The short answer
Do not add elderberry supplements to pazopanib without the oncology team’s review. One case raised a possible liver-safety concern, but the product was unspecified and increased pazopanib levels were not measured.
What this answer covers
Sambucus nigra fruit supplements with oral pazopanib. The available case described an unspecified elderberry supplement without verified species, plant part, brand or dose.
- Supplement or preparation
- Sambucus nigra fruit
- Medication ingredient
- pazopanib
Check the exact treatment
This review concerns oral pazopanib tablets containing the hydrochloride salt, with doses expressed as pazopanib. It is used for specified advanced kidney cancer or soft-tissue sarcoma settings. Keep the prescribed fasting schedule and do not crush the tablets.
What happened in the reported case
A woman receiving pazopanib and radiation developed elevated liver enzymes and gastrointestinal symptoms while taking an elderberry supplement. Her medicines were stopped, symptoms and tests improved, and pazopanib was later restarted at a lower dose without elderberry. This sequence raised suspicion but does not identify a single cause.
Why the mechanism remains uncertain
The report did not measure pazopanib levels or enzyme activity. It did not specify the elderberry brand, quantity, species or plant part. Pazopanib itself can injure the liver, and restarting at a lower dose complicates interpretation. An unspecified supplement cannot establish the same effect for every elderberry fruit product.
Report use and follow monitoring
Show the team any elderberry or immune-support blend you use, including ingredients and recent changes. Keep the scheduled liver tests and report persistent nausea, dark urine or yellowing skin promptly. Do not reduce the cancer-drug dose or rely on a time gap based on this single report.
Evidence and practical considerations
Side effects & toxicity
A low-certainty safety signal warrants review; the exact fruit preparation and proposed drug-level mechanism remain unverified.
- Exact scope
- Sambucus nigra fruit supplements with oral pazopanib. The available case described an unspecified elderberry supplement without verified species, plant part, brand or dose. with RxNorm 714438 IN pazopanib. Current exact oral product: Pazopanib oral hydrochloride tablets. Salt/formulation named explicitly; no transfer to unrelated drugs or routes.
- Medication form and route
- Oral
What remains uncertain
- Case signal is indirect to exact Sambucus nigra fruit identity. All-drug withdrawal, lower-dose rechallenge, radiotherapy and unmeasured PK prevent causal or mechanistic confirmation.
Factors that may matter: Exact oral formulation and supplement preparation; Drug exposure versus clinical outcomes; Dose, duration and other medicines; Individual monitoring plan.
Read the supporting source summaries
Source 1: Current original prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients prescribed the exact oral formulation.
Severe hepatotoxicity and bleeding warnings; CYP3A interaction precautions; avoid grapefruit products.
How this applies: RxNorm 714438 IN pazopanib. Current exact oral product: Pazopanib oral hydrochloride tablets. Salt/formulation named explicitly; no transfer to unrelated drugs or routes.
Exact current oral product source, not a clinical trial of every supplement. Formulation, dose, population and mechanism remain explicit.
Source 2: Original clinical research
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: 65-year-old woman with sarcoma receiving neoadjuvant pazopanib and radiation.
Liver enzymes rose with gastrointestinal symptoms. All medicines stopped; later 400 mg pazopanib restarted without elderberry and no recurrence over two weeks.
How this applies: Exact reported preparation, population and endpoints; transfer to pazopanib explicitly limited.
Dose, brand, species and plant part of supplement unreported; drug itself hepatotoxic, simultaneous withdrawal and lower-dose restart confound. No drug levels or CYP assay.
Source 3: Medication terminology
rxnav.nlm.nih.gov · Source check Sep 10, 2026
Population: Terminology.
pazopanib is IN.
How this applies: Exact ingredient.
Not clinical evidence.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Research summary published | |
| Article prepared | |
| Sources checked and article drafted. |
Article revision: 86e92983e7b88313
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.