Sambucus nigra L

Name of Drug: Sambucus fructus

Source Plant: Latin- Sambucus nigra L

English- Elderberry

Turkish- Murver

Description of Drug

Herbal substance consists of dried ripe berries of elderberry. The wrinkled spherical drupes are dark violet-black and slightly glossy.They contain three elongated stones, each with a seed inside the hard endocarp. Elderberries taste sweet and sourish with a characteristics aroma. Unripe berries contain toxic constituents such as cyanogenic glycosides and should be avoided in elderberry preparation.

The elderberry is a deciduous shrub that grows to 6m tall. The shrub has a light grey bark.

Important chemical ingredients

The berries contain pectic polysaccharides such as homogalacturonan, rhamnogalacturonan, and substituted galacturonans. They also contain phenolic compounds such as:

Flavonoids- Polyphenolic compounds comprising 15 carbons that share a common structure consisting of 2 aromatic rings that are bound together by 3 carbon atoms that form an oxygenated heterocycle

Flavonoids are divided into:

· Flavonones- (eg. Naringenin) They are characterized by the absence of C2-C3 double bond and the presence of chiral centers at C2 and C3.

· Flavan-3-ols and proanthocyanidins

· Anthocyanins-They are glycosylated polyhydroxy derivatives of 2-phenylbenzopyrlium salts. They are water-soluble pigments responsible for the blue, purple, red and orange colors of fruits

There are also other ingredients found in S.nigra L fructus that are of nutritional importance. The berries contain 7.86-11.50% of total sugar and 2.8-8.55% of reducing sugar. The main identified sugars are glucose and fructose and small amounts of sucrose (0.33%). Carbohydrates found in the fruit include dietary fibre, in particular, pectin, pectic acid, protopectin and cellulose. The berry contains 2.7-2.9% whole protein including amino acids, with glutamic acid, aspargic acid and alanine being the dominant amino acids.

Fats are accumulated in the elderberry seeds (22.4%) and seed flour (15.9%). Major fatty acids are polyunsaturated fatty acids such as alpha-linolenic, linoleic and oleic acid. The saturated fatty acids are in smaller proportions.

The berries contain 1 to 1.3% organic acids and citric acid is the most abundant among malic acid, shikimic acid and fumaric acid. They contain 0.9 to 1.55% minerals including potassium, phosphorus, calcium, sodium, magnesium, iron, zinc, manganese and copper. They contain vitamins such as vitamin C, alpha-tocopherol (has the highest vitamin E bioctivity) and gamma-tocopherol.

Tests & Assays

Freeze-dried elderberries were extracted with dichloromethane, 96% ethanol, 50% ethanol, and water (50-100℃) on an accelerated solvent extraction instrument. The phenol-sulfuric acid test and H NMR analyses revealed that carbohydrates were present in the 50% ethanol and 50-100℃ water extracts.

H and C NMR analyses of the ethanol-elderberry extracts show signals from aromatic compounds and organic acids. Carbohydrates from the acidic elderberry-methanol extract, cyaniding-3-glucoside and cyanidin-3-sambubioside, which are the major anthocyanins in elderberry, were isolated, in addition to the aglycone cyaniding. The substances were identified by one- and two- dimensional NMR spectroscopy and the spectroscopic data were compared with those reported in the literature.

Therapeutic Indications

Elderberry may treat cold and flu symptoms by reducing congestion and making you sweat more. Using a standardized elderberry extract could shorten the duration of flu by 3 days. A lozenge with elderberry extract helps reduce flu symptoms when taken within 24 hours of symptoms starting.

Elderberry extract is also indicated for colic, diarrhea and bronchitis. It is also a remedy for long-standing rheumatism, neuralgia, sciatica, sinutis, chronic nasal catarrh with deafness and is also indicated for its local anti-inflammatory action.

Uses

· Immunological activity- Elderberry extracts increases cytokine production

· Antiviral activity- Standardized elderberry extract has inhibitory activity on strains of human influenza A & B type. It prevents virus from binding to host cellulose due to the presence of novel flavonoids such as methylated flavonoid and esterified flavonoid.

· Antioxidative activity- Attributed to anthocyanin flavonoids. Low concentrations of spray-dried elderberry juice can renew α-tocopherol from the α-tocopheroxyl radicals in models of copper-mediated low density lipoproteins oxidation. This may be due to anthocyanins such as cyanidin 3-glucoside and cyanidin 3-sambuboside which are major anthocyanins in the berries.

· Antibacterial activity- Inhibits H.pylori in combination with other extracts with or without addition of clarithromycin.

Elderberry extract is also used as a laxative, a diaphoretic, a diuretic, analgesic and sedative.

Pharmaceutical Forms

Elderberry fruit syrups are standardized to 30-38% elderberry. Powdered extracts are dosed at 500mg (capsule) 2 to 3 times a day for 3 to 4 days , or if it’s in liquid form, dosed at one tablespoonful (15ml) three times a day. Course of treatment is generally at least 3 days in case of acute viral infections.

Posology and Methods of administration

Pediatric

DO NOT give elderberry or any product containing elder to a child without first consulting a pediatrician.

Adult

· Sinupret: 2 tablets taken 3 times a day for bacterial sinusitis

· Sambucol: 4 tablespoons a day for 3 days for colds and flu

Elderberry syrup is made by cooking 2.27kg of fresh berries with 453g of sugar. The mix is cooked to the thickness of honey and taken in large doses orally.

Contraindications

If you are being treated with any of the following medications, you should talk to your health care provider before taking elderberry:

Diuretics (water pills)

Diuretics help the body get rid of excess fluid and increase the amount of urine your body makes. Elderberry may also act as a diuretic, so taking it along with a diuretic could make that drug stronger and raise your risk of dehydration. Diuretics include:

· Hydrochlorothiazide

· Bumetanide (Burinex)

· Furosemide (Lasix)

· Amiloride (Midamor)

· Metolazone (Zaroxolyn)

Diabetes medications.

Elderberry may lower blood sugar levels. If you are also taking drugs for diabetes, taking elderberry may increase your risk of developing hypoglycemia, or low blood sugar.

Chemotherapy.

Elderberry may interact with some chemotherapy drugs. If you are undergoing chemotherapy, ask your oncologist before taking any herb or supplement.

Laxatives.

Elderberry may act like a laxative and should not be taken at the same time as other laxatives.

Theophylline (TheoDur).

Elderberry may reduce levels of theophylline, a drug taken for asthma and other respiratory conditions. That could make the drug not work as well.

Drugs that suppress the immune system.

Because elderberry may stimulate the immune system, it could interfere with medications taken to suppress the immune system. These medications include corticosteroids (prednisone) and medications used to treat autoimmune diseases. People with organ transplants should also avoid elderberry.

Precautions

Elderberry is not a well researched botanical, healthcare practitioners should use caution in recommending it to women who are pregnant or nursing. Berries or juice can lead to vomiting and diarrhea. Certain constituents of the leaves, steams, flowers, and roots contain poisonous alkaloids.

Clinical Information

Clinical studies of the effectiveness of elderberry on flu treatment and blood lipids reduction indicate effectiveness of the aqueous extract for treatment of influenza suggesting a faster recovery. Same studies showed that there may be significant blood lipid reduction at higher doses of the extract.

Use of elderberry extract is not recommended in adolescents and children below 18 years due to insufficient data on safety and efficacy.

Elderberry might interfere with immunosuppressant therapy due to their immunostimulating activity. It stimulates the production of cytokines from human monocytes. Immunostimulating herbal extracts may interfere with immunosuppressant drugs and corticosteroids.

Heat treatment of the fruit or juice will reduce hydrogen cyanide liberated from the seeds and is recommended. Fruits are safe to consume when ripe, cooked or dried. Safety of elderberry during pregnancy and lactation is not well established and therefore they cannot be recommended during pregnancy or lactation.

Other relevant information

Elderberry preparations have been studied in clinical studies or trials and the published clinical studies cannot be considered to fulfill required criteria for well-established medicinal use. Complete information on traditional use with a specified posology and necessary information on a specified strength are missing in order to establish a monograph fulfilling the requirements of medicinal use. Therefore, based on the available information, a community herbal monograph on Sambucus nigra L. fructus cannot be established at present

Marketed Pharmaceutical Products

Elderberry is available as a liquid, syrup, and tincture, as well as in capsule and lozenge forms. Sambucol is standardized to 38% elderberry extract for adults and 19% for children.

References

1. Penn State Hershey

2. Planta Medica

3. European Medicines Agency

4. Alternative Medicine Review

5. Natural Volatiles & Essential Oils

6. Universitas Osloensis