Elderberry
HerbalAlso called · 8 names▾▴
black elderberry, European elder, common elder, elder berry, elderberries, Sambucus nigra, Sambucus canadensis, Sambucus racemosa
Herbal supplement (cold and flu symptoms)
Herbs and supplements are not FDA-approved before sale. About these sources
- Food / spice
- Other
Research strength: 1 / 5
According to NCCIH, little is known about using elderberry for health purposes during pregnancy. A 2014 review found no animal or human studies that tested elderberry pregnancy safety; a 2026 review repeats that result and cites the earlier review. A 2001 survey recorded mild stomach upset in one pregnant elderberry user, but it did not assess pregnancy outcomes or identify the timing of exposure. The EMA herbal committee says medicinal elderberry use is not recommended during pregnancy because data are insufficient and safety has not been established. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- NCCIH: Elderberry: Usefulness and SafetyUS government
- EMA: Assessment report on Sambucus nigra L., fructusEU agencyEuropean guidance
- Holst et al., Frontiers in Pharmacology 2014: Echinacea and elderberry during pregnancyUS government
- Tsui et al., American Journal of Obstetrics and Gynecology 2001: Dietary supplements during pregnancyUS government
- Khalil et al., Inflammopharmacology 2026: Elderberry reviewUS government
Research strength: 1 / 5
According to NCCIH, little is known about using elderberry for health purposes during pregnancy. A 2014 review found no animal or human studies that tested elderberry pregnancy safety; a 2026 review repeats that result and cites the earlier review. A 2001 survey recorded mild stomach upset in one pregnant elderberry user, but it did not assess pregnancy outcomes or identify the timing of exposure. The EMA herbal committee says medicinal elderberry use is not recommended during pregnancy because data are insufficient and safety has not been established. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- NCCIH: Elderberry: Usefulness and SafetyUS government
- EMA: Assessment report on Sambucus nigra L., fructusEU agencyEuropean guidance
- Holst et al., Frontiers in Pharmacology 2014: Echinacea and elderberry during pregnancyUS government
- Tsui et al., American Journal of Obstetrics and Gynecology 2001: Dietary supplements during pregnancyUS government
- Khalil et al., Inflammopharmacology 2026: Elderberry reviewUS government
Research strength: 1 / 5
According to NCCIH, little is known about using elderberry for health purposes during pregnancy. A 2014 review found no animal or human studies that tested elderberry pregnancy safety; a 2026 review repeats that result and cites the earlier review. A 2001 survey recorded mild stomach upset in one pregnant elderberry user, but it did not assess pregnancy outcomes or identify the timing of exposure. The EMA herbal committee says medicinal elderberry use is not recommended during pregnancy because data are insufficient and safety has not been established. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- NCCIH: Elderberry: Usefulness and SafetyUS government
- EMA: Assessment report on Sambucus nigra L., fructusEU agencyEuropean guidance
- Holst et al., Frontiers in Pharmacology 2014: Echinacea and elderberry during pregnancyUS government
- Tsui et al., American Journal of Obstetrics and Gynecology 2001: Dietary supplements during pregnancyUS government
- Khalil et al., Inflammopharmacology 2026: Elderberry reviewUS government
Elderberry — Breastfeeding
Research strength: 1 / 5
According to LactMed, elderberry components have not been measured in breast milk after elderberry ingestion, so it cannot make a recommendation for medicinal doses during breastfeeding. A 2020 review found no reliable or sufficient scientific evidence to support elderberry use in pregnant or lactating women; its clinical studies were in adults. The EMA herbal committee also says use during lactation is not recommended because safety data are insufficient. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- LactMed (NIH): ElderberryUS government
- EMA: Assessment report on Sambucus nigra L., fructusEU agencyEuropean guidance
- Harnett et al., Advances in Integrative Medicine 2020: Elderberry and acute respiratory infectionsUS government
- NCCIH: Elderberry: Usefulness and SafetyUS government
- NHS: Herbal medicines and complementary therapiesUK government
Pregnancy
The EMA's 2014 assessment report for dried ripe Sambucus nigra berries states that safety during pregnancy has not been established and advises against medicinal use because data are insufficient. The peer-reviewed review by Holst et al. searched multiple databases through November 2013 and found no animal or human studies of elderberry pregnancy safety. Khalil et al.'s 2026 review cites Holst 2014 for the same conclusion and reports no new pregnancy-specific study. Among the human pregnancy exposure studies cited here, Tsui et al. 2001 surveyed 150 pregnant patients; the abstract reports mild gastrointestinal discomfort in one elderberry user, but no dose, timing, or pregnancy outcome.
Breastfeeding
LactMed's entry, last revised April 15, 2025, reports that no elderberry components have been measured in milk after elderberry ingestion and makes no recommendation for medicinal-dose use during breastfeeding. Harnett et al.'s 2020 rapid review covered five clinical studies involving 936 adults with acute respiratory infections and stated that evidence was not sufficient to support use in pregnant or lactating women; the trials were not breastfeeding studies. The EMA's 2014 report also says lactation safety is not established and use is not recommended because data are insufficient. These findings describe a lack of evidence and guidance, not a study of effects in nursing women.
LactMed identifies flavonoids such as quercetin and anthocyanidins in elderberry fruit, and sambunigrin in bark, leaves, and root. NCCIH describes cyanide-producing substances in raw or unripe berries and some other tree parts. The available sources mainly describe Sambucus nigra; they do not show whether the findings apply equally to other Sambucus species. LactMed notes that supplements may contain multiple ingredients and that labeled ingredients or amounts may differ from actual contents. The reviewed sources do not identify a specific elderberry product, dose, or supplement format.
What was tested
Holst et al. 2014 searched PubMed, Web of Science, AMED, EMBASE, Natural Medicines Comprehensive Database, and Cochrane Library through November 2013; its review found no animal or human studies testing elderberry pregnancy safety. Tsui et al. 2001 surveyed 150 pregnant patients; the abstract reports one elderberry user with mild gastrointestinal discomfort, but the study was not designed to assess pregnancy outcomes. Harnett et al. 2020 reviewed five clinical studies involving 936 adults with acute respiratory infections; it did not provide pregnancy or lactation treatment data. Khalil et al. 2026 is a broad narrative review whose pregnancy statement cites Holst 2014 and does not report a new pregnancy safety study.
How strongly to advise against medicinal elderberry use when pregnancy data are limited
- Source A says
- The EMA herbal committee says elderberry use is not recommended during pregnancy or lactation because safety has not been established and data are insufficient. (EMA: Assessment report on Sambucus nigra L., fructus)
- Source B says
- NCCIH says little is known about elderberry use for health purposes during pregnancy or breastfeeding, without giving an elderberry-specific recommendation against use. (NCCIH: Elderberry: Usefulness and Safety)
- Why they differ
- The EMA report evaluates medicinal preparations of dried ripe berries and applies a precaution when safety data are missing. NCCIH presents a general information summary and describes the evidence gap without setting an elderberry-specific use rule.
- Other sources
- The NHS gives general advice against herbal medicines during pregnancy and breastfeeding. InfantRisk reports that human pregnancy data for elderberry are unavailable and does not prefer supplement use because dose data are lacking. (NHS: Herbal medicines and complementary therapies, InfantRisk Center: Management of Cold and Flu During Pregnancy)
- What the evidence shows overall
- The sources agree that pregnancy and lactation evidence is limited. The difference is how strongly they translate missing data into advice. The available sources describe uncertainty rather than an established pregnancy or lactation effect.
- NCCIH encourages people to discuss complementary health approaches with their health care providers and notes that little is known about elderberry use during pregnancy or breastfeeding. (NCCIH)
- The EMA herbal committee says medicinal elderberry use is not recommended during pregnancy or lactation because data are insufficient. (European Medicines Agency, Committee on Herbal Medicinal Products)
- LactMed says no recommendation can be made for medicinal doses of elderberry during breastfeeding. (LactMed)
General research, not specific to pregnancy.
For general use, sources distinguish cooked ripe berries from raw or unripe berries and other plant parts. NCCIH and EMA describe gastrointestinal effects from some raw plant parts and note that heat reduces the cyanide-related concern. LactMed also notes that supplement ingredients and amounts may differ from their labels.
- NCCIH says raw or unripe elderberries and some other tree parts contain cyanide-producing substances that can cause nausea, vomiting, and severe diarrhea; cooking eliminates the substance. (NCCIH: Elderberry: Usefulness and Safety)
- The CDC Yellow Book distinguishes elderberry flowers and ripe fruit from bark, leaves, seeds, and raw or unripe fruit, which it associates with gastrointestinal distress. (CDC Yellow Book 2026: Complementary and Integrative Health Approaches to Travel Wellness)
- The EMA report says plant parts other than flowers and ripe berries should not be ingested or included in elderberry preparations, and that heat treatment reduces the small amount of hydrogen cyanide that may come from seeds. (EMA: Assessment report on Sambucus nigra L., fructus)
- LactMed notes that supplements may contain multiple ingredients and that labeled ingredients or amounts may differ from actual contents. (LactMed (NIH): Elderberry)
- NCCIH: Elderberry: Usefulness and SafetyUS governmentSecondary
- LactMed (NIH): ElderberryUS governmentSecondaryPage dated 2025-04-15
- EMA: Assessment report on Sambucus nigra L., fructusEU agencySecondaryPage dated 2014-04-29Independent checkEuropean guidance
- InfantRisk Center: Management of Cold and Flu During PregnancyIndustry-fundedSecondaryPage dated 2024-04-09Independent check
- Holst et al., Frontiers in Pharmacology 2014: Echinacea and elderberry during pregnancyUS governmentPrimaryIndependent check
- Tsui et al., American Journal of Obstetrics and Gynecology 2001: Dietary supplement use during pregnancyUS governmentPrimaryIndependent check
- Khalil et al., Inflammopharmacology 2026: Elderberry reviewUS governmentPrimaryPage dated 2026-02-10
- Harnett et al., Advances in Integrative Medicine 2020: Elderberry and acute respiratory infectionsUS governmentPrimaryPage dated 2020-08-22Independent check
- NHS: Herbal medicines and complementary therapiesUK governmentSecondaryPage dated 2026-05-01Independent check
- CDC Yellow Book 2026: Complementary and Integrative Health Approaches to Travel WellnessUS governmentSecondaryPage dated 2025-04-23
Last reviewed 2026-10-16
Independent check 2026-10-16
Not yet clinician-reviewed
Ask your provider about your situation.