Herb & supplement monograph

American Elder Drug Interactions, Uses, Effectiveness, Safety & More

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS ·Updated July 2026

What is this page for?

First and foremost: how American Elder interacts with medications. The heart of this page is the interaction list — every drug American Elder is known to interact with, and how serious each one is.

But these pages have grown well beyond that into a full monograph — what American Elder is, what people use it for and how strong the evidence is, its safety and side effects, and answers to the questions we’re asked most — written and reviewed by the clinical staff at HelloPharmacist. It’s educational information from our licensed clinical databases, not medical advice, and we don’t sell or endorse products. Our editorial policy

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On this page

American Elder Drug Interactions: The Bottom Line

From the HelloPharmacist Editorial Team · Updated July 2026

Based on the available evidence, the overall risk of a clinically significant American Elder drug interaction appears low for most people, since nearly every listed interaction is theoretical. None of the interactions are rated major, and almost all of them trace back to a single lab-based finding rather than effects seen in people.

Interactions deserving the most attention

The interaction that deserves the most attention involves lithium, a medicine kept within a narrow blood-level range. American elder is thought to act as a mild diuretic, which could reduce how much lithium the body clears and raise its levels. This concern is better supported than the others, though it is still based on the herb's expected properties rather than direct human study. Beyond lithium, no single medication stands out as a proven problem.

What the rest of the list means

The long list of interacting medications comes almost entirely from one laboratory finding that American elder may slow an enzyme the body uses to clear many common drugs. That effect has only been seen in lab research, not in people, so a medication appearing on the list does not mean the combination has caused harm.

Check your medications against American Elder

Based on HelloPharmacist’s American Elder interaction data and reviewed under our editorial standards.

Interaction report

Drugs that interact with American Elder

646 medications have a known interaction with American Elder, graded by severity. Select any drug for the full evidence-based detail.

Don’t want to scroll the list? Just ask.

Tell us the medications you take and we’ll check each one against American Elder using our pharmacist-reviewed interaction data.

AI summaries are generated from our American Elder interaction data for education only — always confirm with your pharmacist. How we use AI

2,830 drugs

Read The List Like a Pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
Probable. Interaction 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.
Possible. 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
Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
Each drug listed above links to the full report for that exact American Elder combination — clinical detail, likelihood, evidence level, and citations.
Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

The big picture

The kinds of drugs American Elder affects

Every type of medication (drug category) American Elder is known to interact with. Open any category for the detail — or search your exact drug in the checker above.

All 2 drug categories American Elder interacts with

Cytochrome P450 3a4 (cyp3a4) SubstratesLithium

Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, taking American elder might increase levels of CYP3A4 substrates.
In vitro research shows that American elder inhibits CYP3A4 enzymes.

Likelihood Possible Evidence D

Lithium

Theoretically, American elder might reduce excretion and increase levels of lithium.
American elder is thought to have diuretic properties. Theoretically, American elder might reduce the excretion of lithium, increasing serum levels.

Likelihood Probable Evidence D

Monograph

American Elder: Uses, Safety & Side Effects

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS · Reviewed July 2026 ·

The bottom line

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.

Scientific name: Sambucus canadensis
Family: Adoxaceae
Part used: Ripe berries (fruit) and flowers; other parts are considered unsafe
Common forms: Syrups, capsules, gummies, lozenges, teas, tinctures, juices, and jams

People commonly use it for

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

Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.

Safety at a glance

OverallUse caution

Cooked ripe berries and flowers are generally well tolerated, but raw or unripe berries and other plant parts can be toxic.

PregnancyLikely 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...

Read the full pregnancy detail

BreastfeedingLikely 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...

Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

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Overview

American elder (Sambucus canadensis) is a flowering shrub native to North America. It produces large clusters of small white or cream-colored flowers and dark blue-purple berries. The plant is closely related to European black elder (Sambucus nigra), which is the type most often found in supplements.

People have long used the cooked, ripe berries and the flowers in foods such as jams, syrups, and teas. In supplement form, elderberry is most popular as a syrup, gummy, or capsule taken for colds, flu, and general immune support.

It is important to know that only the ripe berries (cooked) and the flowers are considered usable. The leaves, stems, bark, roots, seeds, and raw or unripe berries contain compounds that can release cyanide and cause illness.

How it works

Elderberries are rich in plant pigments called anthocyanins and other flavonoids, which act as antioxidants in laboratory tests. Researchers believe these compounds may affect inflammation and parts of the immune response.

Some lab studies suggest elderberry extracts may interfere with how certain viruses enter or multiply in cells. However, most of this work was done in test tubes or animals, and results from a dish do not always carry over to people.

In short, the proposed mechanisms are plausible but not firmly proven in humans, and the active amounts needed are not well defined.

Effectiveness

Does American Elder work?

Here’s what the research actually shows for each use — graded by Natural Medicines and reviewed by Dr. Brian Staiger, PharmD.

Evidence overview · 12 uses evaluated

12 Insufficient evidence

How to read these evidence grades

Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.

1EffectiveStrong, consistent evidence it works.

2Likely EffectiveGood evidence, though not yet conclusive.

3Possibly EffectiveSome evidence suggests a benefit.

4Possibly IneffectiveSome evidence it may not help.

5Likely IneffectiveFairly strong evidence it doesn’t help.

6IneffectiveStrong evidence it doesn’t work.

7Insufficient Reliable Evidence to RateToo little research to say either way.

For American Elder, current evidence isn’t strong enough to rate any specific use. The conditions it has been studied for are listed below.

Also studied for 12 conditions — evidence insufficient to rate

Insufficient Reliable Evidence To Rate Asthma