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Dietary supplement

Black Elderberry Syrup Ingredients & Drug Interactions

by Gaia Herbs

Liquid Category: Botanical
Most serious interaction: Moderate
The interaction bottom line Most serious interaction: Moderate

Black Elderberry Syrup is a dietary supplement by Gaia Herbs with 2 active ingredients. Its ingredients are commonly taken for colds, flu (influenza), other respiratory infections.Based on those ingredients, 247 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are Acerola fruit extract, Black Elderberry (Sambucus nigra) fruit juice concentrate. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

HelloPharmacist Scorecard of Black Elderberry Syrup by Gaia Herbs

Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.

From our pharmacy team — supplement deep dive

What’s inside

Full disclosure
Ingredient Transparency · database check
Full

Every active ingredient lists its own amount on the label.

Why this rating?
  • The label discloses an exact amount for 2 of its 2 active ingredients.
  • No proprietary blends here — you can verify the dose of every single component.

This syrup has two active ingredients. Black elderberry fruit juice concentrate is the main one—a traditional remedy for cold and flu season, though the evidence for most of those uses isn't yet solid enough to rate.

Acerola fruit extract adds vitamin C; it's rated possibly effective for treating vitamin C deficiency. The product also contains inactive ingredients: cane sugar, water, and lemon fruit juice, which serve as sweeteners, solvent, and flavoring.

Does it work?

Not established
Evidence for Intended Use · database check
By FDA rules, dietary supplements can’t claim to treat, cure, or prevent disease — so labels speak in careful marketing language. We discern each product’s intended use from its name, label claims, and label statements, then grade the clinical evidence for that use. How these ratings are computed
Not established

The graded evidence we hold for these ingredients covers different conditions than the ones this product is marketed for, so there's no established rating for its stated use.

Why this rating?
  • The label markets this product for: immune support.
  • We looked for evidence on: Common cold, Upper respiratory tract infection (URTI), Lower respiratory tract infections, Respiratory tract infections, Rhinosinusitis, Flu — and 2 related terms.
  • The closest evidence on file: Elderberry is rated "Insufficient Reliable Evidence To Rate" for Respiratory tract infections (Natural Medicines).
  • Also on file: Elderberry is rated "Insufficient Reliable Evidence To Rate" for Rhinosinusitis, Upper respiratory tract infection (URTI), Lower respiratory tract infections.
  • Also on file: Acerola is rated "Insufficient Reliable Evidence To Rate" for Common cold.

The evidence for black elderberry isn't established for hay fever, heart disease, chronic fatigue, lung disease, thinking and memory, or respiratory infections—our data simply rates all of these as insufficient. Acerola's vitamin C can address a true vitamin C deficiency, but beyond that, evidence for cold prevention and other uses isn't solid either.

The evidence, ingredient by ingredient Elderberry Acerola

How safe is it?

Well-documented data
Safety Information · database check
Well characterized

Adverse-effect, pregnancy, and general safety data are on file for most of these ingredients.

Why this rating?
  • We hold adverse-effect (side-effect) data for 2 of the 2 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 2 of 2.
  • General safety write-ups exist for 2 of 2.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Properly prepared elderberry syrup like this one is generally well tolerated when taken as directed. Because this product is cooked, you're not at risk from the raw berries' toxins (cyanogenic glycosides), which can cause nausea, vomiting, diarrhea, weakness, and dizziness.

One rare case of autoimmune hepatitis has been reported after long-term elderberry use in someone with underlying autoimmune disease; another reported liver injury linked to taking pazopanib alongside elderberry. There isn't enough safety data to recommend this during pregnancy or while breastfeeding.

Acerola in food amounts is considered safe, but concentrated supplement safety isn't well studied. A rare allergy has been reported (one case of rash and breathing difficulty in a person with latex sensitivity).

Side effects, ingredient by ingredient Elderberry Acerola

Meds to double-check

Moderate interaction found
Known Interaction Concern · database check
Moderate identified

The most serious documented interaction for these ingredients is Moderate. Check your medications for a personalized result.

Why this rating?
  • 2 of the 2 matched ingredients can interact with medications — Elderberry, Acerola.
  • The most serious interaction on file is rated Moderate.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; immunosuppressants / transplant drugs; cancer treatments.
  • For scale: 247 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.

Check before use if you take immunosuppressants (used after organ transplant or for autoimmune disease), pazopanib for cancer, chemotherapy drugs (alkylating agents or antitumor antibiotics), estrogen-based birth control or hormone replacement therapy, warfarin or other blood thinners, aspirin, or aluminum-containing antacids.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFully disclosed formula with no established evidence rating for its marketed use. Moderate medication interactions have been identified, and safety information is well characterized.

This syrup is well tolerated by most people at label dose, but it's not proven to prevent or treat colds or flu, and the evidence for other respiratory uses isn't there yet. If you take any immunosuppressant, pazopanib, chemotherapy, estrogen-based birth control or hormone therapy, or blood thinners like warfarin, check your specific medications with the tool on this page before starting.

Talk to your pharmacist if you're pregnant, breastfeeding, or have autoimmune disease.

Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI

Assessment coverage: 2 of 2 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Jul 21, 2022.

This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed

At a glance

General information

Key facts about Black Elderberry Syrup, straight from the product label.

Brand Gaia Herbs
Net contents 3 Fluid Ounce(s); 89 Milliliter(s)
Market status On market
Date entered into DSLD Jul 21, 2022
DSLD ID 270980
Product type Botanical
Supplement form Liquid
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Children 4 or More Years of Age, Vegan, Vegetarian, Adult (18 - 50 Years), Women (not pregnant or lactating), Organic
From the label
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.

Supplement Facts

The label details for Black Elderberry Syrup by Gaia Herbs, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
1.25 mL, 5 mL
Maximum serving Sizes:
1.25 mL, 5 mL
Servings per container
18
IngredientAmount% DV
Calories0 Calorie(s), 20 Calorie(s)--
Total Carbohydrates1 Gram(s), 4 Gram(s)1%, 2%
Added Sugars1 Gram(s), 4 Gram(s)4%, 8%
Total Sugars1 Gram(s), 4 Gram(s)--
Black Elderberry (Sambucus nigra) fruit juice concentrate476 mg, 1903 mg--
Acerola fruit extract37 mg, 147 mg--

Other ingredients: Cane Sugar, Water, Lemon fruit juice

Tap any ingredient to jump to its full detail below.

Label statements
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
Formulation

New look same formula

Immune support Traditionally taken for immune health A delicious daily tonic for the whole family

USDA Organic Certified Organic by Oregon Tilth

Product of Italy

Vegan

Gluten-free Soy-free

Seals/Symbols

USDA Organic

Integrity Purity Potency EST 1987 USA Certified B Corporation

General Statements

Our bestselling formula

meetyourherbs.com Gaia Herbs delivers unprecedented traceability by screening every product and sharing the results online. See for yourself, and learn more about your herbs, by entering the unique ID # below at meetyourherbs.com

Purity - Keep it clean All products are screened for pesticides, microbes & heavy metals. Integrity - Keep it real See the proof at meetyourherbs.com, the world's first herb traceability platform. Potency - Keep it strong Concentrated plant extracts are delivered in our patented Phyto-Caps technology. Discover our guiding truths at: Facebook Instagram @gaiaherbs

A partnership of mutual beliefs Black Elderberry NightTime Syrup is produced in Tuscany, Italy, by Aboca, the herbal supplement leader in Europe since 1978. Gaia Herbs' partnership with Aboca is born from a mutual belief in sustainable product development, dedication to quality, and a deep respect for science and nature working in harmony. Aboca

FDA Statement of Identity

Herbal Supplement

Formula

Each teaspoon contains the equivalent of 14.5 g (14,500 mg) of fresh Elderberries.

Suggested/Recommended/Usage/Directions

Suggested Use Adults & kids (ages 4+): 1 teaspoon daily Ages 1-3: 1/4 teaspoon daily For additional support, ages 12 & up may take 1 teaspoon, 2 times daily. Shake well before use.

Consume within 6 months of opening.

Storage

Refrigerate after opening.

Precautions

Not for use during pregnancy or lactation. If you have a medical condition or take medications, please consult with your doctor before use.

Store away from children.

Do not use if cap seal is broken.

FDA Disclaimer Statement

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Brand IP Statement(s)

Gaia Herbs Connecting plants & people since 1987

See for yourself

Black Elderberry Syrup by Gaia Herbs label

The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.

What’s inside

The Ingredients in Black Elderberry Syrup by Gaia Herbs

These are the 2 active ingredients this product is made of. Select any to open its full monograph.

Serving size1.25 mL Dosage formLiquid Servings per container18 Amounts shown are per serving.

Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.

476 mg per serving

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 sym...

Black Elderberry (Sambucus nigra) fruit juice concentrate monograph & interactions

Acerola fruit extract

Interacts with
128 drugs
37 mg per serving

Acerola is a small tropical fruit prized for its very high natural vitamin C content, and it is mostly used as a food-based source of vitamin C and an...

Acerola fruit extract monograph & interactions

Other (inactive) ingredients: Cane Sugar, Water, Lemon fruit juice. These complete the product’s ingredient list but are not active constituents.

Interaction report

Black Elderberry Syrup by Gaia Herbs Drug Interactions

Want to check YOUR meds against Black Elderberry Syrup?

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Go to the checker
247Drugs
158 Moderate 89 Minor

Ingredients driving the most interactions

Each ingredient & the kinds of drugs it affects

For each ingredient in Black Elderberry Syrup with known interactions, here are the types of medications they can affect. Open any type for the detail — or search your exact drug in the checker above.

Acerola fruit extract6 drug types · 128 drugs

Alkylating Agents

Theoretically, the antioxidant effects of acerola might reduce the effectiveness of alkylating agents.
Acerola contains vitamin C, an antioxidant. There is concern that antioxidants might reduce the activity of chemotherapy drugs that generate free radicals, such as alkylating agents. In contrast, other researchers theorize that antioxidants might make alkylating chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin C have on chemotherapy.

Likelihood Possible Evidence D
Antitumor Antibiotics

Theoretically, the antioxidant effects of acerola might reduce the effectiveness of antitumor antibiotics.
Acerola contains vitamin C, an antioxidant. There is concern that antioxidants might reduce the activity of chemotherapy drugs that generate free radicals, such as antitumor antibiotics. In contrast, other researchers theorize that antioxidants might make antitumor antibiotic chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effects, if any, antioxidants such as vitamin C have on antitumor antibiotic chemotherapy.

Likelihood Possible Evidence D
Aluminum

Theoretically, concomitant use of acerola with aluminum salts might increase the amount of aluminum absorbed.
Acerola contains vitamin C. It is thought that vitamin C chelates aluminum, keeping it in solution and available for absorption. In people with normal renal function, urinary excretion of aluminum likely increases, making aluminum retention and toxicity unlikely. However, patients with renal failure who take aluminum-containing compounds, such as phosphate binders, should avoid acerola in doses that provide more vitamin C than the recommended dietary allowances.

Likelihood Possible Evidence D
Aspirin

Theoretically, acerola might reduce the clearance of aspirin; however, its vitamin C content is likely too low to produce clinically significant effects.
Acerola contains vitamin C. It has been suggested that acidification of the urine by vitamin C can decrease the urinary excretion of salicylates, increasing plasma salicylate levels. However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion. The vitamin C content of acerola is typically about 2000 mg per 100 grams. Thus, a clinically significant interaction between acerola and aspirin is unlikely.

Likelihood Unlikely Evidence B
Estrogens

Theoretically, concomitant use of acerola with estrogens might increase estrogenic effects.
Acerola contains vitamin C. Increases in plasma estrogen levels of up to 55% have occurred under some circumstances when vitamin C is taken concurrently with oral contraceptives or hormone replacement therapy, including topical products. It is suggested that vitamin C prevents oxidation of estrogen in the tissues, regenerates oxidized estrogen, and reduces sulfate conjugation of estrogen in the gut wall. When tissue levels of vitamin C are high, these processes are already maximized and supplemental vitamin C does not have any effect on estrogen levels. However, increases in plasma estrogen levels may occur when women who are deficient in vitamin C take supplements.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, acerola might reduce the effectiveness of warfarin; however, its vitamin C content is likely too low to produce clinically significant effects.
Acerola contains vitamin C. High doses of vitamin C may reduce the response to warfarin, possibly by causing diarrhea and reducing warfarin absorption. This occurred in two people who took up to 16 grams daily of vitamin C, and resulted in decreased prothrombin time. Lower doses of 5-10 grams daily of vitamin C can also reduce warfarin absorption, but this does not seem to be clinically significant. The vitamin C content of acerola is typically about 2000 mg per 100 grams. Thus, a clinically significant interaction between acerola and warfarin is unlikely.

Likelihood Unlikely Evidence D

Black Elderberry (Sambucus nigra) fruit juice concentrate2 drug types · 121 drugs

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
The maker

Brand information

Manufacturer and brand details for Black Elderberry Syrup, from the product label.

Gaia Herbs

See all Gaia Herbs products
Name
Gaia Herbs, Inc.
Street Address
101 Gaia Herbs Drive
City
Brevard
State
NC
ZipCode
28712
Web Address
www.gaiaherbs.com
Pharmacist Counseling Corner

Black Elderberry Syrup by Gaia Herbs: Common Questions

Does Black Elderberry Syrup by Gaia Herbs interact with any medications?
Yes. Based on its ingredients, Black Elderberry Syrup has a known interaction with 247 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Black Elderberry Syrup contains 2 active ingredients, and an interaction can come from any of them. We check every ingredient, combine the results into one list per medication, and show which ingredient and mechanism is responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.
Is it safe to take this while I'm on birth control?
Acerola's vitamin C could theoretically increase how much estrogen your body absorbs from hormonal birth control, but the amount of vitamin C in this syrup is likely too low to cause a real problem. Still, mention it to your pharmacist or doctor, especially if you're concerned about breakthrough bleeding.
Can I use this to prevent colds?
There isn't reliable evidence that elderberry prevents or treats the common cold. The same goes for acerola's vitamin C in this context. You might use it anyway if you like, but don't count on it to keep you from getting sick.
What happens if I take this with chemotherapy?
The vitamin C in acerola may theoretically interfere with how certain cancer drugs work. If you're undergoing chemotherapy, ask your oncologist before starting any supplement, including this one.
Is this syrup safe if I'm pregnant?
There isn't enough safety information about elderberry supplements in pregnancy, so it's best to avoid this product until you talk with your doctor or midwife. It's the same for breastfeeding.
What if I'm allergic to latex?
One case report described a severe reaction (rash and breathing trouble) to acerola juice in a person with a latex allergy, due to cross-reactivity. If you have a latex allergy, talk to your pharmacist before using this product.
Why does the label say not to use raw elderberries?
Raw and unripe elderberries, and the seeds and leaves, contain a toxin (cyanogenic glycosides) that causes nausea, vomiting, and diarrhea. This syrup is cooked, which eliminates that toxin, so it's safe in that regard.

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

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Label information is sourced from the NIH Dietary Supplement Label Database and reflects the product version on file; always read your actual product label. This page is for education only and is not a substitute for professional medical advice. Confirm with your pharmacist or doctor before combining supplements and medications.

Black Elderberry Syrup label
Sources

Sources & How We Checked

Black Elderberry Syrup's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.

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

The 26 references behind this product’s interaction data

Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.

Elderberry 6 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..
  2. Elderberry (Sambucus species). The Poison Plant Patch, Novia Scotia Museum, 2007. Available at: http://museum.gov.ns.ca/poison/?section=species&id=117 (Accessed 16 October 2009).
  3. European elder. Canadian Poisonous Plants Information System. Available at: http://www.cbif.gc.ca/pls/pp/ppack.jump?p_null=all&p_psn=121&p_type=all&p_sci=comm&p_x=px (Accessed 16 October 2009).
  4. Raus K, Pleschka S, Klein P, Schoop R, Fisher P. Effect of an echinacea-based hot drink versus oseltamivir in Influenza treatment: a randomized, double-blind, double-dummy, multicenter, noninferiority clinical trial. . Curr Ther Res Clin Exp. 2015;20;77:6 PubMed
  5. Ramachandran A, Antala D, Pudasainee P, Panginikkod S, Gupta H. A Plausible Association Between the Use of Elderberry and Autoimmune Hepatitis. Cureus 2022;14(4):e24250. PubMed
  6. Agarwal N, Mangla A. Elderberry interaction with pazopanib in a patient with soft-tissue sarcoma: A case report and literature review. Mol Clin Oncol 2024;20(5):36. PubMed

See these in context on the Elderberry monograph →

Acerola 20 references
  1. Back DJ, Breckenridge AM, MacIver M, et al. Interaction of ethinyloestradiol with ascorbic acid in man. Br Med J (Clin Res Ed) 1981;282:1516.
  2. Morris JC, Beeley L, Ballantine N. Interaction of ethinyloestradiol with ascorbic acid in man [letter]. Br Med J (Clin Res Ed) 1981;283:503.
  3. Labriola D, Livingston R. Possible interactions between dietary antioxidants and chemotherapy. Oncology 1999;13:1003-8.
  4. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.
  5. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: National Academy Press, 2000. Available at: http://www.nap.edu/books/0309069351/html/.
  6. Rosenthal G. Interaction of ascorbic acid and warfarin. JAMA 1971;215:1671. DOI
  7. Hume R, Johnstone JM, Weyers E. Interaction of ascorbic acid and warfarin. JAMA 1972;219:1479. DOI
  8. Smith EC, Skalski RJ, Johnson GC, Rossi GV. Interaction of ascorbic acid and warfarin. JAMA 1972;221:1166. DOI
  9. Domingo JL, Gomez M, Llobet JM, Richart C. Effect of ascorbic acid on gastrointestinal aluminum absorption (letter). Lancet 1991;338:1467.
  10. Domingo JL, Gomez M, Llobet JM, Corbella J. Influence of some dietary constituents on aluminum absorption and retention in rats. Kidney Int 1991;39:598-601. PubMed
  11. Partridge NA, Regnier FE, White JL, Hem SL. Influence of dietary constituents on intestinal absorption of aluminum. Kidney Int 1989;35:1413-7. PubMed
  12. Mc Leod DC, Nahata MC. Inefficacy of ascorbic acid as a urinary acidifier (letter). N Engl J Med 1977;296:1413. DOI
  13. Hansten PD, Hayton WL. Effect of antacid and ascorbic acid on serum salicylate concentration. J Clin Pharmacol 1980;20:326-31. PubMed
  14. Vihtamaki T, Parantainen J, Koivisto AM, et al. Oral ascorbic acid increases plasma oestradiol during postmenopausal hormone replacement therapy. Maturitas 2002;42:129-35. PubMed
  15. Feetam CL, Leach RH, Meynell MJ. Lack of a clinically important interaction between warfarin and ascorbic acid. Toxicol Appl Pharmacol 1975;31:544-7. PubMed
  16. Weintraub M, Griner PF. Warfarin and ascorbic acid: lack of evidence for a drug interaction. Toxicol Appl Pharmacol 1974;28:53-6. PubMed
  17. Prasad KN. Rationale for using high-dose multiple dietary antioxidants as an adjunct to radiation therapy and chemotherapy. J Nutr 2004;134:3182S-3S. PubMed
  18. Conklin KA. Cancer chemotherapy and antioxidants. J Nutr 2004;134:3201S-3204S. PubMed
  19. Denadai R, Souza FM, Valle MR. Fecal impaction by rectal acerola bezoar. Indian J Pediatr 2013;80(5):432-3. PubMed
  20. Raulf-Heimsoth M, Stark R, Sander I, et al. Anaphylactic reaction to apple juice containing acerola: cross-reactivity to latex due to prohevein. J Allergy Clin Immunol 2002;109(4):715-6. PubMed

See these in context on the Acerola monograph →

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

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