Interactions on record — worth a quick check against your medications. Based on 3 of 5 ingredients. Check your meds →
Dietary supplement

Elderberry, Zinc & Echinacea Syrup Ingredients & Drug Interactions

by NOW

Elderberry, Zinc & Echinacea Syrup label
See full label image
Liquid Category: Botanical With Nutrients
Most serious interaction: Moderate
Clinical methodology reviewed by · Updated Sep 9, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Elderberry, Zinc & Echinacea Syrup against your medications. The heart of this page is the interaction checker and the full interaction report — how this product’s ingredients may interact with prescription and over-the-counter medicines you may be taking.

Around that, we add a pharmacist’s high-level view of the product as a whole — what’s inside, the evidence for its stated use, how transparent the label is, and what safety data exists — so you can see the full picture in one place. It’s educational information from our licensed clinical databases and the clinical staff at HelloPharmacist — not medical advice — and we don’t sell or endorse products. Our editorial policy

The interaction bottom line Most serious interaction: Moderate

Elderberry, Zinc & Echinacea Syrup is a dietary supplement by NOW with 5 active ingredients. Its ingredients are commonly taken for zinc deficiency, immune support, cold symptoms.Based on those ingredients, 864 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are Echinacea purpurea, Elderberry, Zinc. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

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Check Your Meds Against Elderberry, Zinc & Echinacea Syrup by NOW

Ask about any prescription or over-the-counter medication and we check it for interactions with Elderberry, Zinc & Echinacea Syrup by NOW — and tell you which ingredient is responsible.

Pharmacist-reviewed data Checks every ingredient Answer in seconds
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HelloPharmacist Scorecard of Elderberry, Zinc & Echinacea Syrup by NOW

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

Generated from HelloPharmacist’s pharmacist-curated databases and editorial rules · Last generated Jul 11, 2026

What’s inside

Low disclosure
Ingredient Transparency · database check
Low

Most active ingredients don't disclose an individual amount — you can't tell how much of each you're getting.

Why this rating?
  • The label discloses an exact amount for 1 of its 5 active ingredients.
  • “Unique Blend of” is a proprietary blend — the label gives one combined amount (5 mL) without saying how much of each component you get.

This syrup contains 5 ingredients, two of which are active: zinc (in two forms—zinc and zinc gluconate) and echinacea purpurea. Zinc is an essential mineral important for immune function and wound healing.

Echinacea purpurea is a plant extract traditionally used to support immune health. The product also includes elderberry, though the effectiveness evidence for elderberry on conditions like colds and respiratory infections is not established in our data.

The remaining ingredients are inactive: vegetable glycerin and water, which serve as a base for the liquid formula.

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: all-season immune system support.
  • We looked for evidence on: Influenza, Bronchiolitis, HIV/AIDS, HIV/AIDS-related opportunistic infections, common cold, respiratory infections — and 1 related terms.
  • The closest evidence on file: Zinc is rated "Possibly Ineffective" for HIV/AIDS-related wasting (Natural Medicines).
  • Also on file: Zinc is rated "Possibly Ineffective" for HIV/AIDS-related pregnancy complications.
  • Also on file: Elderberry is rated "Insufficient Reliable Evidence To Rate" for HIV/AIDS.

Zinc is effective for zinc deficiency and likely effective for Wilson disease (a copper-metabolism disorder); it's possibly effective for acne, age-related macular degeneration, diabetes, and a rare skin condition called acrodermatitis enteropathica. Echinacea purpurea and elderberry have insufficient reliable evidence to rate them for the conditions they're commonly used for—allergies, heart health, fatigue, lung disease, cognitive function, and respiratory infections.

The evidence just isn't established in our data for those uses.

The evidence, ingredient by ingredient Zinc Elderberry Echinacea

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 3 of the 3 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 3 of 3.
  • General safety write-ups exist for 3 of 3.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Zinc is well tolerated in doses below the upper limit of 40 mg daily for adults; higher doses raise concerns about copper deficiency, which could lead to anemia and low white blood cell counts. At recommended doses, the most common side effects are abdominal cramps, diarrhea, a metallic taste, nausea, and vomiting—these are dose-related.

Echinacea is generally well tolerated short-term but can cause abdominal pain, diarrhea, nausea, rashes, and stomach upset; rare cases of severe allergic reactions (including anaphylaxis) and hepatitis have been reported, especially in people sensitive to ragweed and related plants. Elderberry made from ripe, cooked fruit is well tolerated; raw or unripe berries and plant parts contain toxins that cause nausea, vomiting, severe diarrhea, and other effects—but this product is properly prepared.

Pregnancy safety data for echinacea is limited, so avoidance is advised unless your doctor approves. For elderberry, safety information during pregnancy is insufficient; it's best to avoid supplements unless your doctor advises otherwise.

There is not enough information about echinacea or elderberry safety during breastfeeding.

Side effects, ingredient by ingredient Zinc Elderberry Echinacea

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?
  • 3 of the 3 matched ingredients can interact with medications — Elderberry, Echinacea, Zinc.
  • The most serious interaction on file is rated Moderate.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; immunosuppressants / transplant drugs.
  • For scale: 865 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.

Before you start, check your exact medications against these drug types: quinolone antibiotics, tetracycline antibiotics, cephalexin (Keflex), penicillamine (Cuprimine, Depen), ritonavir (Norvir), integrase inhibitors, bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy), cisplatin (Platinol-AQ), immunosuppressants, etoposide (VePesid), CYP1A2 substrates (including caffeine), CYP3A4 substrates, warfarin (Coumadin), lopinavir/ritonavir (Kaletra), midazolam (Versed), and pazopanib (Votrient). Altogether, these interactions span 850 individual medications.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFormula with limited ingredient disclosure with no established evidence rating for its marketed use. Moderate medication interactions have been identified, and safety information is well characterized.

This product is worth considering if you're deficient in zinc and want a convenient syrup form. If you take any antibiotics, HIV medications, cancer drugs, immunosuppressants, blood thinners, or sedatives, check with your pharmacist first—the interactions are real and timing matters.

Avoid during pregnancy or breastfeeding unless your doctor says it's okay.

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

Assessment coverage: 5 of 5 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated May 22, 2015.

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 Elderberry, Zinc & Echinacea Syrup, straight from the product label.

Brand NOW
Barcode (UPC) 733739048530
Net contents 4 fl. Oz.; 118 mL
Market status On market
Date entered into DSLD May 22, 2015
DSLD ID 44990
Product type Botanical With Nutrients
Supplement form Liquid
Dietary claims / uses Nutrient, All Other, Structure/Function
Intended target group(s) Vegan, Vegetarian, Adult (18 - 50 Years), Gluten Free, Dairy Free
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 Elderberry, Zinc & Echinacea Syrup by NOW, 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 tsp
Maximum serving Sizes:
1 tsp
Servings per container
24
UPC/BARCODE
733739048530
IngredientAmount% DV
Calories20 {Calories}--
Total Carbohydrates4 Gram(s)1%
Zinc5 mg33%
Zinc Gluconate0 NP--
Elderberry0 NP--
Elder0 NP--
Unique Blend of5 mL--
Echinacea purpurea0 NP--

Other ingredients: Vegetable Glycerin, Water

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.
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.

Formulation

~ All-Season Support*

~ No Added Sugar ~ Alcohol-Free

Vegetarian/Vegan

Not manufactured with wheat, gluten, soy, milk, egg, fish or shellfish ingredients.

Suggested/Recommended/Usage/Directions

Suggested Usage: Take 1 teaspoon 3 times daily, preferably on an empty stomach. Shake well before using.

General Statements

Elderberry, Zinc & Echinacea Syrup is a dietary supplement developed in an easy-to-use liquid form.

Healthy Immune Support*

Botanicals/Herbs Family owned since 1968.

Natural color variation may occur in this product.

Please Recycle.

Formula

Zinc is well known for its critical role in the support of healthy immune system function, and this convenient, great-tasting herb-mineral blend combines Echinacea, Elderberry and Zinc for all-season support.*

Precautions

Caution: For adults only.

Pregnant or nursing women: Do not use unless recommended by your physician. Consult physician if taking medication or have a medical condition.

Keep out of reach of children.

Not manufactured with wheat, gluten, soy, milk, egg, fish or shellfish ingredients. Produced in a GMP facility that processes other ingredients containing these allergens.

General

CODE 4853B V3

FDA Statement of Identity

A Dietary Supplement

Seals/Symbols

GMP QUALITY ASSURED

Storage

Store in a cool, dry, dark place after opening.

Is this label outdated? Report a formula or label change and our pharmacy team will review it.

See for yourself

Elderberry, Zinc & Echinacea Syrup by NOW label

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

Elderberry, Zinc & Echinacea Syrup label

Label images are published by the NIH Dietary Supplement Label Database for the version of this product on file. Always read your actual product label.

View the full label (PDF)
What’s inside

The Ingredients in Elderberry, Zinc & Echinacea Syrup by NOW

These are the 5 active ingredients this product is made of. Select any to open its full monograph.

Serving size1 tsp Dosage formLiquid Servings per container24 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.

Zinc

Interacts with
67 drugs
5 mg per serving Form: Zinc Gluconate

Zinc is an essential mineral that your body needs for immune function, wound healing, taste, and smell. Most people get enough from food, but suppleme...

Zinc monograph & interactions

Unique Blend of

5 mL per serving

Other (inactive) ingredients: Vegetable Glycerin, Water. These complete the product’s ingredient list but are not active constituents.

Interaction report

Elderberry, Zinc & Echinacea Syrup by NOW Drug Interactions

Want to check YOUR meds against Elderberry, Zinc & Echinacea Syrup?

Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.

 Go to the checker
864Drugs
861 Moderate 3 Minor

Ingredients driving the most interactions

Echinacea purpurea 816
Elderberry 121
Zinc 67

Individual Drug Interactions

The ingredients in Elderberry, Zinc & Echinacea Syrup interact with 864 drugs. Click any drug to see the details.

3 of the 5 ingredients in Elderberry, Zinc & Echinacea Syrup interact with drugs. Each result below shows which ingredient is responsible. Echinacea purpurea Elderberry Zinc

Each ingredient & the kinds of drugs it affects

For each ingredient in Elderberry, Zinc & Echinacea 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.

Echinacea purpurea12 drug types · 816 drugs

Caffeine

Echinacea can increase plasma levels of caffeine by inhibiting its metabolism.
Echinacea seems to increase plasma concentrations of caffeine by around 30%. This is likely due to inhibition of cytochrome P450 1A2 (CYP1A2) by echinacea.

Likelihood Probable Evidence B
Cytochrome P450 1A2 (Cyp1A2) Substrates

Echinacea might inhibit the metabolism of CYP1A2 and increase plasma levels of some drugs.
Echinacea appears to inhibit CYP1A2 enzymes in humans. Additionally, echinacea seems to increase plasma concentrations of caffeine, a CYP1A2 substrate, by around 30%. Theoretically, echinacea might increase levels of other drugs metabolized by CYP1A2.

Likelihood Possible Evidence B
Cytochrome P450 3A4 (Cyp3A4) Substrates

Echinacea may induce hepatic CYP3A4 and inhibit intestinal CYP3A4. This may increase or decrease levels of drugs metabolized by CYP3A4.
Several clinical trials have shown that taking echinacea for up to one month does not significantly affect the metabolism of various CYP3A4 substrates, including midazolam, docetaxel, etravirine, lopinavir-ritonavir, and darunavir-ritonavir. However, other clinical research shows that echinacea may increase the clearance of midazolam, suggesting that echinacea might induce CYP3A4. The discrepancy is thought to be due to differing effects of echinacea on intestinal versus hepatic CYP3A4 enzymes. Echinacea appears to induce hepatic CYP3A4 but inhibit intestinal CYP3A4. In some cases, these effects might cancel each other out, but in others, drug levels may be increased or decreased depending on the level of effect at hepatic and intestinal sites. The effect of echinacea on CYP3A4 activity may differ depending on the CYP3A4 substrate.

Likelihood Possible Evidence B
Etoposide (Vepesid)

Echinacea may increase levels of etoposide.
In one report, concomitant use of etoposide and echinacea was associated with more severe thrombocytopenia than the use of etoposide alone, suggesting inhibition of etoposide metabolism. Etoposide is a cytochrome P450 3A4 (CYP3A4) substrate. Echinacea has variable effects on CYP3A4, but some studies have reported inhibition of the enzyme.

Likelihood Possible Evidence D
Immunosuppressants

Echinacea has immunostimulant activity which may interfere with immunosuppressant therapy.
Theoretically, echinacea may interfere with immunosuppressant therapy because of its immunostimulant activity.

Likelihood Possible Evidence B
Darunavir (Prezista)

Theoretically, echinacea may interfere with the metabolism of darunavir; however, a small clinical study found no effect.
Darunavir is metabolized by cytochrome P450 3A4 (CYP3A4) and is administered with the CYP3A4 inhibitor ritonavir to increase its plasma concentrations. Echinacea has variable effects on CYP3A4, but administration of an E. purpurea root extract (Arkocapsulas Echinacea, Arkopharma) 500 mg four times daily for 14 days did not affect darunavir/ritonavir pharmacokinetics in 15 HIV-infected patients.

Likelihood Unlikely Evidence B
Dayquil Severe

Echinacea is reported to have varying effects on a number of Cytochrome P450 metabolizing enzymes in the liver, including CYP1A2 and CYP3A4, which play a role in acetaminophen and dextromethorphan metabolism (both contained in DayQuil Severe), respectively. Studies have reported both enzyme inhibition and induction, making it difficult to predict clinically significant drug interactions with reliability. Specific drug interaction studies reporting definitive results are rare, and potential drug interactions involving echinacea should likely be taken on a case-by-case basis. Based on what we know about how acetaminophen and dextromethorphan are metabolized, the risk of a clinically significant interaction between echinacea and DayQuil Severe is low.

Likelihood Unlikely Evidence A
Docetaxel (Taxotere)

Theoretically, echinacea may interfere with the metabolism of docetaxel; however, a small clinical study found no effect.
Docetaxel is metabolized by cytochrome P450 3A4 (CYP3A4). Echinacea has variable effects on CYP3A4, but taking E. purpurea whole plant extract (Echinaforce, A. Vogel Biopharma AG) 20 drops three times daily for 2 weeks did not alter the pharmacokinetics of docetaxel in one clinical study.

Likelihood Unlikely Evidence B
Etravirine (Intelence)

Theoretically, echinacea may interfere with the metabolism of etravirine; however, a small clinical study found no effect.
Etravirine is metabolized by cytochrome P450 3A4 (CYP3A4). Echinacea has variable effects on CYP3A4, but taking E. purpurea root extract (Arkocapsulas Echinacea, Arkopharma) 500 mg three times daily for 14 days did not alter the pharmacokinetics of etravirine in HIV-infected patients.

Likelihood Unlikely Evidence B
Lopinavir/Ritonavir (Kaletra)

Theoretically, echinacea may interfere with the metabolism of lopinavir; however, a small clinical study found no effect.
Lopinavir is metabolized by cytochrome P450 3A4 (CYP3A4) and is administered with the CYP3A4 inhibitor ritonavir to increase its plasma concentrations. Echinacea has variable effects on CYP3A4, but taking E. purpurea (Echinamide, Natural Factors Nutritional Products, Inc.) 500 mg three times daily for 14 days did not alter the pharmacokinetics of lopinavir/ritonavir in healthy volunteers.

Likelihood Unlikely Evidence B
Midazolam (Versed)

Theoretically, echinacea may increase the metabolism of intravenous midazolam.
Echinacea induces hepatic CYP3A4 and might decrease plasma levels of midazolam by about 20%, reducing the effectiveness of intravenous midazolam. Echinacea also appears to inhibit intestinal CYP3A4, which could theoretically increase the bioavailability of oral midazolam. This may cancel out the decrease in availability caused by induction of hepatic CYP3A4, such that overall plasma levels after oral administration of midazolam are not affected by echinacea.

Likelihood Possible Evidence B
Warfarin (Coumadin)

Echinacea seems to increase the clearance of warfarin, although the effect may not be clinically significant.
Preliminary clinical research in healthy male volunteers suggests that taking echinacea increases the clearance of the active S-isomer of warfarin after a single dose of warfarin, but there was not a clinically significant effect on the INR.

Likelihood Possible Evidence B
Echinacea purpurea full monograph & interactions

Elderberry2 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
Elderberry full monograph & interactions

Zinc10 drug types · 67 drugs

Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)

Theoretically, zinc might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Advise patients that bictegravir/emtricitabine/tenofovir alafenamide should be taken at least 2 hours before or 6 hours after zinc containing products.

Likelihood Probable Evidence D
Cephalexin (Keflex)

Zinc might decrease cephalexin levels by chelating with cephalexin in the gut and preventing its absorption.
A pharmacokinetic study shows that zinc sulfate 250 mg taken concomitantly with cephalexin 500 mg decreases peak levels of cephalexin by 31% and reduces the exposure to cephalexin by 27%. Also, taking zinc sulfate 3 hours before cephalexin decreases peak levels of cephalexin by 11% and reduces the exposure to cephalexin by 18%. By decreasing cephalexin levels, zinc might increase the risk of treatment failure. This effect does not occur when zinc is taken 3 hours after the cephalexin dose. To avoid an interaction, advise patients take zinc sulfate 3 hours after taking cephalexin.

Likelihood Probable Evidence B
Cisplatin (Platinol-Aq)

Theoretically, zinc might interfere with the therapeutic effects of cisplatin.
Animal research suggests that zinc stimulates tumor cell production of the protein metallothionein, which binds and inactivates cisplatin. It is not known whether zinc supplements or high dietary zinc intake can cause clinically significant interference with cisplatin therapy. Cisplatin might also increase zinc excretion.

Likelihood Possible Evidence D
Integrase Inhibitors

Theoretically, taking zinc along with integrase inhibitors might decrease the levels and clinical effects of these drugs.
Zinc is a divalent cation. Pharmacokinetic studies have shown that other divalent cations such as calcium and iron can decrease blood levels of the integrase inhibitor dolutegravir through chelation.

Likelihood Possible Evidence D
Penicillamine (Cuprimine, Depen)

Zinc might reduce the levels and clinical effects of penicillamine.
By forming an insoluble complex with penicillamine, zinc interferes with penicillamine absorption and activity. Zinc supplements reduce the efficacy of low-dose penicillamine (0.5-1 gram/day), but do not seem to affect higher doses (1-2.75 gram/day), provided dosing times are separated. Advise patients to take zinc and penicillamine at least 2 hours apart.

Likelihood Probable Evidence B
Quinolone Antibiotics

Zinc can decrease the levels and clinical effects of quinolones antibiotics.
Quinolones form complexes with zinc in the gastrointestinal tract, reducing absorption of both the quinolone and zinc if taken at the same time. Advise patients to take these drugs at least 2 hours before, or 4-6 hours after, zinc supplements.

Likelihood Probable Evidence B
Ritonavir (Norvir)

Zinc modestly reduces levels of ritonavir.
Clinical research shows that zinc might reduce serum ritonavir levels by chelating with ritonavir in the gut and preventing its absorption. In patients with HIV, ritonavir is taken with atazanavir to prevent the metabolism and increase the effects of atazanavir. A pharmacokinetic study shows that, in patients being treated with atazanavir/ritonavir, co-administration of zinc sulfate (Solvazinc tablets) 125 mg as a single dose or as multiple daily doses for 2 weeks reduces plasma levels of ritonavir by about 16%. However, atazanavir levels still remains high enough to prevent HIV virus replication. Therefore, the decrease in ritonavir levels is not likely to be clinically significant.

Likelihood Probable Evidence B
Tetracycline Antibiotics

Zinc might reduce levels of tetracycline antibiotics.
Tetracyclines form complexes with zinc in the gastrointestinal tract, which can reduce absorption of both the tetracycline and zinc when taken at the same time. Taking zinc sulfate 200 mg with tetracycline reduces absorption of the antibiotic by 30% to 40%. Demeclocycline and minocycline cause a similar interaction. However, doxycycline does not seem to interact significantly with zinc. Advise patients to take tetracyclines at least 2 hours before, or 4-6 hours after, zinc supplements to avoid any interactions.

Likelihood Probable Evidence B
Amiloride (Midamor)

Amiloride can modestly reduce zinc excretion and increase zinc levels.
Clinical research shows that amiloride can reduce urinary zinc excretion, especially at doses of 10 mg per day or more. This zinc-sparing effect can help to counteract zinc losses caused by thiazide diuretics, but it is unlikely to cause zinc toxicity at usual amiloride doses. The other potassium-sparing diuretics, spironolactone (Aldactone) and triamterene (Dyrenium), do not seem to have a zinc-sparing effect.

Likelihood Probable Evidence B
Atazanavir (Reyataz)

Zinc modestly reduces levels of atazanavir, although this effect does not seem to be clinically significant.
Clinical research shows that zinc might decrease serum atazanavir levels by chelating with atazanavir in the gut and preventing its absorption. Although a single dose of zinc sulfate (Solvazinc tablets) 125 mg orally does not affect atazanavir concentrations in patients being treated with atazanavir/ritonavir, co-administration of zinc sulfate 125 mg daily for 2 weeks reduces plasma levels of atazanavir by about 22% in these patients. However, despite this decrease, atazanavir levels still remain at high enough concentrations for the prevention of HIV virus replication.

Likelihood Probable Evidence B
Zinc full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Elderberry, Zinc & Echinacea Syrup, from the product label.

NOW

See all NOW products
Name
NOW Foods
Street Address
395 S. Glen Ellyn Rd.
City
Bloomingdale
State
IL
ZipCode
60108
Web Address
nowfoods.com
Pharmacist Counseling Corner

Elderberry, Zinc & Echinacea Syrup by NOW: Common Questions

Does Elderberry, Zinc & Echinacea Syrup by NOW interact with any medications?
Yes. Based on its ingredients, Elderberry, Zinc & Echinacea Syrup has a known interaction with 864 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Elderberry, Zinc & Echinacea Syrup contains 5 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.
Can I take this while I'm pregnant?
Echinacea and elderberry safety data in pregnancy is limited, so it's best to avoid them unless your doctor approves. Zinc at recommended doses is considered acceptable during pregnancy, but again, talk to your doctor about whether this product is right for you.
What happens if I take this with an antibiotic?
Zinc in this syrup can reduce how much antibiotic your body absorbs—sometimes by up to 40%—making the antibiotic less effective. If you're on a quinolone, tetracycline, or cephalexin, space the antibiotic at least 2–4 hours away from this product. Ask your pharmacist to help you time them right.
Will this actually help prevent a cold?
The evidence isn't established in our data. Echinacea and elderberry are commonly used for colds and respiratory infections, but we don't have reliable evidence showing they work for those purposes.
What are the most common side effects of zinc in this product?
At recommended doses, you might experience abdominal cramps, diarrhea, a metallic taste in your mouth, nausea, or vomiting. These are dose-related—they're more likely at higher doses. Echinacea can cause abdominal pain, diarrhea, nausea, and rashes.
Is this safe to take long-term?
Zinc at recommended doses is generally well tolerated, but long-term high doses above 40 mg daily raise concerns about copper deficiency. Echinacea is generally well tolerated short-term; long-term safety data is limited. Elderberry from ripe, cooked fruit is well tolerated. Talk to your pharmacist about your specific situation.
Can I take this if I'm on an HIV medication?
Zinc can lower levels of ritonavir (Norvir), integrase inhibitors, and bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy), potentially making them less effective. Check with your pharmacist or doctor before adding this product—spacing and monitoring may be necessary.

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.

Elderberry, Zinc & Echinacea Syrup label
Go deeper

The Full Monographs Behind Elderberry, Zinc & Echinacea Syrup’s Ingredients

Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.

Herb & supplement monograph

Zinc

Interacts with 67 drugs

Zinc is an essential mineral that your body needs for immune function, wound healing, taste, and smell. Most people get enough from food, but supplements can help correct or prevent a defici...

Read the full Zinc monograph → Herb & supplement monograph

Elderberry

Interacts with 121 drugs

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 n...

Read the full Elderberry monograph → Herb & supplement monograph

Echinacea

Interacts with 816 drugs

Echinacea is a popular herb taken to help prevent or shorten the common cold, but study results are mixed and the overall benefit appears small at best. It is generally well tolerated for sh...

Read the full Echinacea monograph →
Sources

Sources & How We Checked

Elderberry, Zinc & Echinacea 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 145 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.

Zinc 88 references
  1. Barceloux DG. Zinc. J Toxicol Clin Toxicol 1999;37:279-92.
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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.

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