Quick answer

Elderberry products tested in trials had few reported side effects, though most trials did not look closely. The real hazard is raw or unripe berries, leaves and stems, which can cause nausea and vomiting: in 1983, 11 people fell ill within 15 minutes of drinking homemade elderberry juice. Pregnancy safety is unknown.^1,2,3,4

Key facts

Cooking destroys the substances in raw elderberries that can release cyanide.^2,4
In a 12-week trial in 52 healthy women, liver and kidney blood tests stayed within normal ranges.⁵
A 2014 review found no animal or human studies of elderberry's safety in pregnancy.⁶
Allergic reactions to elderberry products are rare.⁷

Raw berries, leaves and stems

Raw or unripe elderberries, and the leaves, stems, bark and seeds, contain substances that can release cyanide and cause nausea, vomiting and severe diarrhea. Cooking destroys them, so cooked fruit and properly processed products do not carry this concern.^2,4

In 1983, 11 of 25 people at a gathering in California fell ill within 15 minutes of drinking juice made from wild elderberries crushed with their leaves and stems. The eight most affected had nausea, vomiting, stomach cramps and weakness and were flown to hospital, and all recovered.³

Sambunigrin, the main substance in elder that can release cyanide, is highest in the leaves and lowest in unripe berries, and one study found none that could be measured in commercial elderberry juice.⁸

The juice in that outbreak was pressed from berries together with leaves and branches, and those who drank the most were the sickest. Anything made at home should use only ripe berries, cooked, with every stem removed.³

What trials report

Trials have reported few side effects and none serious, but most did not check for them carefully, so how often minor effects happen is uncertain.¹

In the largest trial of elderberry on its own, 3 people taking elderberry and 2 taking placebo reported an adverse event.¹

In the 12-week trial in healthy women, liver and kidney blood tests stayed within normal ranges.⁵

The immune system and medicines

Three small studies measured immune signalling proteins in the blood of healthy people after elderberry. Changes appeared in the two shorter studies but not in the 12-week trial, and reviewers found no sign that elderberry overstimulates the immune system.¹

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.^4,9

Expected from how the two work, not shown in studies

Elderberry might affect insulin and blood sugar levels, so experts advise people with diabetes to use it with caution.^4,9

NCCIH advises anyone who takes a medicine to talk with a health care provider before using elderberry, because some herbs and medicines interact in harmful ways.²

Pregnancy, breastfeeding and children

NIH says the safety of elderberry in pregnancy is not known and that experts recommend against elderberry supplements for pregnant women. A 2014 review found no safety studies in pregnancy, in animals or in people.^4,6

There are no data on elderberry for nursing mothers or their infants, so no recommendation can be made for medicinal doses while breastfeeding.⁷

The sources we use give no safe amount for children. Ask a pediatrician before giving any elderberry product to a child, and never give raw berries.⁴

Allergic reactions to elderberry products are rare. Elderberry contains a known allergen, Sam n1.^7,8

When a product is not what it says

Quality is a safety question too. Analyses have found products sold as elderberry that contained black rice extract, purple carrot or elder flowers instead, so you may not know what you are taking.^4,8

Questions people ask

Is elderberry safe to take daily?

The longest trial in healthy people that we found gave it daily for 12 weeks to 52 women, with normal liver and kidney tests. Most other trials lasted 2 to 16 days, so longer daily use is not well studied.^4,5

Is elderberry safe for kids?

The sources we use give no safe amount for children. Some short trials included children aged 5 and up, but no source we use sets a dose for them. Ask your pediatrician, and never give raw berries.⁴

Does elderberry overstimulate the immune system?

A 2021 systematic review found no sign that it does, based on three small studies that measured immune signalling proteins in healthy people. The evidence on harms is still uncertain.¹

Is elderberry tea safe?

We found no safety study of elderberry tea itself. Use only ripe berries, cooked, and never the leaves or stems, which can release cyanide.^2,4

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Sources

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