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Elderberry
The dark purple berry of the black elder tree, long used in folk medicine for colds and flu, and now sold as a supplement for colds, flu and immune support.
Explained simply · Last reviewed
What it is
Elderberry is the dark purple berry of the European or black elder tree, Sambucus nigra. NCCIH, the US agency that studies complementary medicine, says the tree grows in Europe, North America, Western Asia and North Africa. It states that elderberry has been used in folk medicine for colds and flu, and is now promoted as a dietary supplement for colds, flu and other conditions.
More about Elderberry
NCCIH, the US agency that studies complementary medicine, says the tree grows in Europe, North America, Western Asia and North Africa. It states that elderberry has been used in folk medicine for colds and flu, and is now promoted as a dietary supplement for colds, flu and other conditions.
Europe’s medicines agency, EMA, traces the traditional use of elderberry back to ancient times. Its herbal committee’s 2014 assessment lists documented uses against colds, as a laxative, to promote sweating and as a diuretic. It notes that almost every part of the elder plant was once used, as food and in folk medicine.
EMA found elderberry widely used across Europe in food supplements, but no medicine made from elderberry alone authorized or registered, according to the information available to it. In 2014 its herbal committee concluded that an EU herbal monograph on elderberry “cannot be established at present”. It found that the published trials did not meet its standard for well-established medicinal use. It also found that the records of traditional use lacked a specified strength and dosing.
A 2022 systematic review describes elderberry in supplements marketed for immune health as typically an extract or juice concentrate of the whole fruit, with labels such as “cold and flu relief” and “year-round immune support”. A 2021 systematic review notes that the flowers of the elder plant, known as elderflower, also have a history of use for colds. This page covers the berry.
The ratings below cover flu, colds, catching a cold, COVID-19 and immune support.
Also known as: black elderberry, European elder, common elder, Sambucus nigra
At a glance
Safety: known risks, 4 groups who should avoid it or take extra care and 1 documented interaction. See Safety ↓Claims made about Elderberry, and how strong the evidence is for each:
- Taken once flu symptoms start, makes influenza shorter or milderEvidence rating: Limited
- Makes colds shorter or milderEvidence rating: Limited
- Taken regularly, lowers the chance of catching a coldEvidence rating: Limited
- Helps prevent or treat COVID-19Evidence rating: Insufficient
- Boosts or supports the immune systemEvidence rating: Insufficient
Each rating follows our published rules and the sources cited for it. We don’t add our own medical judgment. How we rate
Safety
Read this before the ratings below.
Risks
- NCCIH, the US agency that studies complementary medicine, states: “Raw or unripe elderberries and other parts of the elder tree, such as the leaves and stem, contain poisonous cyanide-producing substances that can cause nausea, vomiting, and severe diarrhea; cooking eliminates this toxin. Large quantities of the toxin may cause serious illness.”
- Europe’s medicines agency, EMA, in its herbal committee’s 2014 assessment of elderberry, states that plant parts other than the flowers and ripe berries are reported to be poisonous and should not be eaten or be present in elderberry preparations. It recommends heat treatment of the fruit or juice, which reduces the small amount of hydrogen cyanide that can be released from the seeds, and states: “The fruits are safe to consume when ripe, cooked or dried.”
- The same EMA assessment describes a 1984 report from the US Centers for Disease Control. People at a picnic fell ill after drinking juice made from raw elderberries crushed together with their leaves and branches, with nausea, vomiting, weakness, dizziness, numbness and stupor. One person was hospitalized, and all recovered. EMA attributes the poisoning to substances in the leaves, bark and buds that were crushed with the fruit.
- A 2021 systematic review found no serious adverse events reported in any elderberry trial. It adds that the trials paid limited attention to adverse events, so the reviewers are very uncertain about the types and rates of more minor ones. They conclude that elderberry “may be a safe option for treating viral respiratory illness”, but that “the evidence on both benefits and harms is uncertain”.
- The 2021 review also looked for evidence that elderberry could overstimulate the immune system, a concern raised during COVID-19. It found no studies of clinical outcomes such as sepsis or organ failure. Three small studies measured immune signaling proteins (cytokines) in the blood after people took elderberry; one of them used tea made from a related plant, dwarf elder (Sambucus ebulus). The reviewers found some reductions in these proteins, suggesting that elderberry “likely has some effect on inflammatory markers”, though the effect looked weaker in the longer studies. On that evidence the reviewers see no current reason for concern, but say trials in people with inflammatory conditions are needed to judge its clinical significance.
Who should avoid it or take extra care
- Picking or preparing elderberries at home: NCCIH states that raw or unripe elderberries, and the leaves and stem, contain cyanide-producing substances, and that cooking eliminates this toxin. EMA’s assessment states that bark and branches should be avoided in elderberry preparations, and that the leaves and stems should not be crushed, because crushing releases hydrocyanic acid.
- Pregnancy and breastfeeding: NCCIH states that little is known about whether it is safe to use elderberry for health purposes during pregnancy or while breastfeeding. EMA’s assessment states that safety during pregnancy and lactation has not been established, and that in the absence of sufficient data, use during pregnancy and lactation is not recommended “because of potential risk of toxicity”.
- Children and teenagers: EMA’s assessment states that elderberry cannot be recommended in children and adolescents under 18 years of age “due to insufficient data on safety and efficacy”.
- People taking medicines: NCCIH advises anyone who takes any type of medicine to talk with a health care provider before using elderberry or other herbal products, because “some herbs and medicines interact in harmful ways.”
Documented interactions
- Immunosuppressants and corticosteroids: EMA’s assessment states: “Theoretically, elderberry might interfere with immunosuppressant therapy because of possible immunostimulating activity.” It notes that elderberry may stimulate the production of cytokines by human immune cells, though this “must be confirmed in studies of higher quality”, and that immune-stimulating herbal remedies may interfere with immunosuppressant drugs and corticosteroids. Source [1]
Safety sources: Source [1]Source [2]Source [3]
What the evidence says
Each claim is rated on its own evidence. Ratings follow the scale on our methodology page.
Taken once flu symptoms start, makes influenza shorter or milder Evidence rating: Limited
People take elderberry syrup at the first signs of flu hoping to feel better sooner.
Two small trials of an elderberry syrup found faster recovery from flu than with placebo, but a 2021 review rates that evidence very low certainty.
A 2021 systematic review found three placebo-controlled trials of elderberry products taken by people with flu symptoms, with 151 participants in all. Two tested the same syrup and one a lozenge. In the two syrup trials, overall recovery came nearly three days sooner with elderberry, but the two results differed widely. In the smaller trial, of 27 people, more people taking elderberry had recovered by day three and day four, an outcome the review calls cure. The lozenge trial did not report overall recovery in a way the reviewers could use.
The reviewers rate how sure they are (certainty) very low for every one of these outcomes. They cite the trials’ small size and problems in how they were run, such as incomplete outcome data. They conclude that elderberry may shorten flu, “but the evidence is uncertain”. The review lists a company sponsor for two of the three trials; the third did not report one.
The review describes an earlier 2019 review that suggested elderberry could shorten colds or flu. The 2021 reviewers say their findings do not conflict with it, but that it judged the trials’ risk of bias as low, where their own method found problems in each trial.
NCCIH, the US agency that studies complementary medicine, states: “Some preliminary research suggests that elderberry may relieve symptoms of flu, colds, or other upper respiratory infections.” Europe’s medicines agency, EMA, found in 2014 that two trials indicate “possible effectiveness” for flu, adding: “More studies are needed to confirm this effect.” It found that the trials did not meet its standard for well-established medicinal use. This page rates the claim on the review’s very low certainty.
Makes colds shorter or milder Evidence rating: Limited
People take elderberry hoping a cold will pass faster and feel less miserable.
In one trial, of the 29 people who caught a cold, those taking elderberry had shorter, milder colds, but a 2021 review rates this very low certainty.
No trial in the 2021 systematic review gave elderberry alone to people once a cold had started. Its only cold evidence comes from one prevention trial in 312 adults flying overseas, who took an elderberry extract or a placebo for about two weeks around their travel. Of the 29 people in that trial who caught a cold, those taking elderberry had colds about two days shorter, and less severe.
The reviewers rate how sure they are (certainty) very low for both results, because of the trial’s risk of bias and the imprecision of results from so few colds. They conclude that colds may be shorter and milder with elderberry, “but the evidence is uncertain”. The trial was sponsored by a company, according to the review.
A 2022 systematic review of supplements in healthy people included the same trial. It reports the trial’s finding of a two-day shorter cold and a lower symptom score, and notes that the trial publication did not report standard deviations. The two reviews judge the trial differently: the 2022 review rates it high quality, while the 2021 review rates it at high risk of bias for incomplete outcome data and selective reporting.
NCCIH, the US agency that studies complementary medicine, states that some preliminary research suggests elderberry may relieve symptoms of flu, colds or other upper respiratory infections. This page rates the claim on the review’s very low certainty.
Sources: Source [1]Source [2]Source [3]
Taken regularly, lowers the chance of catching a cold Evidence rating: Limited
People take elderberry through the winter, or before a trip, hoping to stay clear of colds.
One trial found no clear difference in how many people caught a cold, and a 2021 review rates that evidence low certainty.
A 2021 systematic review found one trial of elderberry taken to prevent colds. In it, 312 adults flying overseas took an elderberry extract or a placebo for about two weeks around their travel. A well-defined cold developed in 12 of 154 people taking elderberry and 17 of 158 taking placebo. The difference was not statistically significant.
The reviewers rate how sure they are (certainty) low, because of the trial’s risk of bias and the wide range of possible results. They write that elderberry “may not reduce the risk of developing the common cold”. In their discussion they add: “there is insufficient information to be certain about these effects.” The trial was sponsored by a company, according to the review.
A 2022 systematic review of supplements in healthy people included the same trial and also found no statistically significant difference in the number of people who caught a cold. It rates the trial high quality, where the 2021 review rates it at high risk of bias for incomplete outcome data and selective reporting. It points to a lack of studies on taking elderberry to prevent illness.
The trial recorded 29 colds in all, 12 and 17 in the two groups. That is too little evidence to show an effect, not evidence that there is none. This page rates the claim on the 2021 review’s low certainty.
Sources: Source [1]Source [2]
Helps prevent or treat COVID-19 Evidence rating: Insufficient
People turned to elderberry during the pandemic hoping it would protect them from COVID-19.
NCCIH states there is no good evidence to support elderberry for COVID-19, and insufficient evidence to know if it can help with symptoms.
NCCIH, the US agency that studies complementary medicine, states that elderberry “has also been promoted for COVID-19, but there is no good evidence to support its use.” It adds: “Don’t rely on elderberry for prevention or treatment of COVID-19. There is insufficient evidence to know if it can help with symptoms.”
NCCIH also states that the US Food and Drug Administration and Federal Trade Commission have taken action against companies that marketed elderberry products with unsubstantiated claims of effectiveness for COVID-19. This page rates the claim insufficient on the NCCIH statement.
Sources: Source [1]
Boosts or supports the immune system Evidence rating: Insufficient
People take elderberry every day hoping to give their immune system a lift.
EMA found not enough evidence to suggest an effect on the immune system, and a 2022 review found only one elderberry trial in healthy people.
Europe’s medicines agency, EMA, reviewed the laboratory and animal research on elderberry in 2014. In laboratory tests, elderberry extracts increased the production of inflammatory signaling proteins by human immune cells. EMA concludes: “There is not enough evidence to suggest an immune-modulatory effect of elderberry extract.”
A 2022 systematic review looked at supplements sold for immune health, and whether they help healthy people stay well under stress. It notes that elderberry products are often labeled with claims such as “year-round immune support”. It found one elderberry trial that met its criteria, the air-travel cold trial described above. Across all the ingredients it reviewed, the authors write that specific gaps “preclude the authors from making firm statements” about the evidence.
This page’s safety section reports what a 2021 review found when it looked at immune signaling proteins in people who took elderberry.
This page rates the claim insufficient on the EMA statement.
Sources: Source [1]Source [2]
Which form the evidence used
Supplements are sold in several forms. This is what the sources on this page say about them — which form the research used, and any comparison those sources themselves made. Where they made none, this page does not rank the forms.
Elderberry extracts made only from elderberry (syrups, lozenges and capsules), What the sources supportDetails
A 2021 systematic review found four placebo-controlled trials of products made only from elderberry for colds or flu. All tested proprietary extracts: two the same syrup, one a lozenge and one a capsule. The reviewers could not compare doses or formulations, because the data were too few. No cited source compared forms with each other, so this page cannot say that any one works better. Source [1]
Products combining elderberry with other herbs, What the sources supportDetails
The 2021 review found one trial of a hot drink combining echinacea and elderberry, tested against another medicine rather than against a placebo. The reviewers kept it apart from the elderberry-only trials, and say their search may have missed other combination products. The ratings on this page do not rest on it. Source [1]
Sources
- ElderberryNational Center for Complementary and Integrative Health, NIH, 2024 · Health authority summary · Primary source
- Assessment report on Sambucus nigra L., fructus – FinalEuropean Medicines Agency, Committee on Herbal Medicinal Products (HMPC), 2014 · Health authority summary · Primary source
- Public statement on Sambucus nigra L., fructus – FinalEuropean Medicines Agency, Committee on Herbal Medicinal Products (HMPC), 2014 · Health authority summary · Primary source
- Select Dietary Supplement Ingredients for Preserving and Protecting the Immune System in Healthy Individuals: A Systematic ReviewNutrients, 2022 · Systematic review · Primary source
Page history
Show all 2 changes to this page
- — Published.
- — Drafted. Shortening flu, shortening colds and lowering the chance of a cold rated limited; COVID-19 and immune support rated insufficient.