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Elder (Sambucas nigra) Be aware that the U.S. Food and Drug Administration does not strictly regulate herbs and dietary supplements. There is no guarantee of strength, purity or safety of products containing or claiming to contain elder. Decisions to use herbs or supplements should be carefully considered. Individuals using prescription drugs should discuss taking herbs or supplements with their pharmacist or health care provider before starting.
Scientists have studied elder for the following health problems: Bacterial sinusitis | Elder has been observed to reduce excessive sinus mucus secretion in laboratory studies. There is only limited research specifically using elder to treat sinusitis in humans. Combination products containing elder and other herbs (such as Sinupret) have been reported to have beneficial effects when used with antibiotics to treat sinus infections, although the majority of this evidence is not high quality and requires confirmation with better research. Some studies suggest that herbal preparations containing elder result in less swelling of mucus membranes, better drainage, milder headache and decreased nasal congestion. Although early evidence supports the use of elder in combination with other herbs for treating sinusitis, there is no evidence regarding the effects of elder when used alone for treatment of this condition. | Influenza (flu) | Some laboratory studies suggest that elder may reduce mucus production and have anti-inflammatory and antiviral effects. Human study suggests elderberry juice may improve flu symptoms, such as fever, fatigue, headache, sore throat, cough and aches, in less than half the time that it normally takes to get over the flu. It should be noted that berries must be cooked to prevent nausea or cyanide toxicity. However, study designs are weak; therefore, it is unclear whether there is any benefit from elder for this condition. Additional research is needed to reach a firm conclusion. Elder should not be used in place of other more proven therapies, and patients are advised to discuss influenza vaccination with their primary health care provider. | Bronchitis | There is a small amount of research of the combination herbal product Sinupret in patients with bronchitis. This formula contains elder flowers (Sambucus nigra), as well as gentian root, verbena, cowslip flower and sorrel. Although benefits have been suggested, because of study design problems, no clear conclusion can be drawn for either Sinupret or elder in the management of bronchitis. | High cholesterol | There is no reliable human evidence evaluating elder alone as a treatment for high cholesterol. Early study reports that elderberry juice may decrease serum cholesterol concentrations and increase low-density lipoprotein stability. However, this study was a pilot design of a small sample population. It remains unclear whether there is any benefit from elder for this condition. Additional research is needed before a firm conclusion can be reached. Elder should not be used in place of other more proven therapies, and patients should talk to their primary health care provider before using elderberry for treatment of high cholesterol. |
Elder has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially very serious and even life-threatening. You should consult a health care provider before taking elder for any unproven use. Alzheimer's disease
Antioxidant
Antispasmodic
Asthma
Astringent
Blood vessel disorders
Burns
Cancer
Chafing
Circulatory stimulant
Cold sores
Colds
Cough suppressant
Dermatophytic infections
Diabetes
Diuresis (urine production)
Edema
Epilepsy
Fever
Flavoring
Gastrointestinal disorders
Gout
Hair dye
Hay fever
Headache
Helicobacter pylori | Herpes
HIV
Immune stimulant
Increased sweating
Inflammation
Insomnia
Joint swelling
Kidney disease
Laryngitis
Laxative
Liver disease
Measles
Migraines
Mosquito repellant
Nerve pain
Osteoporosis
Perfumes
Psoriasis
Respiratory distress
Sedative
Stress reduction
Syphilis
Toothache
Ulcerative colitis
Vomiting
Weight loss |
Allergies Avoid elder if you have a known allergy to plants in the Caprifoliaceae family (honeysuckle family). There are some reports of allergies in children playing with toys made from fresh elder stems. Symptoms of allergies include skin irritation, rash and difficulty breathing. Side Effects Elderberry products should be used under the direction of a qualified health care provider because of the possible risk of cyanide toxicity, especially from elder bark, root or leaves. Berries must be cooked to prevent nausea or cyanide toxicity. Some people have experienced stomach discomfort, including diarrhea, vomiting, abdominal cramps and weakness, after drinking elderberry juice made from crushed leaves, stems and uncooked elderberries. Allergies are possible from fresh elder stems and include rash, skin irritation or difficulty breathing. In theory, high doses or long-term use of elder flowers may have diuretic (urine-producing) effects. People taking diuretics or drugs that interact with diuretics should be especially careful when taking products containing elder. Additional blood tests may be necessary. Dizziness, headache, convulsions and rapid heart rate have been reported. Pregnancy And Breast-Feeding Elder cannot be recommended during pregnancy or breast-feeding because of the risk of birth defects or spontaneous abortion.
Interactions with drugs, supplements and other herbs have not been thoroughly studied. The interactions listed below have been reported in scientific publications. If you are taking prescription drugs, speak with your health care provider or pharmacist before using herbs or dietary supplements. Interactions With Drugs Based on preliminary research, increased benefits may be seen when elder is used in combination with antibiotics; decongestants, such as oxymetazoline (Afrin); or antioxidants, such as vitamin C. Animal studies suggest that elder may increase the effects and possible adverse effects of some cancer chemotherapies. Other animal studies have suggested that elder flowers may possess anti-inflammatory properties and may have additional effects when used with some drugs that decrease inflammation. Elder may possess diuretic (urine-producing) effects or laxative effects, which may increase when taken with other diuretics or laxative medications. Based on laboratory studies, elder may lower blood sugar levels. Caution is advised if you are using insulin or taking diabetes drugs by mouth. Blood sugar levels should be monitored closely, and dosing adjustments may be necessary. Caffeine and theophylline levels may be affected by the flavonoid quercitin, which is a component of elder. Interactions With Herbs And Dietary Supplements Elder may possess diuretic (urine-producing) effects and laxative effects. Effects may be additive when elder is taken with other herbs and supplements with similar effects, such as horsetail or dandelion, Based on laboratory studies, elder may lower blood sugar levels and may have additive effects with herbs and supplements such as aloe, fenugreek and milk thistle. Increased effects may be seen when elder is taken with other antioxidants, including vitamin C or flavonoids such as quercitin. Taking sucrose and elder together may decrease elimination of the anthocyanin component of elder.
The doses listed below are based on scientific research, publications or traditional use. Because most herbs and supplements have not been thoroughly studied or monitored, safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients even within the same brand. Combination products often contain small amounts of each ingredient and may not be effective. Appropriate dosing should be discussed with a health care provider before starting therapy; always read the recommendations on a product's label. The dosing for unproven uses should be approached cautiously, because scientific information is limited in these areas. There are no standard or well-studied doses of elder, and many different doses are used traditionally. Elder berries must be cooked to prevent nausea or cyanide toxicity. Dried elderflower may be standardized to contain at least 0.8 percent total flavonoids, calculated as isoquercitin. The dried flower may contain at least 25 percent water-soluble extract. Adults (Aged 18 Or Older) Tea: A dose of three to five grams of dried elder flowers steeped in one cup of boiling water for 10 to 15 minutes and taken by mouth three times daily has been used. Be aware of possible toxicity. Sinupret tablets: For bacterial sinusitis, a dose of two tablets of Sinupret taken by mouth three times daily with antibiotics has been used. Sinupret contains elder and several other herbs. Extract: For treating influenza or flu-like symptoms, a dose of four tablespoons of elderberry extract taken daily by mouth for three days has been used. Syrup: A dose of 15 milliliters of elderberry syrup has been taken four times a day for five days for influenza symptoms. Capsules/juice: Patients were given 400 milligrams of spray-dried powder capsules containing 10 percent anthocyanes three times a day, equivalent to five milliliters of elderberry juice for two weeks, in one study of high cholesterol. Hand cream: Cream has been prepared by taking several handfuls of fresh elder flowers, mixing in liquefied petroleum jelly, simmering for 40 minutes, heating, filtering and allowing to solidify. Apply to hands at bedtime. Children (Younger Than 18) There are no standard or well-studied doses of elder, and many different doses are used traditionally. For influenza or flu-like symptoms, a dose of one teaspoon of elderberry juice containing extract syrup taken twice daily has been suggested. However, there is not enough scientific information available to recommend the safe use of elder in children. Be aware of possible toxicity.
Elder has been suggested as a treatment for many conditions. There is some research supporting the use of elder as a decongestant and as a treatment for symptoms of the flu, although it is not clear what dose is safe and effective. The use of elder as a treatment for high cholesterol has not been proven. There is not enough scientific evidence to support the use of elder for any other medical condition. Elder may cause stomach upset, and some parts of the elder plant have the potential to cause cyanide toxicity. Elder should be avoided in pregnant or breast-feeding women and used very cautiously in children. Consult your health care provider immediately if you have any side effects. The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.
- Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
- National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research
Selected Scientific Studies: Elder Natural Standard reviewed more than 85 articles to prepare the professional monograph from which this version was created. Some of the more recent studies are listed below: - Ernst E, Marz RW, Sieder C. [Acute bronchitis: effectiveness of Sinupret. Comparative study with common expectorants in 3,187 patients.] Fortschr Med 1997;Apr 20:115(11):52-53. In German.
- 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 2003;Dec, 33(12):1703-1710.
- Kunitz S, Melton RJ, Updyke T, et al. Poisoning from elderberry juice. MMWR 1984;33(13):173-174.
- Neubauer N, März RW. Placebo-controlled, randomized double-blind clinical trial with Sinupret sugar coated tablets on the basis of a therapy with antibiotics and decongestant nasal drops in acute sinusitis. Phytomed 1994;1:177-181.
- Richstein A, Mann W. [Treatment of chronic sinusitis with Sinupret.] Ther Ggw 1980;Sep:119(9):1055-1060. [Article in German.]
- 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 1995;1(4):361-369.
- 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;Mar-Apr, 32(2):132-140.
Last updated June 20, 2005
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