Elderberry

Elderberry

Common Names

  • Elder
  • elderberry
  • European elderberry; black elder; black elderberry
  • sambucus

For Patients & Caregivers

Elderberry may reduce flu symptoms, but sufficient evidence is lacking to support its use to treat any condition.

Elderberry flowers and fruit are found in remedies to reduce cold and flu symptoms, and a few small studies have demonstrated that effect. The berries are rich in nutrients, but raw elderberries are inedible and must be properly cooked before they can be ingested.

Several components in elderberry may also block infection, but more studies are needed. Laboratory studies indicate that the chemopreventive properties of elderberry are weak, and elderberry has not been found effective for cardiovascular disease or to improve cholesterol levels. Unsubstantiated claims that elderberry prevents or treats AIDS, diabetes, or other diseases have recently been halted by the FDA. Importantly, patients should not forego or avoid legitimate treatments, and consult their physicians about the use of elderberry when being treated for various conditions.

  • To prevent cancer
    Laboratory studies indicate weak chemopreventive properties.
  • To prevent heart disease or lower cholesterol
    Clinical trials have not shown elderberry to be effective.
  • To reduce cold and flu symptoms
    A few small studies have shown that elderberry may reduce flu symptoms.
  • To treat constipation
    A small randomized trial of a compound largely used in Brazil that contains elderberry did find it to be an effective laxative for the treatment of constipation. However, there are no studies isolating elderberry itself as safe and effective for constipation, or whether the other components in the laxative preparation are safe for use by cancer patients.
  • To promote urination
    Laboratory studies indicate that elderberry has diuretic effects.
  • To prevent or treat HIV/AIDS
    Preliminary laboratory studies have found that several components in elderberry may block HIV1 infection, suggesting possible uses along with other proven treatments, but human studies are needed to confirm this activity.
  • To support or stimulate the immune system
    Laboratory and animal studies show that elderberry may affect the immune system.
  • To reduce inflammation
    Elderberry does have anti-inflammatory activities, but clinical trials have yet to be conducted.
  • To prevent or reduce respiratory infections or sinusitis
    Laboratory studies show activity against human respiratory bacterial pathogens and viruses, but clinical trials have yet to be conducted.

Raw or unripe elderberries contain toxic compounds known as cyanogenic glycosides and must be cooked sufficiently to avoid risk of cyanide toxicity. Elderberry leaves and stems also contain these compounds and should not be ingested at all. Consuming elder bark, leaves and raw elderberries have caused poisoning and hospitalization.

Patients should avoid taking elderberry if they:

  • Take antidiabetic medications, as elderberry may increase their effects.
  • Take diuretic or laxative medications, as elderberry may increase their effects.
  • Are pregnant or lactating, due to risk of toxicity and potential gastrointestinal (GI) distress.
  • Have autoimmune disorders such as rheumatoid arthritis, multiple sclerosis, or lupus, or take prescription medications to decrease immune activity, as elderberry can strengthen the immune system.
  • Allergic reactions
  • GI distress
  • Case Report: After ingesting an elderberry juice made from raw elderberries, leaves, and branches, 11 people experienced nausea and vomiting, 8 of whom had acute GI and neurologic symptoms. Other symptoms included dizziness and numbness and one person was hospitalized.
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For Healthcare Professionals

Sambucol®, Sambu®, Sambu® Guard, SambuActin™, Eldertussin™, Theramax®, Zumka™
Sambucus nigra

Elderberries come from a family of flowering shrubs known as Sambucus or elder. They are native to Europe but have become naturalized in many parts of the world including the United States. Cultivated for medicinal and food purposes, the fruit is used to produce jams, syrups, and wine. Elderberry flowers and fruit are incorporated in remedies to reduce cold and flu symptoms, for inflammation and respiratory diseases (1) (2) (3), and as a laxative (4). The berries are a rich source of anthocyanins and other phenolics and nutrients (2). Several species of Sambucus produce elderberries with similar chemical compositions including American Elder (Sambucus canadensis) and Blue Elder (Sambucus caerulea) (1), but European Elder (Sambucus nigra) is the type most studied and used in supplements.

In vitro studies demonstrate that elderberries possess antiviral (5), antibacterial (3), antidiabetic (6), immunomodulatory (7), antioxidant, anti-inflammatory, and chemopreventive properties (1) (2) (8), although inhibition of cancer cell growth was shown to be weak (9). Elderberry flavonoids and proanthocyanidins were shown to block HIV1 infection, and may have additive effects with existing HIV drugs such as enfuvirtide (10). Elderberry also conferred protective effects against oxidative stressors in endothelial cells (8). However, in vitro studies did not find elderberry to be vasoprotective (11) and randomized trials found it ineffective for both cardiovascular disease biomarkers (12) and improving cholesterol levels (13). Small randomized trials found that elderberry significantly reduced influenza symptoms (14), and was safe and effective in a preparation for chronic constipation (4), but more studies are needed before any conclusions can be drawn.

Unsubstantiated claims that elderberry prevents or treats various diseases including AIDS, diabetes and flu have recently been halted by the FDA (15). This is particularly important as patients may forego or avoid legitimate treatments.

  • Bacterial Infections
  • Cancer
  • Circulatory disorders
  • Cold and flu symptoms
  • Constipation
  • HIV/AIDS
  • Inflammation
  • Respiratory infections
  • Sinusitis

Elderberry inhibits H1N1 activities by binding to H1N1 virions and blocking host cell recognition and entry (5). It may also prevent HIV1 infection by binding to viral glycoproteins such as gp120 (10), but additional investigations are required to clarify those mechanisms (3). Elderberry’s anti-inflammatory effects may result from increased cytokine production (19) or inhibition of nuclear transcription factor kappaB and phosphatidylinositol 3-kinase (20). Its antidiabetic properties occur via activation of peroxisome proliferator-activated receptor gamma and stimulation of insulin-dependent glucose uptake (6). Another study indicates its chemopreventive potential is related to induction of quinone reductase as well as cyclooxygenase-2 and ornithine decarboxylase inhibition (2).

  • Raw or unripe elderberries contain cyanogenic glycosides and must be cooked sufficiently to avoid risk of cyanide toxicity.
  • Elderberry leaves and stems also contain cyanogenic glycosides and should not be ingested.
  • Consuming elder bark, leaves and raw elderberries has caused poisoning.
     (23) (16)
  • Avoid use during pregnancy or if lactating due to risk of toxicity and potential GI distress (24).
  • Since elderberry may strengthen or modulate the immune system (7), it should be avoided in patients with autoimmune disorders such as rheumatoid arthritis, multiple sclerosis, and lupus, or those taking immunosuppressants.

Infrequent: Type 1 allergy (25), gastrointestinal (GI) distress (23).
Case Report: Eleven people experienced nausea and vomiting, eight of whom had acute GI and neurologic symptoms after ingesting an elderberry juice made from raw elderberries, leaves, and branches. Other symptoms included dizziness and numbness and one person who had consumed the most juice was hospitalized (23).

Antidiabetic drugs: Elderberry has hypoglycemic activity and may have additive effects with antidiabetic drugs (6).
Diuretics: Elderberry promotes urination and may have additive effects with diuretics (26).
Laxatives: Elderberry may have additive effects (4) (24).
Cytochrome P4503A4 substrates: A commercial product containing Echinacea purpurea and Sambucus nigra was found to inhibit CYP3A4 activity, although the inhibitory potency seems to be exerted by E. purpurea. Until more is known, elderberry should be used with caution with CYP3A4 substrates (27).


  1. Thole JM, Kraft TF, Sueiro LA, et al. A comparative evaluation of the anticancer properties of European and American elderberry fruits. J Med Food. Winter 2006;9(4):498-504.

  2. Roschek B, Jr., Fink RC, McMichael MD, et al. Elderberry flavonoids bind to and prevent H1N1 infection in vitro. Phytochemistry. Jul 2009;70(10):1255-1261.

  3. Waknine-Grinberg JH, El-On J, Barak V, et al. The immunomodulatory effect of Sambucol on leishmanial and malarial infections. Planta Med. May 2009;75(6):581-586.

  4. Youdim KA, Martin A, Joseph JA. Incorporation of the elderberry anthocyanins by endothelial cells increases protection against oxidative stress. Free Radic Biol Med. Jul 1 2000;29(1):51-60.

  5. Jing P, Bomser JA, Schwartz SJ, et al. Structure-function relationships of anthocyanins from various anthocyanin-rich extracts on the inhibition of colon cancer cell growth. J Agric Food Chem. Oct 22 2008;56(20):9391-9398.

  6. Fink RC, Roschek B, Jr., Alberte RS. HIV type-1 entry inhibitors with a new mode of action. Antivir Chem Chemother. 2009;19(6):243-255.

  7. Bell DR, Gochenaur K. Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. J Appl Physiol. Apr 2006;100(4):1164-1170.

  8. Zakay-Rones Z, Thom E, Wollan T, et al. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res. Mar-Apr 2004;32(2):132-140.

  9. U.S. Food and Drug Administration. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm257781.htm…Google257782&utm_source=fdaSearch&utm_medium=website&utm_term=elderberry&utm_content=257781.

  10. Dellagreca M, Fiorentino A, Monaco P, et al. Synthesis of degraded cyanogenic glycosides from Sambucus nigra. Nat Prod Res. Jun 2003;17(3):177-181.

  11. Barros L, Duenas M, Carvalho AM, et al. Characterization of phenolic compounds in flowers of wild medicinal plants from Northeastern Portugal. Food Chem Toxicol. May 2012;50(5):1576-1582.

  12. Schmitzer V, Veberic R, Slatnar A, et al. Elderberry (Sambucus nigra L.) wine: a product rich in health promoting compounds. J Agric Food Chem. Sep 22 2010;58(18):10143-10146.

  13. Barak V, Birkenfeld S, Halperin T, et al. The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines. Isr Med Assoc J. Nov 2002;4(11 Suppl):919-922.

  14. Harokopakis E, Albzreh MH, Haase EM, et al. Inhibition of proinflammatory activities of major periodontal pathogens by aqueous extracts from elder flower (Sambucus nigra). J Periodontol. Feb 2006;77(2):271-279.

  15. Frank T, Janssen M, Netzet G, et al. Absorption and excretion of elderberry (Sambucus nigra L.) anthocyanins in healthy humans. Methods Find Exp Clin Pharmacol. Oct 2007;29(8):525-533.

  16. Frank T, Sonntag S, Strass G, et al. Urinary pharmacokinetics of cyanidin glycosides in healthy young men following consumption of elderberry juice. Int J Clin Pharmacol Res. 2005;25(2):47-56.

  17. Centers for Disease Control and Prevention. Poisoning from elderberry juice—California. MMWR Morb Mortal Wkly Rep. Apr 6 1984;33(13):173-174.

  18. Tsui B, Dennehy CE, Tsourounis C. A survey of dietary supplement use during pregnancy at an academic medical center. Am J Obstet Gynecol. Aug 2001;185(2):433-437.

  19. Chen JK, Chen TT.

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