Elderberry and elder flower

Elder/Drug Interactions:

  • AntibioticsAntibiotics: In human research, concurrent use of doxycycline with Quanterra? Sinus Defense or Sinupret? has been shown to synergistically improve outcomes in patients with acute bacterial sinusitis (25).
  • Antidiabetic agentsAntidiabetic agents: In vitro research (22) refuted earlier research (33) and reported stimulation of glucose metabolism and promotion of insulin secretion from beta cells.
  • Antihypertensive agentsAntihypertensive agents: In human research, elderberry improved blood pressure (7; 8).
  • Anti-inflammatory agentsAnti-inflammatory agents: Anti-inflammatory properties have been demonstrated in animal studies using elder flowers (3). S. nigra is reported to modulate the inflammatory cytokines IL-1 and TNF-alpha in vitro (3; 36); increase human basophil secretion of IL-4, IL-13, and histamine (32); alter function of human neutrophils (37); and inhibit macrophage release of proinflammatory cytokines and nuclear transcription factor-kB and phosphatidylinositol 3-kinase in vitro (4).
  • AntilipemicsAntilipemics: In human research, elderberry juice reduced postprandial lipid levels (28). In human research, elderberry juice decreased cholesterol concentrations and had minor effect on other serum lipids (27).
  • Antineoplastic agentsAntineoplastic agents: Preclinical research reports that elder may increase the effects and possible adverse effects of some cancer chemotherapies, including alkylating agents (9; 10). In vitro, S. nigra inhibited nuclear protein transport in neuroblastoma cells (38).
  • Antiobesity agentsAntiobesity agents: In human research, an S. nigra (elderberry)-containing product decreased mean body weight (7; 8).
  • AntiviralsAntivirals: In laboratory, animal, and human research, elder had antiviral effects (43; 12; 14; 28; 29).
  • CaffeineCaffeine: According to secondary sources, the flavonoid quercetin, which is found in elder, has been reported to inhibit xanthine oxidase and may affect caffeine levels.
  • Cardiovascular agentsCardiovascular agents: In human research, cyanide poisoning from bark, root, leaves, or juice may lead to toxicity (19; 20), including tachycardia.
  • DecongestantsDecongestants: According to secondary sources, according to preliminary research in patients, increased benefits may be seen when elder is used in combination with decongestants, such as oxymetazoline (Afrin?) and antibiotics.
  • Dental agentsDental agents: In human research, an S. nigra-containing mouthwash decreased the gingival index score (34)
  • DiureticsDiuretics: According to animal research, elder may possess diuretic properties and should be used cautiously with drugs that increase urination (13).
  • Electrolyte modulatorsElectrolyte modulators: In human research, an S. nigra-containing product produced a small reduction in potassium during treatment; however, the study did claim that there were no significant differences and whether these effects were from the combination product (23).
  • Gastrointestinal agentsGastrointestinal agents: In human research, there are reports of gastrointestinal distress, diarrhea, vomiting, abdominal cramps, and weakness after drinking elderberry juice made from crushed leaves, stems, and uncooked elderberries (19; 24; 20). According to secondary sources, elder may also possess laxative effects and should be used cautiously with other laxatives.
  • HIV agentsHIV agents: In human research, Sambucol? decreased viral load (14).
  • LaxativesLaxatives: According to secondary studies, elder may possess laxative effects and should be used cautiously with other laxatives. In human research, an S. nigra-containing product decreased colonic transit time (CTT) and increased daily evacuations (23).
  • MethylxanthinesMethylxanthines: According to secondary studies, the flavonoid quercetin, which is found in elder, has been reported to inhibit xanthine oxidase and may affect caffeine and theophylline levels.
  • Neurologic agentsNeurologic agents: In human research, cyanide poisoning from bark, root, leaves, or juice may lead to toxicity (19; 20), including CNS and respiratory depression, and weakness.
  • Vascular endothelial growth factor (VEGF) inhibitorsVascular endothelial growth factor (VEGF) inhibitors: In vitro, OptiBerry IH141 inhibited TNF-alpha-induced vascular endothelial growth factor (VEGF) (1).

    • Elder/Herb/Supplement Interactions:

  • AntibacterialsAntibacterials: In human research, concurrent use of doxycycline with Quanterra? Sinus Defense or Sinupret? has been shown to synergistically improve outcomes in patients with acute bacterial sinusitis (25). Additional supporting evidence in this area is limited.
  • Anti-inflammatory herbsAnti-inflammatory herbs: Anti-inflammatory properties have been demonstrated in in vitro and animal studies using elder flowers (3; 36; 32; 37; 4).
  • AntilipemicsAntilipemics: In human research, anthocyanidin reduced postprandial lipid levels (28). In human research, elderberry juice decreased cholesterol concentrations and had minor effect on other serum lipids (27).
  • Antineoplastic herbsAntineoplastic herbs: Preclinical research reports that elder may increase the effects and possible adverse effects of some cancer chemotherapies, including alkylating agents (9; 10). In vitro, S. nigra inhibited nuclear protein transport in neuroblastoma cells (38).
  • Antiobesity herbsAntiobesity herbs: In human research, an S. nigra (elderberry)-containing product decreased mean body weight (7; 8).
  • AntioxidantsAntioxidants: Elder preparations may exert antioxidant activity, and increased effects may be seen when elder is used in combination with other antioxidants, according to laboratory research (5; 6).
  • AntiviralsAntivirals: In laboratory, animal, and human research, elder had antiviral effects (43; 12; 14; 28; 29).
  • CaffeineCaffeine: According to secondary sources, the flavonoid quercetin, which is found in elder, has been reported to inhibit xanthine oxidase and may affect caffeine levels.
  • Cardiovascular agentsCardiovascular agents: In human research, cyanide poisoning from bark, root, leaves, or juice may lead to toxicity (19; 20), including tachycardia.
  • DecongestantsDecongestants: In theory, increased benefits may be seen when elder is used in combination with decongestants.
  • Dental agentsDental agents: In human research, an S. nigra-containing mouthwash decreased the gingival index score (34).
  • DiureticsDiuretics: Elder may possess diuretic effects and should be used cautiously with other agents that increase urination (13).
  • Electrolyte supplementsElectrolyte supplements: In human research, an S. nigra-containing product reported a small reduction in potassium during treatment; however, the study did claim that there were no significant differences and whether these effects were from the combination product (23).
  • Gastrointestinal agentsGastrointestinal agents: In human research, there are reports of gastrointestinal distress, diarrhea, vomiting, abdominal cramps, and weakness after drinking elderberry juice made from crushed leaves, stems, and uncooked elderberries (19; 24; 20). According to secondary sources, elder may also possess laxative effects and should be used cautiously with other laxatives.
  • HypoglycemicsHypoglycemics: In vitro research (22) refuted earlier research (33) and reported stimulation of glucose metabolism and promotion of insulin secretion from beta cells.
  • HypotensivesHypotensives: In human research, elderberry improved blood pressure (7; 8).
  • LaxativesLaxatives: According to secondary sources, elder may possess laxative effects and should be used cautiously with other laxatives In human research, an S. nigra-containing product decreased colonic transit time (CTT) and increased daily evacuations (23).
  • Neurologic agentsNeurologic agents: In human research, cyanide poisoning from bark, root, leaves, or juice may lead to toxicity (19; 20), including CNS and respiratory depression, and weakness.

    • Elder/Food Interactions:

  • Anthocyanin-rich foodsAnthocyanin-rich foods: Certain foods rich in anthocyanin may increase effects of elder (26). These include raspberries, blueberries, red grapes, plums, radishes, and red cabbage, as well as products with these ingredients (26).
  • SucroseSucrose: Ingestion of sucrose concomitantly with elderberry has been seen to reduce the excretion of anthocyanins found in elder (27).

    • Elder/Lab Interactions:

  • BilirubinBilirubin: In human research, elderberry (anthocyanins) produced significant change in plasma bilirubin, but the clinical impact was minimal, as the bilirubin levels were still within normal physiological levels (26).
  • Blood glucose.Blood glucose: In vitro research (22) refuted earlier research (33) and reported stimulation of glucose metabolism and promotion of insulin secretion from beta cells.
  • Blood pressureBlood pressure: In human research, elderberry improved blood pressure (7; 8).
  • CholesterolCholesterol: In human research, elderberry juice reported reduced postprandial lipid levels (28). In human research, elderberry juice decreased cholesterol concentrations and had minor effect on other serum lipids (27).
  • Colonic transit time (CTT)Colonic transit time (CTT): In human research, an S. nigra-containing product decreased colonic transit time (CTT) (23).
  • ElectrolytesElectrolytes: In human research, an S. nigra-containing product reported a small reduction in potassium during treatment; however, the study did claim that there were no significant differences and whether these effects were from the combination product (23).