Medically reviewed by Drugs.com. Last updated on Aug 4, 2020.
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
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.
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 have not been identified.
Information regarding safety and efficacy in pregnancy and lactation is lacking.
None well documented.
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.
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.
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
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
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
Uses and Pharmacology
Induction of quinine reductase and cyclo-oxygenase-2 has been suggested to be responsible for anticancer effects in vitro.Thole 2006
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
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
Research reveals no animal data regarding the use of elderberry extracts for antiviral effects.
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
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
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
A 2014 systematic review identified grade C level evidence (unclear or conflicting) on the use of elderberry and elderflower for gingivitis.Ulbricht 2014
The compound sambuculin A and a mixture of alpha- and beta-amyrin palmitate demonstrated hepatoprotective properties against carbon tetrachloride-induced liver damage.Lin 1988
Research reveals no animal data regarding the use of elderberry extracts for lipid-lowering effects.
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
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
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
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.
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
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. 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
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
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