Natural Products

Elder

Sambucas nigra, Sambucus canadensis

Efficacy

• Indications with proven efficacy:
  None
• Indications with possible, but poorly documented efficacy - the use of this product cannot be recommended:
  Influenza
• Also used for these other indications, but with no proof of efficacy:
  Bacterial sinusitis (combination product - used with antibiotics)
  Bronchitis (combination product)

Safety

• Risk of Drug Interaction: Low
• Adverse effects: Rare

Description

This shrub, commonly found in Europe (common elder) and North America (American elder), produces berries that are typically used to make wine and pies. It has been used on both continents as a remedy against colds and excess mucous for a very long time.

Elderberry extract is used in syrups and juices while elder flowers are used as infusions, extracts or tinctures.

Warning

In 2004, Canada adopted new regulations that control the manufacturing, packaging, labeling and importing of natural health products. The new regulations also include an adverse reaction reporting system. Products that conform to the regulation's criteria are identified with a natural product number (NPN) or homeopathic medicine number (DIN-HM) and can be legally sold in Canada. This number indicates that the product meets specific criteria for safety and purity, not that it is effective for any indication.

Medicinal plants content varies naturally from plant to plant – just as fruits from the same package may vary in taste and texture. There is no standard to measure the active content of each plant. Thus, efficacy of natural products should be expected to vary from brand to brand as well as from bottle to bottle of the same brand.

For more information about the Natural Health Products Regulations, or to check if a product has been assessed, visit the Health Canada website at http://www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php.

Does it work?

There is evidence that elder may be useful in the treatment of influenza but available data are limited.

• Influenza:
  A 15 ml dose of syrup is administered four times daily, for 3 to 5 days. Initiating treatment within 48 hours of the onset of the first symptoms could help reduce the duration of symptoms by 56%.

There is insufficient reliable information to conclude that elder is effective in any other indication.

Is it safe?

• Elder causes very few adverse events. It is generally safe and rarely results in gastrointestinal disorders.
• Elder is not recommended for women who are pregnant or nursing since its safety has not been established.
• Patients suffering from autoimmune diseases such as multiple sclerosis, lupus erythematosus and rheumatoid arthritis should avoid elder.
• Theoretically, elder may increase the effects of diuretic, decongestant, anti-inflammatory and hypoglycemic drugs and counters the effects of immunosuppressive drugs.

Clinical Notes

• The bark, leaves, seeds and raw/unripe fruit contain sambunigrin, a potentially toxic derivative of cyanide.

References

1. Barnes J. et Al. Herbal Medicines, 2e édition, Pharmaceutical Press, 2002
2. Natural Medicines Comprehensive Database, Therapeutic Research Faculty, 2007
3. Passeportsanté.net. Sureau noir. http://www.passeportsante.net
4. Medline Plus, Elder, medlineplus.gov, January 2007
5. Rotblatt M. et Ziment I. Evidence-Based Herbal Medicine, Hanley & Belfus, 2002