Herbal Study

Elder Flowers and Elderberries are the present study of HCoCM.       

Source: American Botanical Council


Latin Name: Sambucus nigra
Pharmacopeial Name:  S. nigra var. canadensis
Other Names: black elder berry, American elderberry

European elder (Sambucus nigra)

Elder Flowers:

Latin Name: Sambucus nigra
Pharmacopeial Name: Sambuci flos
Other Names: black elder flower, European elder flower


Jan. 31, 2006 Elderberry Study from  http://cms.herbalgram.org:


Date: January 31, 2006 HC# 070752-297

Re:Review of Pharmacology and Clinical Benefits of European Elderberry

Monograph. Sambucus nigra (elderberry) Altern Med Rev. 2005;10(1):51-55.

European elder (Sambucus nigra) has been used historically as a diaphoretic, diuretic, astringent, laxative, and emetic. Berries are consumed in elderberry wine or pies and used as flavoring; traditionally, they were used in dyeing. Extracts of the berries are used currently as antiviral agents. Elderberry has also demonstrated immunomodulating, antioxidant, and insulin-stimulating effects. While the leaves, bark, and flowers have also been used in medications, most clinical studies have been conducted on the berry. [It should also be noted that American elderberry, formerly classified as Sambucus canadensis , is now classified as S. nigra var. canadensis.]

Elderberry fruits have several active constituents, including flavonoids (quercetin and rutin), anthocyanins (cyanidin-3-glucoside and cyanidin-3-sambubioside), hemagglutinin protein Sambucus nigra agglutinin III (SNA-III), cyanogenic glycosides (including sambunigrin), viburnic acid, and vitamins A and C. The pharmacokinetics of many of these constituents are not completely understood. Research has focused on absorption and urinary excretion of the anthocyanins, which are absorbed and excreted intact, without first being hydrolyzed in the gastrointestinal tract.

Elderberry has mostly been studied for antiviral effects. Elderberry constituents were found to neutralize the activity of hemagglutinin spikes on the surface of several viruses, which are used to penetrate a host's cells in order to replicate. Based on these findings, Sambucol®, a syrup with 38% standardized extract of elderberry, was developed by Razei Bar Industries, Jerusalem, Israel. Sambucol has been used in numerous clinical studies. It has been found to neutralize and reduce the infectiousness of influenza viruses A and B, HIV strains, and Herpes simplex virus type 1 (HSV-1) strains and patient isolates. The complete inhibition of four strains of HSV-1 in human diploid fibroblasts warrants clinical trials. A formulation of elderberry flower extract, St. John's wort (Hypericum perforatum) and Saponaria officinalis also inhibited HSV-1 replication. Anecdotal evidence (6 case studies) and laboratory studies indicate that elderberry extract or elderberry combined with a thyme (Thymus spp.) extract (Thy-Mate™; ThymusPlus; Cumming, GA) may reduce viral load in people with HIV.

Elderberry extracts may also be immunomodulatory in healthy individuals as well as those with diseases characterized by immunosuppression. In vitro studies have demonstrated increased cytokine production (including tumor necrosis factor-alpha [TNF-a] and interleukins [IL] -1ß, -6, and -8) when blood-derived monocytes from healthy donors are exposed to various Sambucol preparations.

Anthocyanin flavonoids possess antioxidant properties. Low level concentrations (4 mcg/mL) of elderberry anthocyanins can efficiently regenerate a-tocopherol from a-tocopheroxyl radicals in models of copper-mediated low-density lipoprotein (LDL) oxidation. Also, human aortic endothelial cells incorporate elderberry anthocyanins into both membrane and cytosol, affording significantly enhanced resistance to reactive oxygen species, especially against H2O2-induced loss of cell viability. '[I]t is likely that supplementing with elderberry extracts containing anthocyanins provides significant antioxidant benefit.'

Clinical indications for elderberry extracts are based on its demonstrated effects. Sambucol inhibits both influenza A and B strains when taken orally within 48 hours of onset of symptoms. Further studies on elderberry's ability to suppress other viruses are needed, but case studies on HIV patients, and elderberry's general safety, indicate that supplementation could provide a low-risk benefit. Similarly, with conditions associated with oxidative stress, such as cardiovascular diseases, cancer, neurodegenerative diseases, peripheral vascular disease, autoimmune disease, and multiple sclerosis, elderberry may be beneficial. Elderberry's ability to incorporate into endothelial cells may indicate a role in preventing vascular diseases.

Preliminary studies show that elderberry may cause a reduction in total cholesterol, as well as triglycerides and both high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, thus making it potentially beneficial for individuals with elevated lipid levels. Furthermore, there is evidence that elder flower constituents can directly stimulate insulin secretion and glucose metabolism. Laboratory study investigating this effect was stimulated by the folk medicine belief that elder flower is a diabetes remedy. Clinical study is needed before elderberry can be recommended for these conditions, however.

There is no known drug interaction with elderberry. However, diabetics should monitor blood sugar closely if taking elder flower extracts, due to their ability to potentiate insulin release in vitro. Elderberry extracts generally have no side effects when used in recommended dosages; however, berries must be cooked before consumption. Raw berries or juice can cause vomiting or diarrhea. The leaves, stems, flowers and roots of elder contain toxic alkaloids. Also, a small percentage of the population has a type-1 allergy to elderberry. There are no known contraindications to using elderberry during pregnancy or lactation; however, as it is not well-researched under these conditions, it should be used by pregnant or nursing women only with caution.

Elderberry fruit syrups are most often standardized at 30-38% elderberry. Powdered extracts are taken at 500 mg 2-3 times daily for 3-4 days. Liquid syrups are taken at one tablespoonful (15 mL) three times daily. For acute viral infections, a course of treatment is at least three days.

— Mariann Garner-Wizard





Elder is a small tree native throughout Europe, western and central Asia, and North Africa, naturalized in the United States (Leung and Foster, 1996; Wichtl and Bisset, 1994). Elder is one of Germany's more important medicinal plant crops (Lange and Schippmann, 1997). The material of commerce, however, is mostly collected from the wild, mainly from the former U.S.S.R., former Yugoslavia, Bulgaria, Hungary, Romania, and the United Kingdom (BHP, 1996; Wichtl and Bisset, 1994). The Roman naturalist Pliny the Elder (ca. 23-79 b.c.) wrote of its uses, as did the Swiss alchemist and physician Paracelsus (1493-1541) (Grieve, 1979; Nadkarni, 1976). Its current therapeutic use as a diaphoretic in Germany and the United States stems from traditional Greek medicine. Its same indications for use in traditional Greek medicine have spread to India where it has been introduced into Ayurvedic medicine (Karnick, 1994; Nadkarni, 1976). It is used in Belgium and France as a diuretic (Bradley, 1992; Bruneton, 1995).

Well-designed human clinical studies have not been conducted on elder flower (Newall et al., 1996). The approved modern therapeutic applications for elder flower are supportable based on a combination of factors, including its long history of use in well established systems of traditional medicine, in vitro and in vivo studies in animalsand phytochemical investigations.

In Germany, elder flower is a standard medicinal tea used as a diaphoretic for feverish common colds. In both the United States and Germany it is also used as a component of compounds for cold and flu in dosage forms, including teas, alcoholic fluidextract or tincture, and native extract in solid dosage forms such asdrages (coated tablets) (Bradley, 1992; Leung and Foster, 1996; Wichtl and Bisset, 1994). In the United States and Canada it is often combined with yarrow flower and peppermint leaf in formulas intended to relieve fevers associated with colds.

Pharmacopeial grade dried elder flower must contain not less than 0.8% total flavonoids, calculated as isoquercitrin (DAB 1997; Ph.Eur.3, 1998). The Pharmacopoeia of Switzerland requires not less than 0.7% flavonoids (Ph.Helv.VII, 1987). The dried flower should also contain not less than 25% water-soluble extract (Bradley, 1992).


Elder flower consists of the dried, sifted inflorescence of Sambucus nigra L. [Fam. Caprifoliaceae] as well as its preparations in effective dosage.

Chemistry and Pharmacology

Elder flower contains flavonoids (up to 3%) composed mainly of flavonol glycosides (astragalin, hyperoside, isoquercitrin, and rutin up to 1.9%) and free aglycones (quercetin and kaempferol); minerals (89%), mainly potassium; phenolic compounds (approx. 3% chlorogenic acid); triterpenes (approx. 1%) including α- and β-amyrin; triterpene acids (approximately 0.85% ursolic and oleanolic acids); sterols (approx. 0.11%); volatile oils (0.030.3%) composed of approx. 66% free fatty acids (linoleic, linolenic, and palmitic acids) and approximately 7% alkanes; mucilage; pectin; plastocynin (protein); sugar; tannins (Bradley, 1992; Leung and Foster, 1996; List and Hörhammer, 1973-1979; Newall et al., 1996; Wichtl and Bisset, 1994).

The Commission E reported diaphoretic and increased bronchial secretion activity.

The British Herbal Compendium reported diaphoretic and diuretic actions (Bradley, 1992). The mechanism of action is not fully understood. Its flavonoids and phenolic acids may contribute to the diaphoretic effect (Bradley, 1992). It has demonstrated anti-inflammatory, antiviral, and diuretic actions in in vitro studies. The flavonoids and triterpenes appear to be the main biologically active constituents (Newall et al., 1996).


The Commission E approved the internal use of elder flower for colds. The British Herbal Compendium lists its uses for common cold, feverish conditions, and as a diuretic (Bradley, 1992). The German Standard License for elder flower tea calls it a diaphoretic medicine for the treatment of feverish common colds or catarrhal complaints (Braun et al., 1997).


None known.

Side Effects

None known.

Use During Pregnancy and Lactation

No restrictions known.

Interactions with Other Drugs

None known.

Dosage and Administration


Unless otherwise prescribed: 10-15 g whole flower per day (3-5 g, three times daily).

Infusion: 3-4 g in 150 ml water, 1-2 cups sipped several times daily, as hot as may be taken safely.

Fluidextract 1:1 (g/ml): 1.5-3 ml (Erg.B.6).

Tincture 1:5 (g/ml): 2.5-7.5 ml (Erg.B.6).

Native soft extract 4.0-5.0:1 (w/w): 2-3.75 g (0.7-1.25 g three times daily).