What are the side effects of elderberry concentrate?

November 24, 2025 •

3 min read

While elderberry is a popular folk remedy for colds and flu, it is crucial to understand its potential side effects. Improper preparation or excessive intake of elderberry concentrate, or other elderberry products, can cause a range of adverse reactions, from mild digestive upset to more serious health concerns. Learning about what to expect is key to using this supplement safely and effectively.

Quick Summary

This guide explains the common and serious side effects of elderberry concentrate, highlighting risks associated with improper preparation and high doses. It also covers important interactions with medications and specific precautions for certain populations.

Key Points

Toxicity in Raw Elderberry: The seeds, stems, and unripe berries of the elder plant contain poisonous cyanogenic glycosides that release cyanide.
Cooking is Crucial: Commercial elderberry concentrates are safe because the cooking process removes these toxic compounds.
Common Digestive Upset: Even with safe concentrates, users may experience mild side effects like nausea, vomiting, stomach cramps, and diarrhea, especially at high doses.
Dangerous Medication Interactions: Elderberry can interact negatively with immunosuppressants, diabetes medications, and diuretics, altering their effects.
High-Risk Populations: Pregnant and breastfeeding women, children, and those with autoimmune diseases or organ transplants should avoid elderberry due to insufficient safety data or immune-system effects.
Allergic Reactions: Though uncommon, allergic reactions such as hives, difficulty breathing, or swelling can occur.
Signs of Serious Poisoning: Symptoms of serious elderberry poisoning include severe or ongoing vomiting/diarrhea, weakness, dizziness, and numbness.

Elderberry Toxicity and Raw vs. Cooked Berries

One of the most important distinctions when discussing elderberry is the difference between raw and properly processed products. The leaves, stems, seeds, and unripe berries of the Sambucus tree contain a cyanogenic glycoside, which can release cyanide when ingested. This is the primary reason why consuming raw or improperly prepared elderberries is dangerous and can lead to serious poisoning.

Commercial elderberry concentrate, such as syrups, gummies, and capsules, is made from properly cooked and processed berries, which eliminates the toxic compounds. However, this does not mean the concentrate is completely without risk. Issues can arise from overconsumption, pre-existing health conditions, or allergic reactions.

Common Gastrointestinal Side Effects

Even with properly processed concentrate, some individuals may experience common side effects, primarily related to digestive distress. These symptoms are generally mild and temporary, but can be uncomfortable.

Nausea and Vomiting: This is one of the most frequently reported side effects. While it is a key symptom of toxicity from raw berries, some people with sensitive stomachs may experience it even from processed concentrates, especially when taken in high doses.
Stomach Cramps and Diarrhea: Similar to nausea, digestive upset in the form of cramps, gas, and diarrhea can occur. This is often a result of consuming a large quantity of the supplement.
Constipation: In some cases, the opposite effect may occur, with some individuals reporting constipation rather than diarrhea.
Runny Nose: A less common, but reported, side effect, particularly in individuals with certain immune sensitivities.

Serious Side Effects and Poisoning Symptoms

While rare with commercial concentrates, serious side effects, indicative of elderberry poisoning, can occur, particularly if a homemade or poorly prepared product is used. It is crucial to recognize these symptoms and seek immediate medical attention if they appear.

Symptoms of Cyanide Poisoning:

Numbness: A tingling or loss of sensation in parts of the body.
Weakness and Dizziness: Profound fatigue, confusion, and a feeling of being unsteady.
Severe or Persistent Vomiting and Diarrhea: Ongoing gastrointestinal distress that does not subside.
Stupor: A state of near-unconsciousness or unresponsiveness.

Elderberry and Medication Interactions

Another critical aspect of elderberry concentrate safety is its potential to interact with certain medications, particularly those affecting the immune system.

Comparison Table: Elderberry vs. Medications


Medication Type	Elderberry Interaction	Potential Outcome
Immunosuppressants	Stimulates the immune system.	Decreases the effectiveness of immunosuppressant drugs.
Diabetes Medication	May lower blood sugar levels.	Potentiates hypoglycemic effects, potentially causing dangerously low blood sugar.
Diuretics (Water Pills)	Has a natural diuretic effect.	Increases the effect of diuretics, leading to excessive urination and potential dehydration.
Laxatives	Can promote bowel activity.	Overlapping effects could lead to excessive bowel movements and electrolyte imbalance.
Chemotherapy	Potential interaction with certain compounds.	Risk of side effects may increase.

Precautions and High-Risk Populations

Certain groups of people should exercise extreme caution or avoid elderberry concentrate entirely due to higher risks.

Pregnant and Breastfeeding Women: Due to a lack of sufficient research, elderberry is not recommended for pregnant or breastfeeding individuals.
Children Under 18: There is limited clinical evidence regarding the long-term safety of elderberry for children, and uncooked berries are considered unsafe. Most experts advise against it for those under 18.
Individuals with Autoimmune Conditions: Since elderberry can stimulate the immune system, it is not recommended for those with autoimmune diseases like lupus, multiple sclerosis, or rheumatoid arthritis.
Organ Transplant Recipients: The immune-stimulating properties of elderberry can interfere with immunosuppressant medications required after a transplant.

Conclusion

While elderberry concentrate is often hailed for its potential immune-boosting properties, it is essential to be aware of the associated risks and side effects. For commercial products, the most common issues are mild digestive disturbances. However, the presence of toxic cyanogenic glycosides in raw or improperly prepared elderberry parts means careful sourcing is paramount. Furthermore, significant interactions with medications and contraindications for specific populations, including pregnant women, children, and those with autoimmune diseases, necessitate careful consideration before use. Always consult with a healthcare provider before adding any new supplement to your regimen.

Penn State Health offers a comprehensive newsletter with additional information on medication interactions with elderberry.

Frequently Asked Questions

Yes, some individuals may experience mild stomach upset, including nausea, vomiting, diarrhea, or cramps, especially if they consume large amounts or have a sensitive digestive system.

No. Only products made from fully ripe and properly cooked elderberries are considered safe for consumption. Raw or unripe berries, as well as the leaves and stems, are toxic and should be avoided.

Pregnant or breastfeeding women, children under 18, and people with autoimmune diseases or organ transplants should avoid elderberry. Anyone on medication should consult a doctor first.

Yes. Elderberry can interfere with immunosuppressants, diuretics, and diabetes medications. It's crucial to consult a healthcare provider about potential interactions.

Severe signs of poisoning from improperly prepared elderberry can include severe and persistent vomiting and diarrhea, numbness, extreme weakness, dizziness, and confusion.

The long-term safety of elderberry concentrate is not well-researched. Most experts recommend short-term use, and consultation with a healthcare provider is recommended for prolonged periods.

Yes, although it is not common. Some individuals with pollen allergies may be more susceptible. Symptoms of an allergic reaction include hives, difficulty breathing, and swelling of the face, tongue, or throat.