Purported Benefits, Side Effects & More


Purported Benefits, Side Effects & More

Common Names

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

For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.

What is it?

Elderberry is the dark purple berry that comes from the European or black elder tree. Elderberry has many nutrients. It’s used to make jams, syrups, and wine. Both elderberry flowers and fruits are used to help reduce cold and flu symptoms. 

You can also take elderberry supplements as gummies, tablets, or syrup.

What are the potential uses and benefits?

Elderberry is used to:

  • Prevent and treat symptoms of cold and flu
  • Boost the immune system
  • Reduce inflammation (swelling)
  • Lower cholesterol
  • Relieve constipation (having fewer bowel movements than usual)

Elderberry also has other uses that haven’t been studied by doctors to see if they work.

It’s generally safe to use elderberry in food and tea. But talk with your healthcare providers before taking elderberry supplements.

Herbal supplements are stronger than the herbs you would use in cooking. They can also interact with some medications and affect how they work. For more information, read the “What else do I need to know?” section below.

What are the side effects?

Side effects of using raw elderberries can include:

  • Nausea (feeling like you’re going to throw up)
  • Vomiting (throwing up)
  • Dizziness (feeling faint, woozy, weak or unsteady)
  • Numbness (loss of feeling or sensation in a part of your body)
What else do I need to know?
  • Raw or unripe elderberries have chemicals that can be harmful. It’s important to cook them well before eating. 
  • Don’t eat elderberry leaves and stems. They may have harmful chemicals.
  • Talk to your healthcare provider if you’re taking laxatives (medications to help you have a bowel movement). Elderberry can increase their effects.

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 to relieve constipation (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 AIDS 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) and in reducing episodes of tonsillitis in children (33). It may also help reduce symptoms of influenza (14) (28) (34) (35), but larger studies are needed to confirm these findings (32) (39).

Unsubstantiated claims that elderberry prevents or treats various diseases including AIDS, diabetes, flu (15) and COVID-19 (36) (37) have been halted by the FDA. This is particularly important as patients may forego or avoid legitimate treatments.

Purported Uses and Benefits
  • Cold and flu symptoms
  • Immunostimulation
  • Inflammation
  • High cholesterol
  • Constipation
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).

  • 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).
Adverse Reactions

Infrequent: Type 1 allergy (25), gastrointestinal (GI) distress (23).

Case Reports:

  • 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).
  • Acute pancreatitis: In a 51-year-old man following use of black elderberry. His symptoms resolved after treatment with steroids (38).
  • Autoimmune hepatitis: In a 60-year-old woman with a history of Hashimoto thyroiditis and Medullary sponge kidneys, with long-term use of supplements containing elderberry. Her liver function tests normalized after stopping supplements and administering immuno-suppressive therapy (40).
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).

Dosage (OneMSK Only)
  1. Scopel M, Mentz LA, Henriques AT. Comparative analysis of Sambucus nigra and Sambucus australis flowers: development and validation of an HPLC method for raw material quantification and preliminary stability study. Planta Med. Jul 2010;76(10):1026-1031.
  2. 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.
  3. Krawitz C, Mraheil MA, Stein M, et al. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complement Altern Med. 2011;11:16.
  4. Picon PD, Picon RV, Costa AF, et al. Randomized clinical trial of a phytotherapic compound containing Pimpinella anisum, Foeniculum vulgare, Sambucus nigra, and Cassia augustifolia for chronic constipation. BMC Complement Altern Med. 2010;10:17.
  5. 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.
  6. Christensen KB, Petersen RK, Kristiansen K, et al. Identification of bioactive compounds from flowers of black elder (Sambucus nigra L.) that activate the human peroxisome proliferator-activated receptor (PPAR) gamma. Phytother Res. Jun 2010;24 Suppl 2:S129-132.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. Bell DR, Gochenaur K. Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. J Appl Physiol. Apr 2006;100(4):1164-1170.
  12. Curtis PJ, Kroon PA, Hollands WJ, et al. Cardiovascular disease risk biomarkers and liver and kidney function are not altered in postmenopausal women after ingesting an elderberry extract rich in anthocyanins for 12 weeks. J Nutr. Dec 2009;139(12):2266-2271.
  13. Murkovic M, Abuja PM, Bergmann AR, et al. Effects of elderberry juice on fasting and postprandial serum lipids and low-density lipoprotein oxidation in healthy volunteers: a randomized, double-blind, placebo-controlled study. Eur J Clin Nutr. Feb 2004;58(2):244-249.
  14. 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.
  15. U.S. Food and Drug Administration. FDA seizes elderberry juice concentrate at Kansas company. September 2, 2011. Accessed April 8, 2020.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. Centers for Disease Control and Prevention. Poisoning from elderberry juice—California. MMWR Morb Mortal Wkly Rep. Apr 6 1984;33(13):173-174.
  24. 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.
  25. Forster-Waldl E, Marchetti M, Scholl I, et al. Type I allergy to elderberry (Sambucus nigra) is elicited by a 33.2 kDa allergen with significant homology to ribosomal inactivating proteins. Clin Exp Allergy. Dec 2003;33(12):1703-1710.
  26. Beaux D, Fleurentin J, Mortier F. Effect of extracts of Orthosiphon stamineus Benth, Hieracium pilosella L., Sambucus nigra L. and Arctostaphylos uva-ursi (L.) Spreng. in rats. Phytother Res. May 1999;13(3):222-225.
  27. Schroder-Aasen T, Molden G, Nilsen OG. In vitro Inhibition of CYP3A4 by the Multiherbal Commercial Product Sambucus Force and its Main Constituents Echinacea purpurea and Sambucus nigra. Phytother Res. Feb 8 2012.
  28. Zakay-Rones Z, Varsano N, Zlotnik M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med. Winter 1995;1(4):361-369.
  29. Chen JK, Chen TT. Chinese Medical Herbology and Pharmacology. California: Art of Medicine Press; 2004.
  30. 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.
  31. 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.
  32. The Medical Letter on Drugs and Therapeutics. Elderberry for influenza. Med Lett Drugs Ther. 2019 Feb 25;61(1566):32.
  33. Di Stadio A, Della Volpe A, et al. Difensil Immuno Reduces Recurrence and Severity of Tonsillitis in Children: A Randomized Controlled Trial. Nutrients. 2020 Jun 2;12(6):1637.
  34. Hawkins J, Baker C, Cherry L, Dunne E. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complement Ther Med. 2019 Feb;42:361-365.
  35. Harnett J, Oakes K, Carè J, et al. The effects of Sambucus nigra berry on acute respiratory viral infections: A rapid review of clinical studies.  Adv Integr Med. 2020 Dec;7(4):240-246.
  36. U.S. Food and Drug Administration. Warning Letter. May 7, 2020. Last accessed March 27, 2023.
  37. U.S. Food and Drug Administration. Warning Letter. October 23, 2020. Last accessed March 27, 2023.
  38. Weissman S, Lo A, Patel R, et al. An Unusual Culprit of Drug-Induced Pancreatitis. Dig Dis Sci. 2020 May;65(5):1549-1552.
  39. Wieland LS, Piechotta V, Feinberg T, et al. Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC Complement Med Ther. 2021 Apr 7;21(1):112.
  40. Ramachandran A, Antala D, Pudasainee P, Panginikkod S, Gupta H. A Plausible Association Between the Use of Elderberry and Autoimmune Hepatitis. Cureus. 2022 Apr 18;14(4):e24250.
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