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Elderberry

Scientific Name(s): Sambucus ssp canadensis, Sambucus nigra L.
Common Name(s): American elder (Sambucus canadensis), Common elder, Elderberry, European elder (Sambucus nigra), Sambucol, Sambucus, Sweet elder

Medically reviewed by Drugs.com. Last updated on Dec 19, 2022.

Clinical Overview

Use

Limited clinical trials have been conducted. Elderberry extracts may have some value in the treatment of influenza and duration of cold symptoms, and appear to have antioxidant potential.

Dosing

The bioavailability of active constituents in elderberry extracts is considered to be poor. Dosing information is based on limited evidence from clinical trials. For the treatment of influenza, 15 mL of syrup taken 4 times per day for 5 days has been used in clinical trials. Air travel respiratory health: initially 600 mg/day starting 10 days before travel followed by 900 mg/day starting the day before travel and continued for 4 or 5 days postflight.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Consumption of uncooked berries, leaves, and stems may result in cyanide toxicity, including vomiting and diarrhea. Commercial preparations generally do not cause adverse reactions at the recommended dosage. Type 1 allergy to elderberry (positive skin prick tests) has been recorded.

Toxicology

Poisonous alkaloids, lectins, and cyanogenic glycosides are present in some plant parts. Short-term use of elderberry extract preparations appears to be relatively safe; however, long-term toxicological studies are lacking.

Scientific Family

Botany

The American elder is a tall shrub that grows to 4 m, and is native to North America. The European elder grows to approximately 10 m and has been naturalized to the United States. The tree has light brown/grey bark and narrow, dark green leaves. Clusters of white-cream flowers have a particular fragrance and develop into dark purple-black berries.PLANTS 2011, Wright 2011

History

Elder flowers and berries have been used in traditional medicine and as a flavoring for centuries. In folk medicine, the flowers have been used for their diuretic and laxative properties and as an astringent. Various parts of the elder have been used to treat cancer and many other unrelated disorders. Distilled elder flower water has been used as a scented vehicle for topical preparations, and extracts are used to flavor foods as well as alcoholic beverages. The fruits have been used to make elderberry wine.Duke 1985

Chemistry

European elder flowers contain approximately 0.3% of an essential oil composed of free fatty acids and alkanes. The triterpenes alpha- and beta-amyrin, ursolic acid, oleanic acid, betulin, betulic acid, and a variety of other minor components have been identified.Inoue 1975 The elder leaf contains sambunigrin, a cyanogenic glucoside (0.042% by weight).Leung 1980 Leaves of S. nigra express 2 classes of thaumatin-like proteins. The fruit-specific, thaumatin-like proteins accumulate only during the final stages of fruit ripening.Van Damme 2002

The fruit of the elderberry contains phenolics, including quercetin, kaempferol, rutin, and phenolic acids and anthocyanins. High-performance liquid chromatography and mass spectrometry have been used to identify individual anthocyanins, which give the berry its color, and include cyanidin 3-sambubioside-5-diglucoside, cyanidin-3,5-diglucoside, cyanidin 3-sambubioside, and cyanidin 3-glucoside.Mach 1991, Schmitzer 2010 The total anthocyanin content varies during the growing season and by cultivar. Vitamins A and C are also present, and antioxidant capacity of the berry has been estimated to be similar to that of black raspberries, blackberries, and other dark-fleshed small fruit.Ozgen 2010, Lee 2007

The Sambucus species has been studied for its lectin composition, which has hemagglutinin characteristics useful in blood typing.Mach 1991, Kaku 1990

Uses and Pharmacology

Anticancer

Induction of quinine reductase and cyclo-oxygenase-2 has been suggested to be responsible for anticancer effects in vitro.(Thole 2006)

Anti-inflammatory

Effects on anti-inflammatory markers including increased cytokine production have been demonstrated in vitro.(Curtis 2009, Barak 2002)

Antioxidant

Antioxidant activity of elderberry extracts has been evaluated and is estimated to be similar to that of black raspberries, blackberries, and other dark-fleshed small fruit.(Ozgen 2010, Lee 2007, Ciocoiu 2009, Murkovic 2004, Roy 2002, Nalliah 2009)

Antiviral effects

In vitro studies have shown that elderberry extracts exert activity against the influenza virus A (including H1N1) and B and the herpes simplex virus. Laboratory studies also suggest an inhibitory effect on the infectivity of the HIV virus.(Zakay-Rones 2004, Krawitz 2011, Roschek 2009, Guo 2007, Vlachojannis 2010)

Animal data

A systematic review reported on an exploratory study conducted in chimpanzees that supported antiviral activity of an elderberry fruit supplement (Sambucol) given prophylactically and therapeutically for the flu.(Vlachojannis 2010)

Clinical data

Although in vitro data are promising, few clinical trials have been conducted examining the efficacy of elderberry extracts for the treatment of influenza.(Guo 2007, Vlachojannis 2010) When used within the first 48 hours of onset of symptoms, elderberry extracts reduced the duration of influenza versus placebo.(Zakay-Rones 2004, Zakay-Rones 1995) Anecdotal reports exist for elderberry use in HIV.(Vlachojannis 2010) A 2014 systematic review identified grade B level evidence (good scientific evidence) on the use of elderberry and elderflower for influenza.(Ulbricht 2014)

Diabetes

Animal data

A stimulatory effect on insulin secretion by the polyphenolic content of elderberry fruit has been shown in diabetic rats.(Ciocoiu 2009) In vitro studies using rat abdominal muscle showed increased insulin secretion in response to flower extracts.(Gray 2000, Christensen 2010)

Clinical data

Although traditionally used for diabetes, clinical trials are lacking. Elderberry has been evaluated in combination with asparagus for weight reduction.(Chrubasik 2008, Hasani-Ranjbar 2009) A 2014 systematic review identified grade C level evidence (unclear or conflicting) on the use of elderberry and elderflower for obesity.(Ulbricht 2014)

Diuretic/Laxative

Elder flowers are considered to have diuretic and laxative properties; however, the specific compounds responsible for these activities have not been well established.(Wright 2007, Picon 2010)

Gingivitis

A 2014 systematic review identified grade C level evidence (unclear or conflicting) on the use of elderberry and elderflower for gingivitis.(Ulbricht 2014)

Hepatoprotective

The compound sambuculin A and a mixture of alpha- and beta-amyrin palmitate demonstrated hepatoprotective properties against carbon tetrachloride-induced liver damage.(Lin 1988)

Hyperlipidemia

Animal data

Research reveals no animal data regarding the use of elderberry extracts for lipid-lowering effects.

Clinical data

In a placebo-controlled study among healthy volunteers, there was only a small and statistically insignificant change in cholesterol in the elderberry-treated group compared with placebo. The dosage used in the study may have been too low (anthocyanin 10%).(Murkovic 2004) No change in cardiovascular disease risk factors or fatty acid profiles was found in healthy postmenopausal female volunteers consuming 500 mg of anthocyanins daily for 12 weeks in another study.(Curtis 2009, Vazour 2015) A 2014 systematic review identified grade C level evidence (unclear or conflicting) on the use of elderberry and elderflower for hyperlipidemia and cardiovascular disease risk.(Ulbricht 2014)

Respiratory infections

Cinical data

A proprietary elderberry extract standardized to polyphenols (BerryPharma) was investigated in a double-blind, randomized, placebo-controlled trial for its effect on overall physical, especially respiratory, and mental health of economy travelers on long-haul commercial flights from Australia to an overseas destination. Flights were a minimum of 7 hours with less than a 12-hour layover and a minimum of a 4-day stay at the destination. Surveys were completed at baseline (−10 days), 2 days prior to travel, and 4 or 5 days post-flight. Treatment was initiated 10 days before travel at 600 mg/day followed by 900 mg/day the day before travel and continued 4 or 5 days after arriving at the final destination; duration of treatment ranged from 15 to 16 days. Although no significant difference was found between groups for incidence of cold episodes, the duration of symptoms (117 vs 57 days) between placebo and elderberry was significantly lower with elderberry (P=0.02) as was the symptom score (583 vs 247, respectively, P=0.05). On average, this would result in a 2-day shorter duration of cold symptoms as well as lower symptom severity. Physical health during travel time declined significantly with placebo (P=0.005) and was stable with elderberry. No significant difference was found between groups in symptom survey scores, quality of life, or physical health over the study duration. Mental health improved significantly in both groups over the travel period. Treatment was well tolerated. BerryPharma has previously demonstrated antimicrobial activity against human respiratory bacterial pathogens (ie, Streptococcus pyogenes, group C and G Streptococci, Branhamella catarrhalis) and has been shown to inhibit influenza viruses.(Tiralongo 2016) A 2014 systematic review identified grade C level evidence (unclear or conflicting) on the use of elderberry and elderflower for bacterial sinusitis and bronchitis.(Ulbricht 2014) However, a 2019 meta-analysis of 4 studies (N=108) identified a significant reduction in duration of upper respiratory symptoms due to influenza or the common cold in participants aged 5 to 59 years who consumed elderberry compared to placebo.(Hawkins 2019)

Based on data from 4,521 healthy participants enrolled in 20 randomized controlled trials (including 1 study with elderberry), meta-analyses demonstrated that flavonoid-containing supplements were safe and effective in preventing acute respiratory tract infections (ARTIs) compared to controls, with a relative risk (RR) of 0.81 (95% confidence interval [CI] 0.74 to 0.89; P<0.001) and low heterogeneity. A reduction in mean ARTI sick days was also observed with the supplements; however, heterogeneity was significant (weighted mean difference [WMD], −0.56; 95% CI, −1.04 to −0.08; P=0.021). In a subgroup analysis, significance in mean ARTI sick days was retained with flavonoid mixtures (as seen with elderberry products) but not with use of single flavonoids (ie, quercetin, catechin). Pooled results from 16 of the trials indicated that adverse reactions were not increased in the flavonoid supplement groups compared to controls.(Yao 2022)

Dosing

The bioavailability of active constituents in elderberry extracts is considered to be poor.Vlachojannis 2010, Frank 2007, Bitsch 2004 Anthocyanin-rich foods may increase the effects of elder, whereas consuming elder with sugar has been shown to reduce excretion of anthocyanins found in elder.Ulbricht 2014

Dried elderflower is often standardized to at least 0.8% total flavonoids (as isoquercitrin). (Ulbricht, 2014) Fruit syrups are commonly standardized to 30% to 38% elderberry extract. Powdered extracts are available as capsules and in liquid form.

Doses of 500 mg of anthocyanins per day were taken for 12 weeks in healthy volunteers, with no effect on cardiovascular disease biomarkers.Curtis 2009

Influenza

15 mL of syrup taken 4 times per day for 5 days has been used in clinical trials.Zakay-Rones 2004

Air travel health

600 mg/day BerryPharma (elderberry extract standardized to polyphenols) taken orally starting 10 days before long-haul travel (longer than 7 hours) followed by 900 mg/day starting the day before travel and continued for 4 or 5 days postflight reduced duration and severity of upper respiratory symptoms in economy travelers on overseas flights.Tiralongo 2016

Pregnancy / Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented. Elderberry may potentiate the effects of insulin, blood pressure medications, chemotherapy agents (ie, alkylating agents), and laxatives. Quercetin found in elder can inhibit xanthine oxidase and may affect theophylline and caffeine metabolism.Ulbricht 2014

Adverse Reactions

Consumption of uncooked berries, leaves, and stems may result in vomiting, diarrhea, abdominal cramps, and weakness. Some data from human studies indicate the potential for anorexia or reduced body mass as well as dysmenorrhea; use cautiously in underweight patients or those with eating disorders and menstruating females, respectively. Human studies have also indicated the potential for hypokalemia, headache, and backaches.Ulbricht 2014 Commercial preparations are generally considered relatively free from adverse effects at the recommended dosage. However, a case report of acute pancreatitis after consumption of a homeopathic elderberry extract (Sambucol) has been reported.Weissman 2019 No adverse events were reported in a clinical trial evaluating the efficacy of elderberry extract in the treatment of influenzaZakay-Rones 2004 or in healthy volunteers consuming elderberry extract standardized to 500 mg of anthocyanins per day for 12 weeks.Curtis 2009 Application site reactions have been reported with the use of topical application (patches) for dermatological conditions.Ulbricht 2014

Type 1 allergy to elderberry (positive skin prick tests) has been recorded.Vlachojannis 2010

Elderberry side effects (more detail)

Toxicology

Poisonous alkaloids, lectins, and cyanogenic glycosides are present in some plant parts. While elderberries are safe to consume, particularly when cooked, leaves and stems should not be crushed when making elderberry juice. Uncooked berries may produce nausea. A report of severe illness (nausea, vomiting, weakness, dizziness, numbness, and stupor) following the ingestion of juice prepared from elderberries exists.Vlachojannis 2010, CDC 1984

Toxicity in children who used peashooters made from elderberry stems has been reported.Duke 1985

No effects were recorded on kidney and liver function markers in healthy volunteers consuming elderberry extract standardized to 500 mg of anthocyanins per day for 12 weeks.Curtis 2009 Long-term toxicological studies are lacking.Vlachojannis 2010

References

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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