Drug & supplement interaction

American Elder + Alpelisib

Alpelisib brand name: Piqray.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

American Elder has a moderate interaction with Alpelisib. Theoretically, taking American elder might increase levels of CYP3A4 substrates.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

American Elder and Alpelisib

Here is the interaction we found between these two, with the evidence behind it.

Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Why this applies to Alpelisib

Alpelisib falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group American Elder interacts with.

Theoretically, taking American elder might increase levels of CYP3A4 substrates.
In vitro research shows that American elder inhibits CYP3A4 enzymes.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist for Alpelisib (Piqray): your body relies on a liver enzyme called CYP3A4 to help clear this medication. In lab dish studies, American elder appeared to slow that enzyme down. If that held true in people, alpelisib could build up a bit higher than expected, which might mean stronger side effects like high blood sugar, diarrhea, rash, nausea, or fatigue.

I want to be honest, though: this is only a theoretical concern based on test-tube research, not real patient data, so we don't truly know if it matters. Since alpelisib is a serious cancer drug, I'd still loop in your oncologist or pharmacist before adding any elderberry product, just to play it safe.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:273-82. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

American Elder Also Interacts With Other Medications

American Elder has 643 moderate known drug interactions in our database — the Alpelisib one above is one of them. If you take anything else, check it against the full list below.

Moderate 643 No known interaction 2,187 (incl. Alpelisib)
Taking anything else?

Check Another of Your Medications Against American Elder

Covers the 2,830 medications we’ve checked against American Elder. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Alpelisib

This page covers American Elder only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Alpelisib page lists 139 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Grapefruit (major), St. John's Wort (major), Acacia Rigidula (moderate) and Adrafinil (moderate).

By severity: 3 major · 96 moderate · 40 minor.

From our pharmacist’s overview on the Alpelisib page

“Alpelisib (Piqray) treats PIK3CA-mutated breast cancer, and a drug doing that job leaves little room for supplements that shift its blood level. Yet that is what most of this list does: 121 of the 139 ingredients on file can raise or lower alpelisib through CYP3A4, the liver enzyme that clears it.”

Reviewed by 2 · Jul 18, 2026

Open the Alpelisib interaction page

One more smart check

Taking American Elder as Part of a Dietary Supplement Product? Check It for Interactions

We hold 61 real supplement products containing American Elder, each one broken down to its full ingredient list — and combination products often carry several ingredients besides American Elder. Your product may carry other ingredients that interact with Alpelisib too, on top of American Elder — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where American Elder and Alpelisib Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement American Elder
Top half

#571 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Alpelisib
Steady interest

#1,877 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About American Elder

What is American Elder?

American Elder
  • Cold and flu symptoms
  • Immune support
  • Fever and congestion (traditional)
  • Constipation (traditional)
  • Antioxidant support

American elder is a North American plant whose cooked, ripe berries and flowers are used mainly for colds, flu, and general immune support. The science behind these uses is limited and most studies focus on the closely related European black elder (Sambucus nigra), so benefits are uncertain. Only properly prepared berries and flowers should be used, since raw berries, leaves, bark, and seeds can cause poisoning.

Read the full American Elder monograph & all interactions
Medication

About Alpelisib

What Is Alpelisib Used For?

Brand name: Piqray

Alpelisib is approved for two distinct uses, each tied to a specific brand. Piqray is used in combination with another drug called fulvestrant to treat adults with hormone receptor (HR)-positive, HER2-negative, advanced or metastatic breast cancer whose tumors carry a PIK3CA mutation — and only after the cancer has progressed on or after a hormone-based treatment. A companion diagnostic test is required before starting Piqray.

Vijoice is used to treat adults and children 2 years of age and older who have severe manifestations of PIK3CA-Related Overgrowth Spectrum (PROS) — a rare condition where PIK3CA gene mutations cause abnormal tissue, vascular, and bone overgrowth — and who need systemic (whole-body) therapy. Vijoice's approval for PROS was granted under the FDA's accelerated approval pathway based on response data, and continued approval may depend on confirmatory trials.

See full Alpelisib drug information
Keep checking

Other Drugs & American Elder

Browse every other medication we’ve checked against American Elder — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
643Moderate
0Minor
2,186No known interaction
643 Moderate 2,186 No interaction
Moderate

643 interactions

Showing 60 of 643 moderate interactions — see all 643 on the American Elder page.

No interaction 2,186 drugs checked — show the list

We also checked American Elder against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,186 medications checked with no known interaction — see the full American Elder list.

See the full American Elder interactions page
See every supplement checked against Alpelisib, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
American Elder monograph › Uses, safety, and every drug interaction in one place Alpelisib supplement interactions › Every supplement checked against Alpelisib, ranked by severity Alpelisib drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking American Elder and Alpelisib Together: Common Questions

Can you take American Elder with Alpelisib?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the American Elder and Alpelisib interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Alpelisib and American Elder?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.