Drug & supplement interaction

American Elder + Ferric Citrate

Ferric Citrate brand name: Auryxia.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 20, 2026
The bottom line No known interaction

We found no known interaction between American Elder and Ferric Citrate in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the label for Ferric Citrate states a food rule worth keeping to, and the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

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Interaction report

American Elder and Ferric Citrate

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Ferric Citrate and American Elder in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

American Elder safety at a glance

American Elder overall Use caution Cooked ripe berries and flowers are generally well tolerated, but raw or unripe berries and other plant parts can be toxic.
Pregnancy Likely Unsafe When the leaves, stems, or unripe fruit are used orally. There is insufficient reliable information available about the safety of the flower or cooked fruit dur... Read the full pregnancy detail
Breastfeeding Likely Unsafe When the leaves, stems, or unripe fruit are used orally. There is insufficient reliable information available about the safety of the flower or cooked fruit dur... Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center) — the full detail is in the Special populations card below. Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Ferric Citrate and American Elder? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Ferric Citrate

Interactions in our licensed database are recorded against drug classes, not just single drug names. Ferric Citrate is filed under a single classification — oral drugs. American Elder has documented interactions with 2 drug classes — the most serious being cytochrome p450 3a4 (cyp3a4) substrates (moderate) and lithium (moderate) — and none of Ferric Citrate’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

American Elder Does Interact With Other Medications

American Elder has 644 moderate known drug interactions in our database — Ferric Citrate isn’t one of them. If you take anything else, check it against the full list below.

Moderate 644 No known interaction 2,186 (incl. Ferric Citrate)
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.

What to actually watch for

No Interaction Found — But Data Suggests American Elder and Ferric Citrate May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do.

  • Vomiting / Nausea Additional detail

    American Elder

    “Orally, ingesting several glasses of American elderberry juice has been reported to cause nausea and vomiting (6).”

    American Elder · Natural Medicines adverse-effect record, reported in nausea and vomiting.

    1 source cited
    1. 6. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.

    Ferric Citrate

    Listed in the ADVERSE REACTIONS section of the FDA label for Ferric Citrate. Read the label on DailyMed ›

Reported for American Elder but not commonly for Ferric Citrate: dizziness and numbness or tingling.

Effects for Ferric Citrate come from the ADVERSE REACTIONS section of its FDA label; effects for American Elder come from the Natural Medicines adverse-effect record, quoted above. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

Special populations

American Elder in Pregnancy & Breastfeeding

Pregnancy And Lactation Likely Unsafe

When the leaves, stems, or unripe fruit are used orally. There is insufficient reliable information available about the safety of the flower or cooked fruit during pregnancy or lactation; avoid using.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.© 2026 Therapeutic Research Center

How to take them

Some Ferric Citrate Products Have a Food Rule — American Elder Should Not Break It

At least one FDA label for a product containing Ferric Citrate says to take it with food. If you take American Elder on an empty stomach out of habit, keep them separate — and take Ferric Citrate with a meal where the label says to.

This may not be true of your version. Food instructions belong to the product, not the ingredient: two Ferric Citrate products can carry different directions, and extended-release forms often differ from immediate-release ones. The label we read is quoted below — check the directions on your own box or bottle, or ask your pharmacist, for how to take the exact product you were given.

( 2.2 ) 2.1 Dosage for Hyperphosphatemia in Chronic Kidney Disease on Dialysis The recommended starting dose is 2 tablets, swallowed whole, 3 times per day with meals.

From the Dosage and Administration section of the FDA label we read for Ferric Citrate — where that label names a specific product, the instruction is that product's. Read the label on DailyMed ›

A food rule is not an interaction — it is about how much of the medicine you absorb. The directions that came with your own product, and your pharmacist, outrank anything on this page.

Everything else you take

See Every Supplement That Interacts With Ferric Citrate

This page covers American Elder only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ferric Citrate page lists 17 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Coffee Charcoal (moderate), European Mandrake (moderate), Glucomannan (moderate) and Guar Gum (moderate).

By severity: 1 major · 7 moderate · 9 minor.

From our pharmacist’s overview on the Ferric Citrate page

“Ferric citrate (Auryxia) does its work in the gut, binding dietary phosphate in kidney disease or supplying iron, and all 17 supplements on this list can interfere with how oral medicines get absorbed. That is worth real caution, starting with the single major-rated entry, activated charcoal, which adsorbs many drugs directly and can m…”

Reviewed by 2 · Jul 18, 2026

Open the Ferric Citrate 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. Even though American Elder itself has no known interaction with Ferric Citrate, another ingredient on your label might. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where American Elder and Ferric Citrate 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

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

29 days ago today
Medication Ferric Citrate
Steady interest

#2,380 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.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every American Elder reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 20, 2026. The American Elder and Ferric Citrate records this page draws on were last updated July 10, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
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.

Sambucus canadensis · Adoxaceae · Ripe berries (fruit) and flowers; other parts are considered unsafe · Syrups, capsules, gummies, lozenges, teas, tinctures, juices, and jams

An interaction check asks whether these two react with each other — it does not ask whether American Elder is a good idea for someone in your situation. Here is what our American Elder record says about it on its own.

American Elder: dosing

There is no official standardized dose for American elder, and products vary widely in strength and form. Syrups, gummies, capsules, and teas all contain different amounts of elderberry.The safest approach is to follow the directions on the product label and not exceed the recommended amount.

From our American Elder monograph — the full record covers uses, side effects and every documented interaction.

Read the full American Elder monograph & all interactions
Medication

About Ferric Citrate

What Is Ferric Citrate Used For?

Brand name: Auryxia

Ferric citrate tablets — sold as Auryxia and under the generic name Ferric Citrate — are approved for two related uses in adults with chronic kidney disease (CKD).

For patients on dialysis, they work as a phosphate binder to control high phosphorus (hyperphosphatemia) levels in the blood. For patients with CKD who are not on dialysis, they serve as an iron replacement to treat iron deficiency anemia.

Most-Reported Side Effects for Ferric Citrate

From FAERS, the FDA’s public side-effect reporting system (0 reports, all brands). Reports are voluntary and are not proof the drug caused the effect.

Diarrhea 307 reports
Serum ferritin increased 228 reports
Transferrin saturation increased 169 reports
Faeces discoloured 118 reports
Constipation 83 reports
See full Ferric Citrate 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
644Moderate
0Minor
2,185No known interaction
644 Moderate 2,185 No interaction
Moderate

644 interactions

Showing 60 of 644 moderate interactions — see all 644 on the American Elder page.

No interaction 2,185 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 2,185 medications checked with no known interaction — see the full American Elder list.

See the full American Elder interactions page
See every supplement checked against Ferric Citrate, ranked by severity
Evidence & sources

American Elder References

The 2 references that drive our American Elder monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
  2. 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

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking American Elder and Ferric Citrate Together: Common Questions

Is it safe to take American Elder with Ferric Citrate?
We do not list a known interaction between American Elder and Ferric Citrate. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
Do American Elder and Ferric Citrate have any of the same side effects?
Yes — our sources link each of them separately to 2 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.
Should I take American Elder and Ferric Citrate at the same time of day?
At least one FDA label for a product containing Ferric Citrate says to take it with food. If you take American Elder on an empty stomach out of habit, keep them separate and take Ferric Citrate with a meal where the label says to. Food instructions belong to the product rather than the ingredient — two Ferric Citrate products can differ — so check the directions on your own box. This is about absorption, not an interaction.
How was the American Elder and Ferric Citrate combination checked?
Interactions in our licensed database are recorded against drug classes. Ferric Citrate is filed under 1 classification, and American Elder has documented interactions with 2 drug classes — none of Ferric Citrate's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does American Elder interact with any other medications?
Yes. American Elder has 644 documented drug interactions in our database — Ferric Citrate is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Ferric Citrate interact with any supplements?
Yes. Ferric Citrate has documented interactions with 17 supplements in our database — American Elder is not one of them. The Ferric Citrate interaction page linked on this page lists every one, ranked by severity.

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

Where next

Keep Exploring

American Elder monograph Uses, safety profile, and every drug interaction in one place Ferric Citrate drug information The full plain-English guide to this medication Ferric Citrate supplement interactions Every supplement checked against Ferric Citrate, ranked by severity Supplement interaction checker Check any supplement or product against your medications Browse medications A–Z Every drug we’ve checked against herbs & supplements References The 2 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Ferric Citrate 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.