Quick answer

Ask your pharmacist or doctor before combining. NIH says elderberry might reduce the effect of medicines that suppress the immune system, because it may stimulate immune activity. It says so in 2 fact sheets and names no medicine, amount or product form. NCCIH advises talking with a provider before using elderberry with any medicine.^1,2,3

Key facts

NIH's health professional sheet says elderberry might reduce the effectiveness of immunosuppressant medications because of its potential immunostimulatory activity.¹
NIH says studies of elderberry have mainly used extracts, not the berries themselves.¹
NIH says recent analyses suggest some elderberry supplements are highly diluted or adulterated with a cheaper ingredient, such as black rice extract.¹
The cyclosporine label has a section on dietary supplements that change its levels. It names St. John's wort and does not name elderberry.⁴

Ask your pharmacist or doctor first

Because elderberry may stimulate the immune system, NIH says it might reduce the effect of medicines that suppress the immune system.^1,2

Expected from how the two work, not shown in studies

Why does elderberry come up with immune-suppressing medicines?

NIH's reasoning is short. It says compounds in elderberry might have immune-stimulating effects, and a medicine that suppresses the immune system is meant to do the reverse. NIH's health professional sheet therefore says that, because of its potential immunostimulatory activity, elderberry might reduce the effectiveness of immunosuppressant medications. The consumer sheet says elderberry might reduce the effectiveness of medications that suppress the immune system.^1,2

The pair is marked expected because it follows from how the two work. It is NIH's reasoning, worded with might and potential, and the sheets cite no amount of elderberry at which the concern starts.¹

What do the medicine labels and MedlinePlus say?

MedlinePlus describes mycophenolate as a medicine that weakens the immune system so it will not attack and reject a transplanted organ, and azathioprine as one that decreases immune activity for transplants and severe rheumatoid arthritis.^5,6

The cyclosporine label has a section on drugs and dietary supplements that change cyclosporine levels, and it names the herbal supplement St. John's wort, with reports of organ rejection. It does not name elderberry. Do not read that as a finding either way. It only shows that the elderberry concern comes from NIH, not from that label.⁴

NCCIH's elderberry page does not mention immunosuppressants. It says only that anyone taking any type of medicine should talk with a health care provider before using elderberry, because some herbs and medicines interact in harmful ways.³

Why does the product itself matter?

A pharmacist judging this question needs to know what is in the bottle. NIH says some elderberry supplements are highly diluted or have been adulterated with a cheaper ingredient, and that trials have used extracts rather than berries. The sheets do not separate syrups, gummies and capsules, so none of them is singled out here.¹

Blends add another layer. NIH describes a review that included a trial of an herbal preparation containing both elderberry and echinacea, and it raises the same immunosuppressant caution for echinacea, andrographis and ginseng. Check each ingredient on the panel, not only the first one.¹

What other cautions does NIH list for elderberry?

The bark, leaves, seeds and raw or unripe fruit contain a toxin that can cause nausea, vomiting and diarrhea. Cooking destroys it, and NIH says cooked fruit and properly processed commercial products do not pose this concern.¹
NIH says elderberry might affect insulin and glucose metabolism, so people with diabetes should use it with caution.¹
The safety of elderberry in pregnancy is not known, and experts recommend against supplements during pregnancy.¹

What to ask before you start or continue

Does my medicine count as an immunosuppressant for this purpose?
Is there anything in my elderberry product besides elderberry, such as echinacea or zinc?
Should I wait to start it, or stop it, while this question is open?
Who on my care team should I tell about every supplement I take?

Questions people ask

Can you take elderberry with immunosuppressants?

Ask your pharmacist or doctor first. NIH says elderberry might reduce the effectiveness of immunosuppressant medications, and NCCIH advises talking with a provider before using it with any medicine.^1,3

Does elderberry weaken immunosuppressant medicines?

NIH says it might, because of its potential immunostimulatory activity. NIH's sheets word it as a possibility and give no amount, medicine or product form.^1,2

Is elderberry syrup different from capsules for this?

NIH's sheets do not separate forms, so the sources checked do not answer it. That is not a finding either way, so ask your pharmacist about the exact product.¹

Do immunosuppressant labels name elderberry?

The cyclosporine label names St. John's wort among supplements that change its levels and does not name elderberry. The elderberry concern comes from NIH, not from that label.⁴

See what we make

Every product shows its whole label and what its lab report covers. The store opens soon.

See the Full Measure line

Sources

This page is information, not medical advice. Talk to your doctor or pharmacist about your own situation.