What does the research show about elderberry?

Elderberry

A small meta-analysis and a systematic review report shorter, milder colds and flu, with the review rating the evidence uncertain. A 2020 emergency room trial found no change in flu duration. Elderberry did not lower the chance of catching a cold. A 1983 California outbreak followed juice pressed with leaves and stems.

Add to Bio HackChecked 2026-11-09

Status: Dietary supplement and food in the US. Not approved as a drug for any use.
Also called: Sambucus nigra, black elderberry, European elder, elderberry syrup, elderberry extract, Sambucol, elderflower
Taken for: colds, flu, immunity, upper respiratory symptoms, cold prevention, antiviral, cholesterol

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help1

LimitedSmall trials found fewer cold days in air travelers, 57 against 117 on placebo. A review rated the evidence uncertain.

Reported risks2

LimitedCase reports: 11 of 25 people had nausea and vomiting after drinking juice from wild elderberries crushed with leaves and stems. All recovered.How often is not known
LimitedOne trial found that, in a post hoc subgroup, flu symptoms were 2 days worse on elderberry alone than on placebo alone.How often is not known

What people take it for, and what was found

Shown to help1

Limited

Cold and upper respiratory symptoms

Small trials found fewer cold days in air travelers, 57 against 117 on placebo. A review rated the evidence uncertain.

The numbers and sources

Effect: A meta-analysis of 180 participants reported a large reduction in upper respiratory symptoms with elderberry [1]. A systematic review of 5 randomized trials found elderberry may reduce cold duration and severity, with uncertain evidence [2]. In 312 air travelers, cold days totaled 57 on elderberry and 117 on placebo, and summed symptom scores 247 against 583 [3].
Population: 180 participants [1], 5 RCTs [2], 312 economy-class passengers flying from Australia [3].
Sources: [1], [2], [3]
Caveats: The meta-analysis abstract gives no effect size or trial count. It was funded by the Franklin Institute of Wellness [1]. The air travel trial was funded by Iprona AG, which supplied the capsules and was partly involved in design [3].

Mixed results1

Limited

Flu duration

Small trials found mixed results: one saw flu symptoms ease about 4 days sooner, and a later trial of 87 patients saw no difference.

The numbers and sources

Effect: In 60 Norwegian adults with flu symptoms for 48 hours or less, 15 mL of elderberry syrup four times a day for 5 days relieved symptoms about 4 days sooner than placebo, with less rescue medicine [4]. In a 2020 trial of 87 emergency room patients with PCR-confirmed flu, days until symptoms were none or mild were 5.3 on elderberry and 4.9 on placebo (p 0.57), and days to full resolution were 8.6 and 8.7 [5]. The systematic review rated the flu duration evidence uncertain [2].
Population: 60 adults aged 18 to 54 [4]. 87 patients aged 5 and older [5].
Sources: [4], [2], [5]
Caveats: The two trials disagree. The 2020 trial was powered above 0.90 to detect a 2-day difference and was funded by the Wendel Family Foundation and Cleveland Clinic [5]. The abstract of [4] does not report funding.

Not shown to help1

Limited

Preventing colds

Limited evidence: cold episodes did not differ significantly from placebo in air travelers, and a review found elderberry may not lower cold risk.

The numbers and sources

Effect: In 312 air travelers, cold episodes were 12 on elderberry and 17 on placebo, a difference that was not significant (p 0.4) [3]. The systematic review found elderberry may not reduce the risk of developing a cold [2].
Population: Air travelers [3], 5 RCTs [2].
Sources: [3], [2]
Caveats: Few prevention trials.

Doses studied

The Norwegian flu trial gave 15 mL of elderberry syrup four times a day for 5 days [4]. The 2020 flu trial gave 15 mL (5.7 g) of extract twice a day to children aged 5 to 12 and four times a day to those over 12, for 5 days [5]. A cholesterol trial gave 400 mg capsules of spray-dried extract three times a day for 2 weeks [6].

Risks

Reported risks2

LimitedHow often is not known

Poisoning from juice pressed with leaves and stems

Case reports: 11 of 25 people had nausea and vomiting after drinking juice from wild elderberries crushed with leaves and stems. All recovered.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: In August 1983, 11 of 25 people at a California gathering had nausea and vomiting within 15 minutes of drinking juice from wild elderberries crushed with their leaves and branches. Eight were flown to hospital and one was hospitalized overnight. Severity tracked the amount drunk. All recovered. Serum cyanide levels were normal. The CDC report notes that fresh leaves, flowers, bark, buds and roots contain a glucoside that can produce hydrocyanic acid, and that uncooked berries may produce nausea [7].
Population: 25 people at one gathering [7].
Sources: [7]
Caveats: One outbreak report, involving a western US species (Sambucus mexicana), not a commercial extract.

LimitedHow often is not known

Worse flu course without oseltamivir

One trial found that, in a post hoc subgroup, flu symptoms were 2 days worse on elderberry alone than on placebo alone.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: In a post hoc analysis of the 2020 trial, symptom outcomes for elderberry taken alone, without oseltamivir, were 2 days worse than for placebo taken alone [5].
Population: Subgroup of 87 emergency room flu patients [5].
Sources: [5]
Caveats: Post hoc subgroup of a small trial.

Checked, no increase found1

Limited

Immune overstimulation

Limited evidence: a review found no studies linking elderberry to clinical inflammatory outcomes, and rated the evidence on harms uncertain.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: A systematic review prompted by COVID-19 concern about cytokine storm found no studies linking elderberry to clinical inflammatory outcomes. Three studies measured cytokines ex vivo after elderberry, and the effect on markers may decline with ongoing use. Against oseltamivir, an elderberry-containing product may be associated with fewer flu complications and adverse events [2].
Population: 5 RCTs and 3 ex vivo cytokine studies [2].
Sources: [2]
Caveats: The review rated the evidence on harms uncertain [2].

Claims tested and not found

That elderberry shortens the flu. In 87 emergency room patients with confirmed flu, time to mild or no symptoms and time to full resolution did not differ from placebo [5].
That elderberry prevents colds. Cold episodes did not differ significantly from placebo in 312 air travelers [3].
That elderberry lowers cholesterol. In 34 young volunteers given extract for 2 weeks, cholesterol went from 199 to 190 mg/dL against 192 to 196 mg/dL on placebo, a change that was not significant [6].

Sources

Hawkins J, Baker C, Cherry L, et al. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complementary Therapies in Medicine. 2019. https://doi.org/10.1016/j.ctim.2018.12.004
Wieland LS, Piechotta V, Feinberg T, et al. Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC Complementary Medicine and Therapies. 2021. https://doi.org/10.1186/s12906-021-03283-5
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. https://doi.org/10.3390/nu8040182
Zakay-Rones Z, Thom E, Wollan T, et al. 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. 2004. https://doi.org/10.1177/147323000403200205
Macknin M, Wolski K, Negrey J, et al. 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. 2020. https://doi.org/10.1007/s11606-020-06170-w
Murkovic M, Abuja PM, Bergmann AR, et al. 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. 2004. https://doi.org/10.1038/sj.ejcn.1601773
Centers for Disease Control and Prevention. Poisoning from Elderberry Juice, California. Morbidity and Mortality Weekly Report. 1984. https://www.cdc.gov/mmwr/preview/mmwrhtml/00000311.htm

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