Elderberry
Summary
Elderberry trials are few, small and conflicting. A 2021 review of 5 RCTs found it may not lower the chance of catching a cold and may shorten colds and flu, but rated the evidence uncertain. Early flu trials reported symptoms clearing about 4 days sooner; a 2020 trial in 87 people with lab-confirmed flu found no benefit (grades C–D). Raw berries are toxic.
Key facts
- Cooked berry extract of the black elder tree, Sambucus nigra; sold as syrup, capsules and gummies[1]
- Catching a cold: no clear effect (C); cold duration: shorter in one industry-funded trial (D); flu duration: conflicting trials (C–D)[2][4][5][6]
- 600–900 mg/day of a standardized extract in capsules, or 15 mL of syrup up to 4 times a day for 5 days[4][5][6]
- None set; elderberry is a botanical, not a nutrient[1]
- None documented in our sources; NCCIH advises checking with a clinician if you take medicines[1]
- Trials reported it as well tolerated; raw or unripe berries can cause nausea, vomiting and severe diarrhea[1][5]
- 5 graded human outcomes on this page
- October 10, 2026
How it works
ProposedLab studies found an elderberry extract reduced hemagglutination and blocked replication of several influenza strains in cell culture, and ingested elderberry shifts some cytokine markers measured outside the body. Whether either explains any clinical effect is unproven.[2][7]
What the human research says
Human trials only, one row per outcome. The form column shows what each trial actually tested. Grades follow our evidence-grading policy.
At a glance: strongest evidence per outcome
| Outcome | Grade | Effect | Strongest evidence | Rows |
|---|---|---|---|---|
| Colds | Grade C | No effect | RCT · n = 312 · 2016 | 2 rows |
| Flu | Grade C | No effect | RCT · n = 87 · 2020 | 2 rows |
| Colds and flu | Grade D | Improved | Meta-analysis · n = 180 · 2019 | 1 row |
Every graded row
| Outcome | Effect | Grade | Best evidence | PMID |
|---|---|---|---|---|
| Catching a cold during long-haul air travel | No effect | Grade C | RCT · n = 312 · 2016 Economy-class passengers flying from Australia overseas Form: membrane-filtered elderberry extract capsules · Dose: 600 mg/day before travel, 900 mg/day while travelling · Duration: About 2 weeks (10 days before to 4–5 days after arrival) Cold episodes were 12 with elderberry vs 17 with placebo, not a significant difference (p=0.4). | 27023596 (opens PubMed)Source [4] |
| Influenza duration and severity (lab-confirmed flu) | No effect | Grade C | RCT · n = 87 · 2020 Emergency-room patients aged 5 and older with PCR-confirmed influenza and symptoms under 48 h (US) Form: elderberry extract syrup · Dose: 15 mL (5.7 g extract) four times a day over age 12; twice a day ages 5–12 · Duration: 5 days Days until symptoms were mild or gone did not differ (5.3 vs 4.9 days, p=0.57), nor did days to full resolution (8.6 vs 8.7, p=0.87). A post hoc analysis found elderberry alone did about 2 days worse than placebo alone. | 32929634 (opens PubMed)Source [6] |
| Cold duration and severity | Improved | Grade D | RCT · n = 312 · 2016 Economy-class passengers flying from Australia overseas Form: membrane-filtered elderberry extract capsules · Dose: 600–900 mg/day · Duration: About 2 weeks Total cold days were 57 with elderberry vs 117 with placebo (p=0.02), and average symptom scores over those days were lower (247 vs 583, p=0.05). | 27023596 (opens PubMed)Source [4] |
| Upper respiratory symptoms | Improved | Grade D | Meta-analysis · n = 180 · 2019 Participants with colds or influenza in pooled RCTs Form: black elderberry preparations · Dose: Varied across trials · Duration: Varied across trials Pooled analysis found elderberry substantially reduced upper respiratory symptoms, with a large mean effect size. | 30670267 (opens PubMed)Source [3] |
| Influenza symptom duration | Improved | Grade D | RCT · n = 60 · 2004 Adults 18–54 with influenza-like symptoms for 48 h or less (Norway, 1999–2000 season) Form: elderberry syrup · Dose: 15 mL four times a day · Duration: 5 days Symptoms were relieved on average 4 days earlier, and rescue medication use was lower, than with placebo syrup. | 15080016 (opens PubMed)Source [5] |
Forms
| Form | Elemental % | Absorption (human data) | GI tolerance | Studied for |
|---|---|---|---|---|
| Elderberry syrup or liquid extract | Varies[5] | No human absorption data in our sources.[5] | Reported as safe in a 60-person flu trial at 15 mL four times daily for 5 days.[5] | Influenza trials (15 mL up to four times a day for 5 days) |
| Standardized elderberry extract capsules | Varies[4] | No human absorption data in our sources.[4] | No tolerance problems reported in the air-travel trial abstract.[4] | Air-travel cold trial (600–900 mg/day) |
| Raw or unripe berries, leaves and stems (not a supplement form) | Varies[1] | Not applicable.[1] | Contain cyanide-producing substances that can cause nausea, vomiting and severe diarrhea; cooking removes the toxin.[1] | Not studied; avoid |
Studied doses
Doses studied in human trials ranged from 600 to 900 mg/day of a standardized extract in capsules over about 2 weeks of travel, and 15 mL of syrup up to four times a day for 5 days during flu.[4][5][6]
Interactions
Published interactions only: each row cites a source. No row means none was found in our sources, not that a combination is safe.
None found in our sources.
Who should be careful
- Raw or unripe berries and plant parts
- Raw or unripe berries, leaves and stems contain cyanide-producing substances that can cause nausea, vomiting and severe diarrhea. Use cooked or commercially prepared products.[1]
- Pregnancy and breastfeeding
- Little is known about safety in pregnancy or while breastfeeding.[1]
- Flu with risk factors
- In the emergency-room trial elderberry did not shorten lab-confirmed flu, and alone it did worse than placebo in a post hoc analysis. It is not a substitute for antivirals your clinician prescribes.[6]
- COVID-19
- There is no good evidence for elderberry against COVID-19; FDA and FTC have acted against companies making such claims.[1]
Talk to your pharmacist or clinician before starting a supplement, especially if you take prescription medicines.
Safety
Commercial cooked elderberry products look well tolerated in short trials; the raw plant is the main hazard.
- Raw plant toxicity
- Cyanide-producing substances in raw or unripe berries, leaves and stems can cause serious illness in large amounts.[1]
- Immune overstimulation
- A 2021 systematic review found no evidence that elderberry overstimulates the immune system or triggers a cytokine storm, though data were limited.[2]
How to read the label
- Label dose vs clinical doseFlu trials used 15 mL of syrup up to four times a day (60 mL/day), while many syrup labels suggest a single daily spoonful. The cold trial used 600–900 mg/day of one standardized extract.[4][5][6]
- Extracts differThe travel trial used a proprietary membrane-filtered extract standardized to polyphenols; other products are not interchangeable with it.[4]
- GummiesNo trial in our sources tested elderberry gummies.[2]
Cost per studied dose, without the sales pitch
Compare any product you already have by the amount it delivers, not by capsule count or front-of-pack weight.
Cost per studied dose
Enter the price, servings and the amount per serving from your label.
Frequently asked questions
Does elderberry work for colds?
It probably does not stop you catching one. One industry-funded trial in air travellers found shorter, milder colds, and a 2021 review rated the evidence on duration as uncertain.[2][4]
Does elderberry shorten the flu?
Results conflict. A 60-person trial in Norway found symptoms cleared about 4 days sooner, but a 2020 US emergency-room trial of 87 people with lab-confirmed flu found no difference.[5][6]
How much elderberry syrup did studies use?
Flu trials used 15 mL four times a day for 5 days in adults; capsule trials used 600–900 mg/day of a standardized extract.[4][5][6]
Is elderberry safe?
Cooked, commercial products were well tolerated in short trials. Raw or unripe berries, leaves and stems are toxic, and safety in pregnancy is unknown.[1][5]
Can elderberry overstimulate the immune system?
A 2021 systematic review found no evidence of a cytokine storm or clinical overstimulation, though the data are limited.[2]
Does elderberry help with COVID-19?
There is no good evidence that it does, and US regulators have acted against companies claiming it does.[1]
Sources
- [1]Elderberry: Usefulness and Safety (last updated November 2024). NIH National Center for Complementary and Integrative Health, 2024. fact-sheet
- [2]Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review.. BMC Complement Med Ther, 2021. systematic-review
- [3]Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials.. Complement Ther Med, 2019. meta-analysis
- [4]Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial.. Nutrients, 2016. RCT
- [5]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. RCT
- [6]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. RCT
- [7]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. RCT
What changed
- First draft. Every PMID checked against NCBI E-utilities esummary (title and year taken from the record) and abstracts read for the cited rows.
- Adversarial review pass: every evidence row re-read against its PubMed abstract; doses and Iprona AG funding taken from the air-travel trial full text (PMC4848651). Retraction and expression-of-concern check run on all 6 PMIDs via PubMed records: none flagged. Page set indexable.