Awaiting clinical review. This entry is sourced but has not yet been signed off by a pharmacist or clinician.
Elderberry
Elderberry may shorten colds and flu by a day or two, but the trials are small, mostly funded by the makers of the product tested, and one independent trial found no benefit. The main caution is that raw or unripe berries, leaves and stems contain cyanide-producing compounds that cause nausea, vomiting and severe diarrhoea; cooking removes the toxin. It is not shown to prevent colds, and there is no good evidence it helps with COVID-19.
At a glance
Last reviewed 29 September 2026What it's used for
Evidence is rated per use. The same ingredient can be strong for one thing and traditional for another.
| Use | Evidence | What the research shows |
|---|---|---|
| Shortening influenza symptoms | Limited | Two small Israeli trials of the syrup Sambucol (60 and 27 people) reported faster recovery than placebo, about 4 days earlier in the larger one; that trial was sponsored by the maker, Razei Bar. A systematic review pooled them and put the shortening at about 2.7 days (95% CI 0.13 to 5.23 days), but rated the certainty of evidence very low, with high inconsistency between trials. A later trial in 87 emergency-room patients with PCR-confirmed influenza found no difference in time to symptom resolution (8.7 days on placebo versus 8.6 on elderberry).1,2,4,8 |
| Shortening common colds | Limited | One trial of 312 air travellers, funded by the capsule manufacturer Iprona AG, found that people who caught a cold had fewer cold days on elderberry than on placebo (57 versus 117 total days, p = 0.02). Only 29 people developed a cold, and the systematic review rated the certainty as very low. A 2019 meta-analysis of small trials (180 participants in total) reported a large effect on upper respiratory symptoms, but it pooled few, small trials and the systematic review above rates the underlying evidence as very low certainty.1,3,5 |
| Preventing colds | Limited | In the same air-travel trial, 12 of 154 people on elderberry and 17 of 158 on placebo developed a well-defined cold (relative risk 0.69, 95% CI 0.34 to 1.39), so the difference could easily be chance. The systematic review concluded elderberry may not reduce the risk of developing a cold.1,3 |
How much
Ranges below are what studies used and what supplements commonly contain. They are not a recommendation for you. Start at the low end.
How people take it
Safety
Who should avoid
- Raw or unripe berries, leaves, stems and bark — cyanide-producing compounds
- Pregnancy and breastfeeding — too little safety data to recommend
- Anyone taking medicines — ask your pharmacist or doctor first
- As a treatment for COVID-19 — no good evidence it works
Known interactions
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Questions people ask
Does elderberry work for colds and flu?
It might shorten them by a day or two, but the evidence is weak. A systematic review rated the certainty as low to very low, most trials were funded by the product's maker, and a later independent trial in 87 flu patients found no benefit.
Are raw elderberries poisonous?
Yes. NCCIH says raw or unripe berries, and the leaves and stems, contain cyanide-producing substances that can cause nausea, vomiting and severe diarrhoea, and large amounts may cause serious illness. Cooking removes the toxin. The ripe fruit in commercial syrups and extracts is processed for this reason.
Can I take elderberry while pregnant or breastfeeding?
There is no good evidence either way. NCCIH says little is known about its safety in pregnancy or breastfeeding, and the LactMed database says no recommendation can be made on medicinal doses while breastfeeding.
Does elderberry help with COVID-19?
No good evidence supports it. NCCIH says there is insufficient evidence to know if it can help with symptoms, and the US FDA and Federal Trade Commission have acted against companies marketing elderberry products with unsubstantiated COVID-19 claims.
Sources
- Systematic review Wieland LS, Piechotta V, Feinberg T, et al. Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC Complement Med Ther. 2021.
- Randomised trial 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.
- Randomised trial Tiralongo E, Wee SS, Lea RA. Elderberry supplementation reduces cold duration and symptoms in air-travellers: a randomized, double-blind placebo-controlled clinical trial. Nutrients. 2016.
- Randomised trial Macknin M, Wolski K, Negrey J, Mace S. Elderberry extract outpatient influenza treatment for emergency room patients ages 5 and above: a randomized, double-blind, placebo-controlled trial. J Gen Intern Med. 2020.
- Meta-analysis Hawkins J, Baker C, Cherry L, Dunne E. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: a meta-analysis of randomized, controlled clinical trials. Complement Ther Med. 2019.
- Regulator/health agency NCCIH. Elderberry: Usefulness and Safety. National Center for Complementary and Integrative Health (last updated November 2024).
- Regulator/health agency Drugs and Lactation Database (LactMed). Elderberry. National Institute of Child Health and Human Development. 2025.
- Randomised trial 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.
Last reviewed 29 September 2026 · Next review March 2027 · How we rate evidence