Is elderberry safe while breastfeeding?

What does the evidence say about elderberry while breastfeeding?

1. No data exist on the excretion of any component of elderberry into breast milk, or on the safety and efficacy of elderberry in nursing mothers or infants, and no recommendations can be made on medicinal doses during breastfeeding. 1
2. The bark, leaves and root of the elder plant contain sambunigrin, which can release cyanide and is potentially toxic. Cooked berries do not carry that risk. 1
3. Raw or unripe elderberries and other parts of the elder tree contain cyanide-producing substances that can cause nausea, vomiting and severe diarrhea, and cooking eliminates the toxin. NCCIH also states that little is known about whether elderberry is safe to use during pregnancy or while breastfeeding. 2
4. A rapid review of five clinical studies in 936 adults found that elderberry taken within 48 hours of symptom onset was linked to roughly halved symptom duration, with adverse events rare and no serious events reported. The authors note that none of those studies evaluated use in pregnant or breastfeeding women. 3
5. Herbal products are not required to prove safety before sale and have no standards for ingredients and strength, and they may contain contaminants such as lead, arsenic or mercury, pesticides, or ingredients not listed on the label. Tinctures and liquid products can also contain alcohol. 4

How elderberry changes by nursing stage

• Early weeks. Newborn weeks. This is the stage where an unstudied concentrated botanical is hardest to justify, because a very young infant clears things slowly and you have no milk-transfer data to reason from. Elderberry pie or a cooked syrup drizzled on food is a different exposure from a daily standardized capsule.
• Established nursing. Established feeding, and the stage where most people reach for elderberry because a cold has arrived. The honest position is that the clinical trials showing shorter symptom duration were done in adults who were not breastfeeding, so the benefit side is borrowed and the safety side is blank.
• Weaning. Older baby, fewer feeds. Exposure through milk falls as feeds drop, but the underlying gap does not close: no published information on excretion into milk, and none on effects in nursing infants. The plant-part rule still applies regardless of stage, since bark, leaves and root contain sambunigrin.