Elderberry

Share
Print
Share
Print
Elderberry

Common Names

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

For Patients & Caregivers

How It Works

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

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.

Purported Uses
  • 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
    Small studies have shown that elderberry may reduce flu symptoms.
  • To treat constipation
    A small randomized trial of a compound that contains elderberry found it to be an effective laxative for the treatment of constipation.
  • 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 effect.
  • 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.
Patient Warnings

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.

Do Not Take If
  • You are taking antidiabetic medications, as elderberry may increase their effects. Clinical relevance is not known.
  • You are taking diuretic medications, as elderberry can increase their effects. Clinical relevance is not known.
  • You are taking laxative medications, as elderberry may increase their effects.
  • You are pregnant or lactating, due to risk of toxicity and potential gastrointestinal (GI) distress.
Side Effects
  • 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.
Back to top

For Healthcare Professionals

Brand Name
Sambucol®, Sambu®, Sambu® Guard, SambuActin™, Eldertussin™, Theramax®, Zumka™
Scientific Name
Sambucus nigra
Clinical Summary

Elderberry belongs to 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). 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, it did not demonstrate vasoprotective effects (11), and randomized trials found it ineffective in improving cardiovascular disease biomarkers (12) or for improving cholesterol levels (13). Small studies found elderberry to be safe and effective in a preparation for chronic constipation (4); it may also help reduce influenza symptoms (14) (32), but larger studies are needed and its safety remains unclear (33).

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.

Purported Uses
  • Cancer
  • Circulatory disorders
  • Cold and flu symptoms
  • Constipation
  • Promote urination
  • HIV/AIDS
  • Inmmunestimulation
  • Inflammation
  • Respiratory infections
Mechanism of Action

Elderberry inhibits H1N1 activities by binding to H1N1 virions as well as by 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). An elderberry extract improved metabolic disturbances in a murine model of obesity by lowering serum triglycerides, inflammatory markers and insulin resistance (30). Its antidiabetic properties occur via activation of peroxisome proliferator-activated receptor gamma and stimulation of insulin-dependent glucose uptake (6). Elderberry may also influence HDL dysfunction associated with chronic inflammation by affecting hepatic gene expression in hyperlipidemic mice (31). Another study indicates its chemopreventive potential is related to induction of quinone reductase as well as cyclooxygenase-2 and ornithine decarboxylase inhibition (2).

Warnings
  • 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)
Contraindications
  • Avoid use during pregnancy or if lactating due to risk of toxicity and potential GI distress (24).
Adverse Reactions

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).

Herb-Drug Interactions

Antidiabetic drugs: Elderberry has hypoglycemic activity and may have additive effects with antidiabetic drugs (6). Clinical relevance has yet to be determined.
Diuretics: Elderberry promotes urination and may have additive effects with diuretics (26). Clinical relevance has yet to be determined.
Laxatives: Elderberry was reported to have laxative effects in clinical studies, and can therefore, 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 (27). Clinical relevance has yet to be determined.

Dosage (OneMSK Only)
References
  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. FDA seizes elderberry juice concentrate at Kansas company. September 2, 2011. Accessed April 8, 2020.

  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. Farrell NJ, Norris GH, Ryan J, Porter CM, Jiang C, Blesso CN. Black elderberry extract attenuates inflammation and metabolic dysfunction in diet-induced obese mice. Br J Nutr. 2015 Oct 28;114(8):1123-31.

  20. Farrell N, Norris G, Lee SG, Chun OK, Blesso CN. Anthocyanin-rich black elderberry extract improves markers of HDL function and reduces aortic cholesterol in hyperlipidemic mice. Food Funct. 2015 Apr;6(4):1278-87.

  21. The Medical Letter on Drugs and Therapeutics. Elderberry for influenza. Med Lett Drugs Ther. 2019 Feb 25;61(1566):32.

Back to top
Back to top
Email your questions and comments to aboutherbs@mskcc.org.

Last Updated