Plant Description

European elder is a large shrub or small tree that grows up to 30 feet tall in wet or dry soil in a sunny location. Elder is native to Europe, Africa, and parts of Asia, but it has become widespread in the United States. Deciduous leaves grow in opposite pairs and have 5 to 7 leaflets. Flowers are white and flat topped with 5 primary rays. Berries are green, turning red, then black when ripe.

Parts Used

The berries and flowers are used as medicine. Berries must be cooked before they are taken. Raw berries contain a chemical similar to cyanide.

Medicinal Uses and Indications

Colds and Flu

Elderberry may help treat cold and flu symptoms by reducing congestion and possibly making you sweat more. One study suggested that using a standardized elderberry extract, Sambucol, could shorten the duration of flu by about 3 days. Sambucol contains other herbs plus vitamin C, so no one knows whether elderberry by itself would have the same effect.

Another preliminary study found that a lozenge with elderberry extract (ViraBLOC) helped reduce flu symptoms when taken within 24 hours of symptoms starting. In the lab, one study suggested that elderberry could kill the H1N1 virus ("swine flu") in test tubes, but researchers do not know whether it would be effective against H1N1 in people.

Bacterial Sinusitis (Sinus Infection)

One study examined the use of a proprietary product, Sinupret, to treat bacterial sinusitis along with an antibiotic (doxycycline or vibramycin) and a decongestant. People who took the combination did better compared to those who did not take Sinupret. However, Sinupret contains other herbs along with elderberry, so no one knows whether taking elderberry alone would work as well.

Available Forms

Elderberry is available as a liquid, syrup, and tincture, as well as in capsule and lozenge forms. Dried elder flower is usually standardized to at least 0.8% flavonoids. Sambucol is standardized to 38% elderberry extract for adults and 19% for children. Sinupret contains 18 mg of elder flower.

How to Take It

Pediatric

DO NOT give elderberry or any product containing elder to a child without first talking to your pediatrician.

Adult

• Sinupret: 2 tablets taken 3 times a day for bacterial sinusitis
• Sambucol: 4 tbsp. a day for 3 days for colds and flu
• Tea: Steep 3 to 5 g dried elder flower in 1 cup boiling water for 10 to 15 minutes. Strain and drink 3 times per day.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a health care provider.

DO NOT use unripe or uncooked elderberries. They may be poisonous.

Elderberry appears to have few side effects when used properly for short periods of time (up to 5 days).

Pregnant and breastfeeding women should not take elderberry.

If you have an autoimmune disease, such as rheumatoid arthritis or lupus, ask your doctor before taking elderberry, as it may stimulate the immune system.

Possible Interactions

If you are being treated with any of the following medications, you should talk to your health care provider before taking elderberry:

Diuretics (water pills). Diuretics help the body get rid of excess fluid and increase the amount of urine your body makes. Elderberry may also act as a diuretic, so taking it along with a diuretic could make that drug stronger and raise your risk of dehydration. Diuretics include:

• Hydrochlorothiazide
• Bumetanide (Burinex)
• Furosemide (Lasix)
• Amiloride (Midamor)
• Metolazone (Zaroxolyn)

Diabetes medications. Elderberry may lower blood sugar levels. If you are also taking drugs for diabetes, taking elderberry may increase your risk of developing hypoglycemia, or low blood sugar.

Chemotherapy. Elderberry may interact with some chemotherapy drugs. If you are undergoing chemotherapy, ask your oncologist before taking any herb or supplement.

Laxatives. Elderberry may act like a laxative and should not be taken at the same time as other laxatives.

Theophylline (TheoDur). Elderberry may reduce levels of theophylline, a drug taken for asthma and other respiratory conditions. That could make the drug not work as well.

Drugs that suppress the immune system. Because elderberry may stimulate the immune system, it could interfere with medications taken to suppress the immune system. These medications include corticosteroids (prednisone) and medications used to treat autoimmune diseases. People with organ transplants should also avoid elderberry.

Supporting Research

Gray AM, Abdel-Wahab YH, Flatt PR. The traditional plant treatment, Sambucus nigra (elder), exhibits insulin-like and insulin-releasing actions in vitro. J Nutr. 2000;130(1):15-20.

Kong F. Pilot clinical study on a proprietary elderberry extract: efficacy in addressing influenza symptoms. Online Journal of Pharmacology and Pharmacokinetics. 2009;5:32-43.

Mikulic-Petkovsek M, Slatnar A, Stampar F, Veberic R. HPLC-MSn identification and quantification of flavanol glycosides in 28 wild and cultivated berry species. Food Chem. 2012;135(4):2138-46.

Rakel: Integrative Medicine. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012.

Roschek B, Fink RC, McMichael MD, et al. Elderberry flavonoids bind to and prevent H1N1 infection in vitro. Phytochemistry. 2009;70:1255-61.

Roxas M, Jurenka J. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Altern Med Rev. 2007 Mar;12(1):25-48. Review.

Swaminathan K, Dyason JC, Maggioni A, von Itzstein M, Downard KM. Binding of a natural anthocyanin inhibitor to influenza neuraminidase by mass spectrometry. Anal Bioanal Chem. 2013;405(20):6563-72.

Ulbricht C, Basch E, Cheung L, et al. An evidence-based systematic review of elderberry and elderflower(Sambucus nigra) by the Natural Standard Research Collaboration. J Diet Suppl. 2014;11(1):80-120.

Uncini Manganelli RE, Zaccaro L, Tomei PE. Antiviral activity in vitro of Urtica dioica L., Parietaria diffusa M. et K. and Sambucus nigra L. J Ethnopharmacol. 2005 Apr 26;98(3):323-7.

Vlachojannis JE, Cameron M, Chrubasik S. A systematic review on the sambuci fructus effect and efficacy profiles. Phytother Res. 2010 Jan;24(1):1-8. Review.

Vlachojannis C, Zimmermann BF, Chrubasik-Hausmann S. Quantification of anthocyanins in elderberry and chokeberry dietary supplements. Phytother Res. 2015;29(4):561-5.

Wright CI, Van-Buren L, Kroner CI, Koning MM. Herbal medicines as diuretics: A review of the scientific evidence. J Ethnopharmacol. 2007 Oct 8;114(1):1-31.

Zakay-Rones Z, Thom E, Wollan T, Wadstein J. 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. 2004;32:132-40.