Elderberry dosing science is blank like this dropper bottle
Elderberry dosing science is blank like this dropper bottle

By Nnenna Udensi, MD

People around the world use elderberry in various foods including wine, jams, desserts, drinks, etc., and when used for these purposes, elderberry is added for taste or nutrition. For medicinal preparations though, ideally, medical professionals need to know how much of the active ingredients should be administered to achieve a particular effect. But current supplemental preparations containing elderberry vary in the concentration of active elderberry ingredients present because there is currently no standardization in dosing of elderberry for specific diseases. Furthermore, given that the effectiveness of elderberry for treating disease has not been proven, it is difficult to speak to the correct dose of elderberry for given conditions.

However, what I can speak to is the amounts given in clinical trials I reviewed, some of which have statistically significant results, and the amounts that can be safely consumed. Please keep in mind that these doses (below) have not be standardized and cannot be used as a guide for consumers who wish to take elderberry as a supplement.

  • In recent clinical trials9Tiralongo E, Wee SS, Lea RA. Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Nutrients. 2016;8(4):182. doi:10.3390/nu8040182. 10European public assessment reports. European Medicines Agency - Find medicine - Raxone. https://www.ema.europa.eu/about-us/how-we-work/what-we-publish/european-public-assessment-reports. Accessed September 29, 2018. 11Levine WZ, Samuels N, Sheshet MEB, Grbic JT. A Novel Treatment of Gingival Recession using a Botanical Topical Gingival Patch and Mouthrinse.  The Journal of Contemporary Dental Practice. 2013;14:948-953. doi:10.5005/jp-journals-10024-1431. 12Vauzour D, Tejera N, Oneill C, et al. Anthocyanins do not influence long-chain n-3 fatty acid status: studies in cells, rodents and humans.  The Journal of Nutritional Biochemistry. 2015;26(3):211-218. doi:10.1016/j.jnutbio.2014.09.005. 13Nilsson A, Salo I, Plaza M, Björck I. Effects of a mixed berry beverage on cognitive functions and cardiometabolic risk markers; A randomized cross-over study in healthy older adults. PLoS ONE.  (2015-2018) the doses tested ranged from 300mg/day – 500mg/day, and the condition most commonly tested was influenza infection. The periods tested varied from one day9Tiralongo E, Wee SS, Lea RA. Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Nutrients. 2016;8(4):182. doi:10.3390/nu8040182. to five weeks.13Nilsson A, Salo I, Plaza M, Björck I. Effects of a mixed berry beverage on cognitive functions and cardiometabolic risk markers; A randomized cross-over study in healthy older adults. PLoS ONE.
  • An over the counter lozenge preparation that contains 175mg of extract and is taken 4/day for a total of 700mg daily for 2 days.9Tiralongo E, Wee SS, Lea RA. Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Nutrients. 2016;8(4):182. doi:10.3390/nu8040182.
  • Certain over the counter syrup preparations recommend 15ml 4 times daily.8Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized Study of the Efficacy and Safety of Oral Elderberry Extract in the Treatment of Influenza A and B Virus Infections.  Journal
  • A juice preparation that was studied was the juice of 50 g of elderberries over 5 weeks.13Nilsson A, Salo I, Plaza M, Björck I. Effects of a mixed berry beverage on cognitive functions and cardiometabolic risk markers; A randomized cross-over study in healthy older adults. PLoS ONE.

In the forms that are typically consumed as supplements: fruit syrups, powered or liquid extracts, and juices, the range of doses varies. However, on average, the concentrations of syrups range from 30-40% elderberry, the extracts average in 500mg 2-4 times daily range, and the Juices vary based on concentration.1Assessment Report On Sambucus Nigra L., Fructus. European Union: Committee on Herbal Medicinal Products (HMPC); 2013:1-26. http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_HMPC_assessment_report/2013/04/WC500142245.pdf. Accessed September 24, 2018. 4Elderberry Juice - Biotta Juices. Biotta Juices. http://www.biottajuices.com/products/elderberry-juice/. Published 2018. Accessed September 25, 2018. 6ELDERBERRY Monograph: Natural Medicines Comprehensive Database. Naturaldatabase.therapeuticresearch.com. http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=&s=ND&pt=100&id=434&ds=. Published 2018. Accessed September 25, 2018. 9Tiralongo E, Wee SS, Lea RA. Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Nutrients. 2016;8(4):182. doi:10.3390/nu8040182. The wide range in dosage recommendations by different companies is indicative of the lack of research in this area for elderberry.

If you’re confused about how much elderberry you should take for some expected medical benefit, you should be!  The medical data is just not there. As far as evidence-based dosing for over the counter preparations, I wasn’t able to find any. While small doses where tested in clinical trials, I was unable to find any data on a maximum safe dose. But given the strong safety data for correct preparations of elderberry combined with the relatively low use in modern medicine, it likely has not been explicitly studied.

Overall, more studies on dosage will help to standardize the preparations in the market. Alongside testing the effectiveness of elderberry against different disease states, going forward, studies will also hopefully test specifically how much or how little elderberry it takes to achieve those effects. Until then, elderberry products will continue to reflect the doses studied or the approximations of the companies that sell them.

9 Tiralongo E, Wee SS, Lea RA. Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Nutrients. 2016;8(4):182. doi:10.3390/nu8040182.
10 European public assessment reports. European Medicines Agency - Find medicine - Raxone. https://www.ema.europa.eu/about-us/how-we-work/what-we-publish/european-public-assessment-reports. Accessed September 29, 2018.
11 Levine WZ, Samuels N, Sheshet MEB, Grbic JT. A Novel Treatment of Gingival Recession using a Botanical Topical Gingival Patch and Mouthrinse.  The Journal of Contemporary Dental Practice. 2013;14:948-953. doi:10.5005/jp-journals-10024-1431.
12 Vauzour D, Tejera N, Oneill C, et al. Anthocyanins do not influence long-chain n-3 fatty acid status: studies in cells, rodents and humans.  The Journal of Nutritional Biochemistry. 2015;26(3):211-218. doi:10.1016/j.jnutbio.2014.09.005.
13 Nilsson A, Salo I, Plaza M, Björck I. Effects of a mixed berry beverage on cognitive functions and cardiometabolic risk markers; A randomized cross-over study in healthy older adults. PLoS ONE. 2017;12(11):e0188173. doi:10.1371/journal.pone.0188173
8 Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized Study of the Efficacy and Safety of Oral Elderberry Extract in the Treatment of Influenza A and B Virus Infections.  Journal of International Medical Research. 2004;32(2):132-140. doi:10.1177/147323000403200205.
1 Assessment Report On Sambucus Nigra L., Fructus. European Union: Committee on Herbal Medicinal Products (HMPC); 2013:1-26. http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_HMPC_assessment_report/2013/04/WC500142245.pdf. Accessed September 24, 2018.
4 Elderberry Juice - Biotta Juices. Biotta Juices. http://www.biottajuices.com/products/elderberry-juice/. Published 2018. Accessed September 25, 2018.
6 ELDERBERRY Monograph: Natural Medicines Comprehensive Database. Naturaldatabase.therapeuticresearch.com. http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=&s=ND&pt=100&id=434&ds=. Published 2018. Accessed September 25, 2018.