elderberry

Complementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

REMS

Common cold and influenza relief.
Immune system support.
Sinus and allergy relief.

Action ⬆ ⬇

Contains flavonoids and anthocyanins that bind to viral proteins and inhibit viral adhesion and replication.Helps activate the immune response by stimulating macrophages and monocytes.

Therapeutic effects:

Reduced duration and severity of the common cold and influenza.
Enhanced immune system support.
Reduced sinus pressure and congestion.

Pharmacokinetics ⬆ ⬇

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	Unknown	Unknown	Unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Allergy to plants in the Caprifoliaceae family;
Autoimmune diseases (lupus, rheumatoid arthritis).

Use Cautiously in:

Diabetes;
GI conditions;
Surgery (discontinue ≥2 wk before procedure);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Children <2 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

GI: abdominal cramps, diarrhea, nausea, vomiting

Endo: hypoglycemia

Neuro: headache, dizziness

Misc: hypersensitivity reactions

Interactions ⬆ ⬇

Natural-Drug Products:

May ↑ risk of hypoglycemia with antidiabetic drugs.
May have synergistic effect with antivirals.
May ↑ effect ofdiuretics, causing dehydration or electrolyte imbalance.
May ↓ effectiveness of immunosuppressants.

Natural-Natural Products:

May ↑ overstimulation of the immune system with echinacea, astragalus, andrographis, and reishi.
May ↑ risk of hypoglycemia with ginseng.
May ↑ risk of bleeding with garlic andturmeric.

Route/Dosage ⬆ ⬇

PO (Adults ): Capsules: 150–600 mg 1–2 times daily.

Availability ⬆ ⬇

Syrup: ^OTC
Capsules: ^OTC
Lozenges: ^OTC
Tea: ^OTC
Gummies: ^OTC

Assessment ⬆ ⬇

Assess for hypersensitivity reactions (rash, itching, difficulty breathing).
Assess for signs/symptoms of immune overstimulation.
Monitor for nausea, vomiting or GI upset.

Lab Test Considerations:

Monitor glucose level in patients with diabetes.

Toxicity and Overdose:

Raw elderberry berries, bark, or leaves should not be ingested due to the possibility of cyanide toxicity in severe cases.

Implementation ⬆ ⬇

PO: Administer at 1st sign of symptoms. Take every 3–4 hr (up to 4 doses/day) for up to 5 days.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of herb to patient.
Advise patient to consult with health care provider before using any herbal supplement, especially when taken concurrently with Rx or OTC medications or vitamins.
Advise patient to discontinue use of elderberry and notify health care provider if common cold or influenza symptoms worsen or persist >5 days.
Advise patient that elderberry is not a substitute for vaccination or antiviral therapy.
Advise patient never to ingest raw elderberries, leaves, stems, or bark due to the possibility of severe cyanide toxicity.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or breastfeeding before using this herb.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇