SUPPLEMENT/MEDICATION /COMPOUND NAME: Black Elderberry (Sambucus nigra) extract, Elderflower

Trade name: “Sambucol” ©, Flos Sambuci

USE: 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).

(1) Two randomized, placebo-controlled, double-blind studies demonstrated the elderberry extract, Sambucol, effectively inhibited both influenza A and B strains when given orally to patients in the first 48 hours of influenza symptoms. In the earlier study, 27 individuals experiencing typical early flu symptoms were given Sambucol or placebo daily for three days—2 tablespoons (children) or four tablespoons (adults). Patients were followed for six days and symptoms monitored. Serum from all subjects was analyzed for antibodies to influenza A and B at the initial dose and during the convalescent phase. In the treatment group, significant improvement in flu symptoms was observed in 93.3 percent of subjects within two days after initial dosing, while 91.7 percent of the control group demonstrated improvement after six days. A complete resolution was achieved in the treatment group in 90 percent of patients after 2–3 days, while the placebo group yielded similar results after six days. Of these 27 patients, 23 had laboratory confirmation of influenza B.

POTENTIAL BENEFIT: Prophylaxis and treatment of Influenza. Some laboratory studies suggest that elder may reduce mucus production and possess anti-inflammatory and antiviral effects. Proven to kill H5N1 in-vitro. The flowers and berries (blue/black only) contain flavonoids, which have been found pre-clinically to possess a variety of biochemical and pharmacological actions, including antioxidant and immunologic properties.


Elderberry constituents neutralize the activity of the hemagglutinin spikes found on the surface of several viruses. When these hemagglutinin spikes are deactivated the viruses can no longer pierce cell walls or enter the cell and replicate. Based on these findings, Sambucol[R], a syrup containing 38-percent standardized extract of black elderberry, was developed. Numerous studies using the Sambucol preparation have shown it to neutralize and reduce the infectivity of influenza viruses A and B, HIV strains and clinical isolates, and Herpes simplex virus type 1 (HSV-1) strains and clinical isolates. (15) It probably does so in the same manner as with influenza viruses, via neutralization of the virus resulting in reduced infectivity.




There are no confirmed drug interactions with elderberry extract. However, due to the ability of Sambucus flower extracts to potentiate insulin release in vitro, patients with diabetes should be advised to monitor blood sugar closely when using flower extracts.


Elderberry extracts are generally without side effects when taken in the suggested dosages. Berries should be cooked, as the consumption of uncooked berries or juice can result in vomiting and diarrhea. Certain constituents of the leaves, stems, flowers, and roots contain poisonous alkaloids. It has also been reported that small percentages of the general population have a type-1 allergy to Sambucus nigra as evidenced by positive-skin prick or RAST test.


Currently there are no reported adverse effects in regard to fetal development, pregnancy, or lactation. However, as elderberry is not a well-researched botanical, health care practitioners should use caution in recommending it to women who are pregnant or nursing. Link:


Elderberry fruit syrups are often standardized to 30–38 percent elderberry.
Powdered extracts are dosed at 500 mg (capsule) 2–3 times daily.
Liquid form, dosed at one teaspoonful (10 mL) 4 times daily.
For children one teaspoon times per day.
In the case of acute viral infections, course of treatment is generally at least three days.


Health food supplements. Sambucol © supplement is the formulation tested in the Isreali study posted above.

WHERE FROM: Health food suppliers.


Sambucus Nigra Monograph Alternative Medicine Review, Volume 10, Number 1, 2005, 5 page pdf In a second study, 60 patients (ages 18–54 years) experiencing early influenza symptoms were given 15 mL of Sambucol or placebo syrup four times daily for five days. Symptoms were monitored for eight days. In the treatment group, the majority of patients reported “pronounced improvement” after an average of 3–4 days, while the placebo group required 7–8 days to reach the same level.

Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. Zakay-Rones Z, Varsano N, Zlotnik M, et al. J Altern Complement Med 1995;1:361–369.

Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. Full article. Zakay-Rones Z, Thorn E, Wollan T, Wadstein J. J Int Med Res 2004;32:132–140. PubMed abstract Patients received 15 ml of elderberry or placebo syrup four times a day for 5 days, and recorded their symptoms using a visual analogue scale. Symptoms were relieved on average 4 days earlier and use of rescue medication was significantly less in those receiving elderberry extract compared with placebo. Elderberry extract seems to offer an efficient, safe and cost-effective treatment for influenza. These findings need to be confirmed in a larger study.

The Effect of Sambucol, a Black Elderberry-Based, Natural Product, on the Production of Human Cytokines: I. Inflammatory Cytokines full article available for free after registration. PubMed Abstract Barak V, Halperin T, Kalickman I Eur Cytokine Netw. 2001;12(2):290–296. Abstract: Sambucus nigra L. products - Sambucol - are based on a standardized black elderberry extract. They are natural remedies with antiviral properties, especially against different strains of influenza virus. Sambucol was shown to be effective in vitro against 10 strains of influenza virus. In a double-blind, placebo-controlled, randomized study, Sambucol reduced the duration of flu symptoms to 3–4 days. Convalescent phase serum showed a higher antibody level to influenza virus in the Sambucol group, than in the control group.

The present study aimed to assess the effect of Sambucol products on the healthy immune system – namely, its effect on cytokine production. The production of inflammatory cytokines was tested using blood - derived monocytes from 12 healthy human donors. Adherent monocytes were separated from PBL and incubated with different Sambucol preparations i.e., Sambucol Elderberry Extract, Sambucol Black Elderberry Syrup, Sambucol Immune System and Sambucol for Kids. Production of inflammatory cytokines (IL-1â, TNF-á, IL-6, IL-8) was significantly increased, mostly by the Sambucol Black Elderberry Extract (2–45 fold), as compared to LPS, a known monocyte activator (3.6–10.7 fold). The most striking increase was noted in TNF-á production (44.9 fold).

The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines. Isr Med Assoc J. 2002 Nov;4(11 Suppl):919–22. BACKGROUND: Some herbal remedies are sold as food additives and are believed to have immune-enhancing properties. OBJECTIVES: To study the effect of five herbal remedies—Sambucol Black Elderberry Extract, Sambucol Active Defense Formula and Sambucol for Kids (with known antiviral properties), Protec and Chizukit N (containing propolis and Echinacea, claimed to be immune enhancers)--on the production of cytokines, one of the main components of the immune system. METHODS: The production of four inflammatory cytokines (interleukin-1 beta, tumor necrosis factor alpha, and IL-6 and IL-8) and one anti-inflammatory cytokine (IL-10) was tested using blood-derived monocytes from 12 healthy donors. RESULTS: The Sambucol preparations increased the production of five cytokines (1.3–6.2 fold) compared to the control. Protec induced only a moderate production of IL-8 (1.6 fold) and IL-10 (2.3 fold) while Chizukit N caused only a moderate increase in IL-10 production (1.4 fold). Both Protec and Chizukit N caused moderate decreases in IL-1 beta, TNF alpha and IL-6 production. Lipopolysaccharide, a known activator of monocytes, induced the highest levels of cytokine production (3.6–10.7 fold). CONCLUSIONS: The three Sambucol formulations activate the healthy immune system by increasing inflammatory and anti-inflammatory cytokines production, while the effect of Protec and Chizukit N is much less. Sambucol could therefore have immunostimulatory properties when administered to patients suffering from influenza (as shown before), or immunodepressed cancer or AIDS patients who are receiving chemotherapy or other treatments. PMID: 12455180


Sambucol has been documented to decrease the duration and severity of illness in common seasonal influenza, and with its known mechanism of action of decreasing viral replication, intuitively appears a good choice for treating other influenza strains, including H5N1.

Studies reported to date on H5N1 indicate that severe illness and death (potentially due to ARDS) is related to high viral load. Elderberry reduces viral load in seasonal influenza. It also has some antioxident capabilties that may protect tissues affected by cytokine damage.

However, elderberry also increases cytokine production. One specific concern with H5N1 infections is the possibility that this strain of flu may induce cytokine storm, leading to ARDS and the high mortality assosciated with it. It is unknown if the increased circulating cytokines that elderberry and other alternative medicines induce could increase a victims risk of cytokine storm.

Medical science does not currently know the exact mechanism that triggers cytokine storm. We cannot say if increased cytokine levels before or during infection is a risk factor for ARDS or an effect of some other mechanism that begins the inflammatory cascade that results in it. High cytokine levels are documented to be assosiated with ARDS, but causation is unknown.

Due to its documented ability to increase cytokine levels, the use of elderberry preparations for avian influenza has created controversy in the online flu communities. Like all other interventions presented here, it is unknown if elderberry will be benficial in H5N1 infections or if there is potential harm from its use.

If contemplating using the extract and the subject is in the target range for a cytokine storm or A.R.D.S., it may be inappropriate to use the extract. One could add an anti-inflammatory herb or substance to the regimen along with other antivirals in the hope that this will neutralise excess TNF-a and pro-inflammatory cytokines in addition to reducing viral load.

The FluWiki or any of its authors or contributers do not specifically endorse or recommend this or any intervention for the prevention or treatment of any disease or illness. We collate and provide this information for your consideration and strongly recommend you discuss the potential use of elderberry or any other intervention with your healthcare provider.

Page last modified on December 16, 2008, at 10:16 PM by pogge