Drug & supplement interaction

Elderberry + Azathioprine

Azathioprine brand names: Imuran, Azamune.

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

Elderberry has a moderate interaction with Azathioprine. Theoretically, elderberry might interfere with immunosuppressant therapy due to its immunostimulant activity.

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

Elderberry and Azathioprine

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

Moderate

IMMUNOSUPPRESSANTS

Why this applies to Azathioprine

Azathioprine falls under IMMUNOSUPPRESSANTS — the group Elderberry interacts with.

Theoretically, elderberry might interfere with immunosuppressant therapy due to its immunostimulant activity.
Elderberry has immunostimulant activity, increasing the production of cytokines, including interleukin and tumor necrosis factor.
Severity Moderate Likelihood Possible Evidence B

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 tug-of-war to keep in mind: azathioprine works by calming down your immune system, which is exactly what you want after a kidney transplant or with stubborn rheumatoid arthritis. Elderberry seems to do the opposite. In lab and animal studies, it appears to rev up the immune system by boosting signals like interleukins and tumor necrosis factor. So in theory, elderberry could push against the very effect azathioprine is trying to create.

If that happened, you might see your condition act up again, like more joint pain and swelling, or in transplant patients, a worry about the body turning on the new organ. I want to be honest though: this is mostly theory, not proven in people. Because azathioprine is such an important medication, please don't start or stop elderberry without checking with your doctor or pharmacist first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Barak V, Halperin T, Kalickman I. The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. Eur Cytokine Netw 2001;12:290-6..

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

Elderberry Also Interacts With Other Medications

Elderberry has 120 moderate known drug interactions in our database — the Azathioprine one above is one of them. If you take anything else, check it against the full list below.

Moderate 120 No known interaction 2,710 (incl. Azathioprine)
Taking anything else?

Check Another of Your Medications Against Elderberry

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

From our Q&A

Questions About Elderberry or Azathioprine

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Elderberry or Azathioprine, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Azathioprine

This page covers Elderberry only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Azathioprine page lists 106 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Beer (major), Siberian Cocklebur (major), Wine (major) and Active Hexose Correlated Compound (ahcc) (moderate).

By severity: 4 major · 92 moderate · 10 minor.

From our pharmacist’s overview on the Azathioprine page

“Azathioprine (Imuran) quiets an overactive immune system, which is why people take it after a transplant or for autoimmune disease, and it is also why I read this interaction list with real caution. Fully half of the 106 supplements on file, 53 of them, appear because they stimulate immunity and could blunt the very effect you depend on.”

Reviewed by 2 · Jul 18, 2026

Open the Azathioprine interaction page

One more smart check

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

We hold 226 real supplement products containing Elderberry, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Elderberry. Your product may carry other ingredients that interact with Azathioprine too, on top of Elderberry — 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 Elderberry and Azathioprine 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 Elderberry
Top 25%

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

29 days ago today
Medication Azathioprine
Top 25%

#607 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 Elderberry

What is Elderberry?

Elderberry
  • Colds
  • Flu (influenza)
  • Other respiratory infections
  • Immune support
  • Sinus and upper respiratory symptoms

Elderberry is a popular herbal supplement, mainly taken to help with colds and flu. Some small studies suggest it may modestly shorten cold or flu symptoms, but the evidence is limited and not conclusive. Cooked berries and properly prepared products are generally well tolerated, but raw or unripe parts can cause nausea and should be avoided.

Read the full Elderberry monograph & all interactions
Medication

About Azathioprine

What Is Azathioprine Used For?

Brand names: Imuran, Azamune

Azathioprine is used alongside other medications to help prevent the body from rejecting a kidney transplant (renal homotransplantation). It is also used to treat active rheumatoid arthritis — reducing signs and symptoms in adults who have not responded well enough to other treatments.

Other pain relievers such as aspirin, NSAIDs, or low-dose steroids may be continued alongside azathioprine for rheumatoid arthritis. Combining azathioprine with disease-modifying antirheumatic drugs (DMARDs) has not been well studied and is not recommended.

See full Azathioprine drug information
Keep checking

Other Drugs & Elderberry

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

0Major
120Moderate
0Minor
2,709No known interaction
120 Moderate 2,709 No interaction
Moderate

120 interactions

Showing 60 of 120 moderate interactions — see all 120 on the Elderberry page.

No interaction 2,709 drugs checked — show the list

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

Showing the 60 most looked-up of 2,709 medications checked with no known interaction — see the full Elderberry list.

See the full Elderberry interactions page
See every supplement checked against Azathioprine, 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
Elderberry monograph › Uses, safety, and every drug interaction in one place Azathioprine supplement interactions › Every supplement checked against Azathioprine, ranked by severity Azathioprine 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 Elderberry and Azathioprine Together: Common Questions

Can you take Elderberry with Azathioprine?
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 Elderberry and Azathioprine 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 Azathioprine and Elderberry?

Our pharmacists answer your medication & supplement questions — free.

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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.