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Elderberries are a favorite family remedy for upper respiratory tract infections. However, there have been some rumors about the safety of elderberries. This article covers the safe use of elderberries, the history of elderberry use in pregnancy and lactation, contraindications to elderberry use, and the harm caused by the improper preparation of elderberry products.

Medicinal Uses Of Elderberry Syrup

Elderberry syrup has a long history of use in natural medicine. It has been used to treat coughs and colds, boost the immune system, reduce fever, help with joint problems, reduce allergic/asthmatic symptoms, and help restore the body to health after illness. 

Modern use of elderberry syrup focuses on elderberry’s ability to treat viral upper respiratory infections, like minor coughs, colds, and influenza. 

Elderberry syrup is also commonly used as a seasonal immune-strengthening agent for kids and adults. In my practice, I often prescribe elderberry syrup as a daily preventative during the fall and winter months for people of all ages. However, when it comes to pregnant and breastfeeding women, I prefer short-term use to err on the side of caution. 

Safety Of Elderberry Syrup In Pregnancy & Lactation
A close up photo of a pregnant woman's belly with her hands resting on her belly.

While pregnant or breastfeeding, it is vital for women to consider the safety of what they consume, as this may affect the long-term health of their children. Given this knowledge, it makes sense to question whether the medications and supplements we commonly use are safe during pregnancy and lactation. 

Unfortunately, we don’t have human trials demonstrating the safety and efficacy of most medications and herbal supplements during pregnancy and lactation. Instead, we have to rely on other evidence, including observational studies of use during pregnancy, case reports, animal studies, knowledge of chemical constituents, and traditional use.  

Many herbalists consider elderberry likely safe for use during pregnancy and lactation given that there have been no adverse effects reported despite regular use by pregnant and lactating women. In addition, elderberries are commonly consumed as part of the usual diet in some cultures, even during pregnancy and lactation. Elderberry doesn’t contain phytochemicals known to increase the risk of miscarriage, cause birth defects, change hormonal function, or reduce breast milk supply. However, animal studies and human studies are lacking so some urge caution. 

Elderberry syrup is traditionally used for short-term (5-7 days) treatment of upper respiratory infections during pregnancy and lactation rather than as a daily immune booster. In my clinical practice, I reserve elderberry syrup as a short-term treatment for most moms. Instead, I have them take a probiotic and a mushroom based immune enhancer if needed. As always, speak to your doctor or midwife before taking any supplements during pregnancy or lactation. 

A Case Of Cyanide Toxicity From Raw Elderberries In A Smoothie

Unripe, raw, and unprocessed elderberries contain high levels of phytochemicals called cyanogenic glycosides. The human body easily manages and excretes cyanogenic glycosides in low quantities; however, cyanogenic glycosides can cause cyanide poisoning if consumed in high quantities. Many common foods like almonds, stone fruits, chickpeas, cashews, lima beans, flax seeds, and more contain low levels of cyanogenic glycosides and are safely consumed by humans of all ages. It is only high levels of cyanogenic glycosides that are problematic.

A previous version of this article stated that a review of the past 30 years had found no cases of cyanide poisoning from elderberries. However, in January 2022, a smoothie company used raw elderberries in a frozen smoothie product sold online in Canada, resulting in several cases of mild cyanide toxicity and a recall of the product

The cyanide toxicity from raw elderberries in the 2022 incident was mild and symptoms were confined to the gastrointestinal tract. However, this underscores the importance of purchasing herbal supplements from companies that have true herbal expertise and stringent manufacturing standards.

Reasons For Caution With Elderberry Supplements

I hesitate to recommend an elderberry supplement if someone is taking medication to suppress the immune system. Elderberry may make certain immune-suppressing medications less effective so caution is urged. 

Some theorize that elderberry supplements may worsen autoimmune conditions or cause flares as elderberry can stimulate the immune system. However, I have not been able to find any case reports of this occurring and I have not seen it in my practice. For more information, see this article Important Immunity Terms To Know – Dr. Green Mom.


Elderberry has a long history of use by pregnant and breastfeeding women, but human safety trials are lacking. In my practice, I often recommend that pregnant and breastfeeding women take elderberry syrup for up to 7 days for the short-term treatment of upper respiratory tract infections. 

Choosing which herbs to take during pregnancy and while breastfeeding is personal and should be guided by a qualified professional who understands herbal medicine.



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Elderberry Clinical Guide 

Elderberry: Health Benefits, Side Effects, Uses, Dose & Precautions

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Dr. Green Mom

Dr. Mayer is a naturopathic medical doctor and an expert in nutrition and wellness as it relates to pediatrics and families. Her passion for prevention of disease as cure fueled her desire to immerse herself into specializing in adult onset chronic conditions, as well as childhood chronic illness.

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