Elderberry (Garnett Meggs , University of Mississippi School of Pharmacy

Elderberry

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Scientific name: Sambucus nigra

Background/history: Elderberry is a berry from the black elder tree found in Europe, North America, North Africa, and Asia during warmer weather. It is dark purple in color. Historically, the elder tree was thought to protect against evil spirits, witches, and death.

Common uses: used to treat colds, flu, and general upper respiratory infections. Also used for cardiovascular benefit.

Pharmacology/mechanism of action: there are numerous proposed mechanisms of action. Multiple active ingredients are present including numerous ribosome inactivating proteins and flavonoids. Quercitin is present in noticeable amounts. Elderberry modulates IL-1 and TNF-alpha in vitro; increases IL-4, IL-13, and histamine; and modulates many other inflammatory pathways to lower inflammation. The flavonoid component provides antioxidant activity. Laboratory research shows inhibition of influenza and herpes simplex virus replication.

Dosage forms: liquid extracts, dry powder capsules, elderberry juice, lozenges, and creams.

Typical dosing: reported doses for influenza were 175mg of elderberry extract four times a day for two days or 15mL of syrup four times a day for five days. General use has been reported as 3-5 grams of dried flowers placed in one cup of boiling water for 10-15 minutes. The resulting product is take three times daily. Cardiovascular use was reported as two capsules of 500 mg.

Effectivness: S. Nigra has shown inhibition of influenza type A and B viruses along with herpes simplex virus 1. Symptoms of upper respiratory infections also saw improvement and included headache, cough, sore throat, fever, and fatigue from two studies albeit with design flaws. A long-term RCT from Curtis et. al. showed a lack of cardiovascular benefit. [2]

Safety: Cooked berries or flowers are likely safe if cyanide levels are below 25 ppm according to the systematic review by Ulbricht et. al. [2]

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Adverse effects: Cyanide poisoning, tachycardia due to cyanide poisoning, application site reactions for topicals, GI distress, dysmenorrhea, CNS/respiratory depression, diuretic effect, and increased coughing have all been reported in various human studies. [2]

Toxicities: the root, bark, and leaves of elderberry contain cyanide in low levels. Interactions: synergistic effect with doxycycline, may increase effects/adverse effects of alkylating cancer agents, may affect caffeine levels from quercetin, additive effect with diuretics, and add to VEGF inhibitor effects. [2]

Professional opinion: Elderberry has the most amount of evidence supporting its use in reducing symptoms or duration of upper respiratory infections, specifically influenza type A and B. It is generally regarded as safe especially if bought from pharmacies in the supplement form. I recommend 15mL of Sambucol® 4 times a day starting within two days of flu symptoms. ~ G Meggs

References 1. European Elder. NCCIH. https://www.nccih.nih.gov/health/elderberry 2. Ulbricht C, Basch E, Cheung L, et al. An evidence-based systematic review of elderberry and elderflower (Sambucus nigra) by the Natural Standard Research

Collaboration. J Diet Suppl. 2014;11(1):80-120. doi:10.3109/19390211.2013.859852 3. Elderberry: Store bought vs Natural. Mountain Meadow Herbs. Published August 5, 2020. Accessed March 4, 2022. https://www.mmherbs.com/blog/mountain-meadowherbs-blog-3/post/elderberry-store-bought-vs-natural-93 4. https://marronspharmacy.ie/product/sambucol-extra-defence-liquid-120ml/