At a glance: Elder, Sambucus nigra L., provides two very different medicinal materials: elder flower and elderberry fruit. The EMA has a European Union herbal monograph for the flowers, traditionally used at the early stage of a common cold, but did not adopt an EU herbal monograph for the fruit. Elderberry nevertheless has its own food, folk-medicine and clinical-research history, especially in acute respiratory infections.[1][2]
Botanical profile
- Accepted name: Sambucus nigra L.
- Common names: elder, black elder.
- Family: Adoxaceae.
- Medicinal parts: flowers and fruit.
- EMA herbal drugs: Sambuci flos (elder flower) and separately assessed Sambuci fructus (elderberry).[1][2]
Flower and berry are not interchangeable
Elder flower and elderberry are different drugs:
- Flower: aromatic, flavonoid-rich material traditionally used in hot infusions during the early phase of colds.
- Fruit: anthocyanin-rich dark berries used in syrups, foods and concentrated extracts, with modern respiratory-infection trials focusing primarily on berry preparations.
Major constituents — flowers
Elder flowers contain:
- flavonoids, including rutin and isoquercitroside-related compounds;
- phenolic acids;
- volatile aromatic constituents; and
- triterpenes and other polyphenols.[3]
Major constituents — fruit
The ripe black fruits are especially rich in:
- anthocyanins responsible for their deep purple-black colour;
- flavonols and other polyphenols;
- organic acids and sugars; and
- vitamin- and mineral-related food constituents.
Traditional use
Elder flowers have traditionally been taken as a hot infusion at the start of colds, particularly where chills, congestion and a desire to encourage warmth and perspiration are prominent. They have also been used in household teas for upper-respiratory discomfort.
Elderberries have traditionally been made into syrups, rob, wines, cordials and preserves and taken during winter illnesses, sore throats and convalescence. They occupy a particularly strong overlap between food and medicine.
Contemporary herbal practice
Elderflower remains a classic Western herbal tea for the early stages of a cold, often combined with peppermint and yarrow in the traditional hot infusion. Elderberry is used differently: commonly as a syrup, rob or concentrated winter preparation. Practitioners therefore tend to think in terms of flower for the hot aromatic/diaphoretic tradition and fruit for the nourishing berry preparation, even though both come from the same shrub.
EMA regulatory assessment: elder flower
The EMA HMPC has a European Union herbal monograph for elder flower. Revision 1 was published in 2018, with a later assessment-report addendum in 2025. The monograph recognises traditional use for relief of early symptoms of the common cold.[1]
The assessed preparations include dried/comminuted flower and liquid extracts or tinctures made with specified solvents.[3]
EMA assessment: elderberry fruit
Elderberry fruit was assessed separately by the HMPC, but no European Union herbal monograph was adopted; the EMA therefore provides a public statement rather than an authorised herbal monograph for the fruit.[2]
This is an important distinction because consumer products often imply that flower and berry have the same regulatory status.
Elderberry and respiratory-infection research
A systematic review of five randomised trials found that elderberry may reduce the duration or severity of cold and influenza symptoms, but rated the evidence uncertain and found no evidence that elderberry prevented common colds.[4]
A rapid review of clinical studies likewise reported possible reductions in symptom duration and severity when berry preparations were started early in acute respiratory viral illness, while emphasising limitations in the evidence base.[5]
The “cytokine storm” claim
During the COVID-19 pandemic, online claims circulated that elderberry would dangerously “overstimulate” the immune system and cause a cytokine storm. The 2021 systematic review found no clinical evidence supporting that claim.[4]
This does not prove that every elderberry product is risk-free; it does show why theoretical immunology should not be presented as a documented clinical event without evidence.
Raw elder and processing
Only properly identified and appropriately processed elder fruit should be used. Unripe berries and other parts of the plant can contain cyanogenic glycosides and may cause nausea, vomiting or other toxicity if consumed improperly.
Commercial syrups and cooked ripe berries are not equivalent to chewing raw unripe fruit or bark.
Food versus medicine
Elderberry is a strong example of a medicinal food. Jam, cordial and syrup may be consumed as foods, while clinical trials usually use more standardised extracts or defined commercial formulations.
A positive trial on a concentrated extract should not be translated automatically into a clinical dose of homemade jam.
Safety
Properly prepared elder flower and ripe elderberry products are generally well tolerated in short-term use. Gastrointestinal upset can occur. Improperly prepared raw elder material can cause more significant symptoms.
Pregnancy and breastfeeding
Reliable safety evidence for concentrated medicinal preparations in pregnancy and breastfeeding is limited, so food use should not be treated as proof that medicinal-dose extracts are appropriate.
Student note: common evidence traps
- Elder flower and elderberry are different herbal drugs.
- The EMA monograph applies to the flower, not the fruit.
- Berry trials should not be used as evidence for elderflower tea.
- Do not repeat the “cytokine storm” claim as established fact.
- Raw/unripe fruit and properly processed ripe berry preparations have different safety profiles.
- Food syrups and standardised clinical extracts are different exposures.
References
- European Medicines Agency, Committee on Herbal Medicinal Products. Sambuci flos — Sambucus nigra L., flos. European Union herbal monograph, Revision 1, assessment report and later addendum. EMA. Revision 1 published 2018; addendum published 2025.
- European Medicines Agency. Sambuci fructus — Sambucus nigra L., fructus. Public statement and assessment documents. EMA.
- European Medicines Agency. Assessment report on Sambucus nigra L., flos. EMA.
- Wieland LS, et al. Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. 2021. PubMed.
- Harnett J, et al. Effects of Sambucus nigra berry on acute respiratory viral infections: rapid review of clinical studies. 2020. PubMed.
- Meta-analysis of black elderberry supplementation and upper-respiratory symptoms. PubMed.
Additional materia medica sources
- Blumenthal M, et al., eds. The Complete German Commission E Monographs, including elder flower. American Botanical Council; 1998.
- British Herbal Medicine Association. British Herbal Pharmacopoeia 1983 and traditional-use publications.
- Hoffmann D. Medical Herbalism. Healing Arts Press; 2003.
- American Herbal Pharmacopoeia and contemporary phytotherapy literature for elder fruit where preparation-specific evidence is discussed.
Last reviewed: 20 September 2026. Educational reference only; not an individual respiratory-infection treatment guide.
← Return to the Herbal Monograph Library | Herbal Medicine Safety and Interactions