Elderberry

What is elderberry, and which parts are used?

NCCIH describes elderberry as the dark purple fruit of the European or black elder tree, which grows in Europe, North America, western Asia, and North Africa; it has been used in folk medicine to treat colds and flu. ^[1] In the Ministry of Agriculture and Forestry Plant List, Sambucus nigra is on the positive (P) list as “Mürver, Kara Mürver” (elderberry, black elderberry) with its flower and fruit parts; Sambucus ebulus (dwarf elderberry; fruit, flower) appears in a separate row. ^[8] The clinical results on this page belong to black elderberry (S. nigra) products; no separate evidence is reported for dwarf elderberry.

Role in the body and purpose of use

Elderberry is not a nutrient; it has no required function in the body and no deficiency. According to NCCIH, it is marketed as a supplement for colds, flu, and other conditions; it has also been marketed for COVID-19, but there is no good evidence supporting this. ^[1] The number of human studies is small: NCCIH says that there are few studies evaluating colds, flu, and other upper respiratory tract infections and that very little research has been done on other uses. ^[1]

Is elderberry proven against colds and flu?

The systematic review by Wieland and colleagues (2021) screened 1,187 records on elderberry for the prevention and treatment of viral respiratory illnesses and included 5 randomized trials. The authors reported that elderberry may not reduce the risk of catching a cold; that it may reduce the duration and severity of colds, but the evidence is uncertain; and that it may reduce the duration of flu, but the evidence is uncertain. Compared with oseltamivir, a product containing elderberry was noted to possibly be associated with lower risk with respect to flu complications and adverse events. ^[2] The review’s conclusion: elderberry may be a safe option for treating viral respiratory illness, but evidence for both benefit and harm is uncertain and new studies are needed for a firm conclusion. ^[2]

What did the air travel study show?

The RCT by Tiralongo and colleagues included 312 economy-class passengers traveling overseas from Australia; a standardized, membrane-filtered elderberry extract was compared with placebo. There were more cold episodes in the placebo group (17 vs 12), but the difference was not significant (p = 0.4). The total duration of cold days was significantly longer in the placebo group (117 vs 57 days; p = 0.02), and the mean symptom score was also higher (583 vs 247; p = 0.05). According to the statement in the full text of the study, the study was funded by a product company; the company supplied the extract and placebo capsules and took part partly in the design; randomization, data collection, analysis, and the decision to publish were the responsibility of the researchers. ^[4] The absence of a significant difference in the number of episodes is consistent with Wieland and colleagues’ statement that it “may not reduce the risk of catching a cold.”

What did the meta-analysis find?

The 2019 meta-analysis by Hawkins and colleagues covered a total of 180 participants; elderberry supplementation was reported to substantially reduce upper respiratory symptoms, with a large effect size. ^[3] Because of the small number of participants, a large effect size cannot on its own be considered strong evidence; NCCIH’s general statement is likewise that preliminary research suggests it may relieve symptoms, but that there are few studies. ^[1]

Why do the flu studies conflict?

In the study by Zakay-Rones and colleagues, 60 people (aged 18–54) in Norway during the 1999–2000 flu season, with influenza-like symptoms lasting 48 hours or less, received elderberry syrup or placebo in a randomized, double-blind, placebo-controlled design. Symptoms resolved about 4 days earlier in the elderberry group and use of rescue medication was significantly lower; the authors stated that the findings need to be confirmed in a larger study. ^[6]

The RCT by Macknin and colleagues covered 87 patients aged 5 and over in three emergency departments in the US, with PCR-confirmed influenza and symptoms lasting less than 48 hours (43 elderberry, 44 placebo; mean age 25). Patients could also take standard oseltamivir if they wished. The time for all symptoms to be absent or mild was a mean of 4.9 days in the placebo group and 5.3 days in the elderberry group (p = 0.57); time to full recovery was 8.7 and 8.6 days (p = 0.87). The authors state that power to detect a 2-day benefit was above 0.90; in the post hoc analysis, among those taking only elderberry (without oseltamivir), primary outcomes were about 2 days worse than in those taking placebo. The authors stated that their results contradict earlier studies and that new studies are needed. ^[5]

Read side by side, the two studies look like this: a small (60-person) and favorable study versus a larger (87-person) study conducted in PCR-confirmed patients that found no benefit. The review by Wieland and colleagues therefore characterizes the evidence for flu as “uncertain.” ^[2]

Does elderberry overstimulate immunity, and is it used for COVID-19?

Wieland and colleagues note that during COVID-19 the concern was raised that elderberry might increase the risk of a “cytokine storm.” The review found no study linking clinical inflammation outcomes to elderberry; in three studies, cytokine production had been measured ex vivo after elderberry intake, and evidence was found that elderberry had some effect on inflammatory markers; this effect could diminish with continued supplementation. The authors concluded that there is no evidence that it overstimulates the immune system. ^[2] NCCIH reports that the US Food and Drug Administration (FDA) and the Federal Trade Commission have taken action against companies marketing elderberry products with unproven claims of efficacy for COVID-19. ^[1]

Is elderberry safe, and which parts are toxic?

According to NCCIH, raw or unripe elderberries and other parts of the tree such as the leaves and stems contain toxic substances that produce cyanide and can cause nausea, vomiting, and severe diarrhea; cooking eliminates this toxin, and large amounts of toxin can cause serious illness. Little is known about the safety of use for health purposes in pregnancy and breastfeeding; NCCIH also states in general that herbal products can interact harmfully with some drugs. ^[1]

A CDC (MMWR) report describes 11 people in California in 1983 who had nausea and vomiting after juice made from wild elderberries (Sambucus mexicana) pressed together with leaves and branches; the eight most affected had nausea, vomiting, abdominal cramps, and weakness, some had dizziness and stupor, and one person was hospitalized; serum cyanide levels were normal and all recovered quickly. Severity of illness was related to the amount of juice drunk; only those who drank tea did not become ill. ^[7] This incident concerns S. mexicana, not black elderberry, and is a single incident report; the report’s editorial note states that the fruit may be safe particularly when eaten cooked (uncooked fruit may cause nausea) and that leaves and stems should not be crushed and added when preparing juice.

How reliable is the evidence overall?

The shared feature of the elderberry studies is small sample size and short duration. The available randomized trials for colds and flu include 60, 87, and 312 people; the total number of participants covered by the meta-analysis is 180. ^{[6] [5] [4] [3]} Because the studies were conducted with different products (syrup, capsule, extract) and different patient groups (flu patients, healthy air travelers), the results cannot easily be transferred to one another. Wieland and colleagues state that evidence for both benefit and harm is uncertain and that information from new and ongoing studies is needed for a firm conclusion. ^[2]

What is elderberry’s status in Türkiye?

In the July 16, 2026 update of the Ministry of Agriculture and Forestry Plant List, Sambucus nigra (“Mürver, Kara Mürver”; flower, fruit) and Sambucus ebulus (“Cüce Mürver”, dwarf elderberry; fruit, flower) are listed as positive (P); the rows carry no additional label warning. ^[8] In the September 21, 2026 version of the Dietary Supplements Restricted Substances List, black elderberry (Sambucus nigra) appears as a source in two separate rows. In the “Polyphenols” row (together with grape, echinacea, tea, black elderberry, aronia, pomegranate, and cat’s claw), 270 mg/day is written in the ages 4–10 maximum column and 540 mg/day in the ages 11 and over maximum column (ages 11 and over published May 2, 2016, ages 4–10 June 16, 2017). In the “Anthocyanosides/Anthocyanidins/Anthocyanins” row (bilberry, currant, grape, aronia, black carrot, and black elderberry), 500 mg/day is written in the ages 4–10 maximum column and 1,000 mg/day in the ages 11 and over maximum column (published January 23, 2017). ^[9] These limits are marker compound amounts such as total polyphenols and anthocyanins; they are not in the same unit as the extract or syrup volume used in studies. Dietary supplements are also covered on the Supplement regulation in Türkiye page. This guide does not recommend products or suppliers and does not set personal doses.

Evidence table: claim, population, and limits