Elderberry (Sambucus nigra)

Elderberry — scientific infographic poster
Elderberry antiviral mechanism


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Table of Contents

  1. Historical and Traditional Use
  2. Botanical Profile
  3. Active Compounds and Phytochemistry
  4. Immune System Effects
  5. Cold and Influenza Trials
  6. Antiviral Properties
  7. Antioxidant Capacity
  8. Anti-Inflammatory Effects
  9. Cardiovascular Research
  10. Respiratory Health
  11. Blood Sugar Research
  12. Skin Health
  13. Digestive Health
  14. Forms and Preparations
  15. Doses Used in the Clinical Trials
  16. Cautions and Contraindications
  17. Key Research Papers
  18. Featured Videos

Historical and Traditional Use

Elderberry has kept human company for thousands of years — gathered as far back as the Stone Age, written up by the ancient physicians Dioscorides and Pliny, and known across medieval Europe as the “medicine chest of the country people,” the tree that supplied a free remedy for nearly every common ailment. It is wrapped in deep folklore, from the guardian spirit known as the Elder Mother to the long-held rule that the berries must always be cooked, and its modern revival as a cold-and-flu remedy began with laboratory research in the 1990s. The fuller story is told in the dedicated History & Traditional Use article.

Botanical Profile

The European elder (Sambucus nigra) is a deciduous shrub or small tree, placed today in the family Adoxaceae and formerly in Caprifoliaceae. The features below are the ones that matter for identification and for the safety findings further down this page.

Active Compounds and Phytochemistry

The ripe berries are rich in pigmented polyphenols. Which of these compounds, if any, explains a clinical effect has not been established.

Immune System Effects

Most of the immune findings come from cell-culture and animal work. They describe what elderberry preparations did in those systems, not proven effects in people.

The fuller account is on the Immune Modulation page.

Cold and Influenza Trials

Colds and influenza are where elderberry has been tested most in people. The trials are small, each tested one proprietary product, and their results conflict.

Each trial is set out in full on the Cold and Flu page.

Antiviral Properties

The antiviral findings come from cell-culture and animal studies. Activity in a dish does not show that an oral dose reaches the airway at an active concentration.

Antioxidant Capacity

Elderberry preparations show antioxidant effects in vitro, and reviews list this among the best-supported laboratory findings (Vlachojannis 2010). The human data are limited:

Anti-Inflammatory Effects

The anti-inflammatory evidence is preclinical. A systematic review concluded that antibacterial and anti-inflammatory effects “seem possible, but need further support”; in rats, an ethanol extract of the fruit improved chemically induced colitis, and an aqueous extract produced central depression and analgesia (Vlachojannis 2010).

The cell-culture cytokine finding runs the other way: elderberry preparations raised inflammatory cytokine production by monocytes (Barak 2001). No clinical trial has tested elderberry in arthritis, gout or other inflammatory conditions.

Cardiovascular Research

Two randomized, placebo-controlled human studies have tested elderberry on cardiovascular markers:

A systematic review counted one animal experiment and one clinical trial as backing a weak lipid-lowering effect (Vlachojannis 2010). No trial has measured heart attacks, strokes or blood pressure outcomes. More detail is on the Antioxidant and Cardiovascular page.

Respiratory Health

Apart from the cold and influenza trials above, the respiratory evidence is thin:

Blood Sugar Research

Elder has a traditional use for diabetes, and the evidence for it is laboratory work:

Skin Health

No clinical trials of elderberry or elderflower for skin conditions, sun protection or skin ageing were found in the sources reviewed for this page. Claims about these uses rest on the berry's antioxidant chemistry and on folk use, not on tested outcomes in people.

Digestive Health

The digestive evidence is from animals: in rats, an ethanol extract of elderberry fruit improved acetic acid-induced colitis (Vlachojannis 2010). No human trials of elderberry for gut conditions, the microbiome or constipation were found in the sources reviewed for this page. On the other side, nausea is the best-documented effect of uncooked berries (CDC 1984).

Forms and Preparations

Elderberry is sold and prepared in several forms. What the research reports about them:

Doses Used in the Clinical Trials

The doses below are what the trials used, reported as findings, not as instructions. Each trial tested one proprietary product, so results may not transfer to other products.

Cautions and Contraindications

The safety findings below are reported as findings. Decisions about supplements belong with a clinician.

The full safety record, including species differences and the CDC report, is on the Preparation and Safety page.

Key Research Papers

  1. Centers for Disease Control (CDC) (1984). Poisoning from elderberry juice — California. MMWR Morbidity and Mortality Weekly Report 33(13):173-174. — PubMed PMID: 6422238 (full text: CDC MMWR)
  2. Senica M, Stampar F, Veberic R, Mikulic-Petkovsek M (2016). Processed elderberry (Sambucus nigra L.) products: A beneficial or harmful food alternative? LWT — Food Science and Technology 72:182-188. — doi:10.1016/j.lwt.2016.04.056
  3. Senica M, Stampar F, Veberic R, Mikulic-Petkovsek M (2017). The higher the better? Differences in phenolics and cyanogenic glycosides in Sambucus nigra leaves, flowers and berries from different altitudes. Journal of the Science of Food and Agriculture 97(8):2623-2632. — PubMed PMID: 27734518
  4. Appenteng MK, Krueger R, Johnson MC, Ingold H, Bell R, Thomas AL, Greenlief CM (2021). Cyanogenic glycoside analysis in American elderberry. Molecules 26(5):1384. — PubMed PMID: 33806603
  5. Mikulic-Petkovsek M, Schmitzer V, Slatnar A, Todorovic B, Veberic R, Stampar F, Ivancic A (2014). Investigation of anthocyanin profile of four elderberry species and interspecific hybrids. Journal of Agricultural and Food Chemistry 62(24):5573-80. — PubMed PMID: 24830391
  6. Kaack K, Austed T (1998). Interaction of vitamin C and flavonoids in elderberry (Sambucus nigra L.) during juice processing. Plant Foods for Human Nutrition 52(3):187-98. — PubMed PMID: 9950080
  7. Zakay-Rones Z, Varsano N, Zlotnik M, Manor O, Regev L, Schlesinger M, Mumcuoglu M (1995). 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. Journal of Alternative and Complementary Medicine 1(4):361-369. — PubMed PMID: 9395631
  8. Zakay-Rones Z, Thom E, Wollan T, Wadstein J (2004). Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. Journal of International Medical Research 32(2):132-140. — PubMed PMID: 15080016
  9. Tiralongo E, Wee SS, Lea RA (2016). Elderberry supplementation reduces cold duration and symptoms in air-travellers: a randomized, double-blind placebo-controlled clinical trial. Nutrients 8(4):182. — PubMed PMID: 27023596
  10. Hawkins J, Baker C, Cherry L, Dunne E (2019). Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: a meta-analysis of randomized, controlled clinical trials. Complementary Therapies in Medicine 42:361-365. — PubMed PMID: 30670267
  11. Macknin M, Wolski K, Negrey J, Mace S (2020). Elderberry extract outpatient influenza treatment for emergency room patients ages 5 and above: a randomized, double-blind, placebo-controlled trial. Journal of General Internal Medicine 35(11):3271-3277. — PubMed PMID: 32929634
  12. Wieland LS, Piechotta V, Feinberg T, Ludeman E, Hutton B, Kanji S, Seely D, Garritty C (2021). Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC Complementary Medicine and Therapies 21(1):112. — PubMed PMID: 33827515
  13. Vlachojannis JE, Cameron M, Chrubasik S (2010). A systematic review on the sambuci fructus effect and efficacy profiles. Phytotherapy Research 24(1):1-8. — PubMed PMID: 19548290
  14. Barak V, Halperin T, Kalickman I (2001). The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. European Cytokine Network 12(2):290-296. — PubMed PMID: 11399518
  15. Ho GT, Ahmed A, Zou YF, Aslaksen T, Wangensteen H, Barsett H (2015). Structure-activity relationship of immunomodulating pectins from elderberries. Carbohydrate Polymers 125:314-22. — PubMed PMID: 25857988
  16. Kinoshita E, Hayashi K, Katayama H, Hayashi T, Obata A (2012). Anti-influenza virus effects of elderberry juice and its fractions. Bioscience, Biotechnology, and Biochemistry 76(9):1633-8. — PubMed PMID: 22972323
  17. Krawitz C, Mraheil MA, Stein M, Imirzalioglu C, Domann E, Pleschka S, Hain T (2011). Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complementary and Alternative Medicine 11:16. — PubMed PMID: 21352539
  18. Roschek B Jr, Fink RC, McMichael MD, Li D, Alberte RS (2009). Elderberry flavonoids bind to and prevent H1N1 infection in vitro. Phytochemistry 70(10):1255-61. — PubMed PMID: 19682714
  19. Torabian G, Valtchev P, Adil Q, Dehghani F (2019). Anti-influenza activity of elderberry (Sambucus nigra). Journal of Functional Foods 54:353-360. — doi:10.1016/j.jff.2019.01.031
  20. Fink RC, Roschek B Jr, Alberte RS (2009). HIV type-1 entry inhibitors with a new mode of action. Antiviral Chemistry and Chemotherapy 19(6):243-55. — PubMed PMID: 19641233
  21. Weng JR, Lin CS, Lai HC, Lin YP, Wang CY, Tsai YC, Wu KC, Huang SH, Lin CW (2019). Antiviral activity of Sambucus FormosanaNakai ethanol extract and related phenolic acid constituents against human coronavirus NL63. Virus Research 273:197767. — PubMed PMID: 31560964
  22. Curtis PJ, Kroon PA, Hollands WJ, Walls R, Jenkins G, Kay CD, Cassidy A (2009). Cardiovascular disease risk biomarkers and liver and kidney function are not altered in postmenopausal women after ingesting an elderberry extract rich in anthocyanins for 12 weeks. Journal of Nutrition 139(12):2266-71. — PubMed PMID: 19793846
  23. Murkovic M, Abuja PM, Bergmann AR, Zirngast A, Adam U, Winklhofer-Roob BM, Toplak H (2004). Effects of elderberry juice on fasting and postprandial serum lipids and low-density lipoprotein oxidation in healthy volunteers: a randomized, double-blind, placebo-controlled study. European Journal of Clinical Nutrition 58(2):244-9. — PubMed PMID: 14749743
  24. Gray AM, Abdel-Wahab YH, Flatt PR (2000). The traditional plant treatment, Sambucus nigra (elder), exhibits insulin-like and insulin-releasing actions in vitro. Journal of Nutrition 130(1):15-20. — PubMed PMID: 10613759
  25. Neubauer N, März RW (1994). 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. Phytomedicine 1(3):177-181. — doi:10.1016/s0944-7113(11)80061-9
  26. Glatthaar-Saalmüller B, Rauchhaus U, Rode S, Haunschild J, Saalmüller A (2011). Antiviral activity in vitro of two preparations of the herbal medicinal product Sinupret® against viruses causing respiratory infections. Phytomedicine 19(1):1-7. — PubMed PMID: 22112724
  27. Asgary S, Pouramini A (2022). The pros and cons of using elderberry (Sambucus nigra) for prevention and treatment of COVID-19. Advanced Biomedical Research 11:96. — PubMed PMID: 36518861
  28. Ramachandran A, Antala D, Pudasainee P, Panginikkod S, Gupta H (2022). A plausible association between the use of elderberry and autoimmune hepatitis. Cureus 14(4):e24250. — PubMed PMID: 35602846
  29. Holst L, Havnen GC, Nordeng H (2014). Echinacea and elderberry — should they be used against upper respiratory tract infections during pregnancy? Frontiers in Pharmacology 5:31. — PubMed PMID: 24624087
  30. Drugs and Lactation Database (LactMed) (2006–). Elderberry. Bethesda (MD): National Institute of Child Health and Human Development; entry revised April 15, 2025. — PubMed PMID: 30000895

PubMed Topic Searches

The following PubMed topic searches open live queries, so the result set stays current as new research is published.

  1. PubMed: Influenza
  2. PubMed: Upper respiratory infection randomized trial
  3. PubMed: Antiviral mechanism
  4. PubMed: Anthocyanins and antioxidant activity
  5. PubMed: Common cold duration
  6. PubMed: Immune function and cytokines
  7. PubMed: Rhinovirus
  8. PubMed: Elderberry syrup clinical trial
  9. PubMed: Cardiovascular and blood pressure
  10. PubMed: Systematic review and meta-analysis
  11. PubMed: Safety and cyanogenic glycosides

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