoms persist—this may indicate need for alternative diagnosis or treatment 5, 2

When to Seek Alternative Treatment

• If cough worsens or fails to improve within 7-14 days 2, 3
• If new symptoms develop (fever, chest pain, hemoptysis, significant dyspnea) 5
• If underlying asthma or COPD control deteriorates 5

Treatment Duration and Follow-Up

Standard Treatment Course

• Acute cough: 7-14 days is typically sufficient 3
• Chronic bronchitis: Up to 4 weeks may be appropriate 2
• Reassessment timing: Evaluate response at 7-10 days; discontinue if no benefit 2, 3

Monitoring Parameters

• Cough frequency and severity (subjective rating scales) 2, 4
• Sleep quality and nighttime awakenings 1, 4
• Impact on daily activities and school/work attendance 4
• Adverse effects, particularly gastrointestinal symptoms 2, 3