Herb & supplement monograph

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

But these pages have grown well beyond that into a full monograph — what Elderberry 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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Elderberry 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 Elderberry drug interaction appears low for most people. None of the listed interactions are rated major, and all of them rest on theoretical or very limited evidence rather than well-documented human studies.

Interactions deserving the most attention

The concern that stands out most involves immunosuppressants. Elderberry can stimulate the immune system, so in theory it could work against medicines meant to calm immune activity, such as those used after an organ transplant or for autoimmune conditions. There is also a single report of serious liver injury in a person taking the cancer medicine pazopanib along with elderberry, though one case cannot prove elderberry was the cause. If you take medicines in either group, this combination deserves a closer look.

What the rest of the list means

The long list of interacting medications mostly reflects that one theoretical immune concern applied across many different immune-suppressing drugs. None of these interactions has been confirmed in well-controlled human studies, so a medicine appearing on the list does not mean the combination has been shown to cause harm in people.

Check your medications against Elderberry

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

Interaction report

Drugs that interact with Elderberry

121 medications have a known interaction with Elderberry, 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 Elderberry using our pharmacist-reviewed interaction data.

AI summaries are generated from our Elderberry 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 Elderberry 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 Elderberry affects

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

All 2 drug categories Elderberry interacts with

ImmunosuppressantsPazopanib (votrient)

Immunosuppressants

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.

Likelihood Possible Evidence B

Pazopanib (Votrient)

Theoretically, elderberry might interact with pazopanib, potentially increasing the risk of adverse effects.
In one case, a 65-year-old patient taking pazopanib for 4 weeks for soft-tissue sarcoma developed severe nausea, loose stools, and elevated alanine transaminase and aspartate transaminase levels and was diagnosed with grade 3 liver injury. The patient reported taking elderberry supplements for 2 years, dose unspecified, and was also taking a multivitamin and a calcium supplement. The patient's symptoms and liver enzyme levels improved upon discontinuation of pazopanib and all supplements. Pazopanib treatment was re-initiated, at a lower dose, with no further evidence of liver injury. It was unclear in this case report if the elderberry supplements were derived from the berry, the flower, or the combination.

Likelihood Possible Evidence D

Monograph

Elderberry: Uses, Safety & Side Effects

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

The bottom line

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.

Scientific name: Sambucus nigra
Family: Adoxaceae
Part used: Berries and flowers (ripe, cooked fruit and dried flowers)
Common forms: Syrup, gummies, lozenges, capsules, tablets, teas, and liquid extracts

People commonly use it for

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

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

Safety at a glance

OverallUse caution

Properly prepared (cooked) elderberry products are generally well tolerated, but raw or unripe berries, leaves, bark, and seeds can be toxic.

PregnancyLikely Safe

When consumed in the amounts typically found in foods. There is insufficient reliable information available about the safety of elderberry when used f...

Read the full pregnancy detail

BreastfeedingLikely Safe

When consumed in the amounts typically found in foods. There is insufficient reliable information available about the safety of elderberry when used f...

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

Elderberry comes from the Sambucus plant, a shrub or small tree that produces clusters of small dark purple or black berries. Sambucus nigra (black elder) is the species most often used in supplements, though American elder (Sambucus canadensis) is also used. The plant is native to Europe, parts of Asia, and North America.

People have used elderberry in traditional medicine for centuries. The ripe, cooked berries and the flowers are the parts most commonly used. Today elderberry is one of the most popular over-the-counter supplements, especially during cold and flu season. It is sold as syrups, gummies, lozenges, capsules, and teas, and the berries are also used in foods like jams, jellies, and wine.

How it works

Elderberries are rich in compounds called anthocyanins and other flavonoids, which are natural plant pigments with antioxidant properties. Laboratory studies suggest these compounds may have some antiviral activity and may affect parts of the immune system.

It is important to know that much of this research has been done in test tubes or animals, not in people. So while these mechanisms are promising in the lab, they do not prove that taking elderberry will produce the same effects in the human body.

Effectiveness

Does Elderberry work?

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

Evidence overview · 16 uses evaluated

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

Also studied for 16 conditions — evidence insufficient to rate

Insufficient Reliable Evidence To Rate Allergic rhinitis (hay fever)