Nutritional Supplement
Ginkgo
Negative Interactions
23- Potential Negative Interaction
Ginkgo
Aspirin
There have been two case reports suggesting a possible interaction between ginkgo Ginkgo biloba and an anticoagulant drug or aspirin leading to increased bleeding. In the first, a 78-year-old woman taking warfarin developed bleeding within the brain following the concomitant use of ginkgo (the amount used is not given in the case report). In the second, a 70-year-old man developed slow bleeding behind the iris of the eye (spontaneous hyphema) following use of ginkgo (80 mg per day) together with aspirin (325 mg per day). While this interaction is unproven, anyone taking anticoagulant medications or aspirin should inform their physician before using ginkgo.
AspirinGinkgo- Matthews MK Jr. Association of Ginkgo biloba with intracerebral hemorrhage. Neurology 1998;50:1933-4 [letter].
- Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med 1997;336:1108 [letter].
- Potential Negative Interaction
Ginkgo
Bendroflumethiazide
One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic. Ginkgo was not proven to be the cause of this reaction.
BendroflumethiazideGinkgo- Shaw D et al. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17:342-56.
- Potential Negative Interaction
Ginkgo
Chlorothiazide
One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic. Ginkgo was not proven to be the cause of this reaction.
ChlorothiazideGinkgo- Shaw D et al. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17:342-56.
- Potential Negative Interaction
Ginkgo
Chlorpropamide
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
In a preliminary trial, administration of Ginkgo biloba who were taking oral anti-diabetes medication resulted in a significant worsening of glucose tolerance. Ginkgo did not impair glucose tolerance in individuals whose diabetes was controlled by diet. Individuals taking oral anti-diabetes medication should consult a doctor before taking Ginkgo biloba.
ChlorpropamideGinkgo- Kudolo GB. The effect of 3-month ingestion of Ginkgo biloba extract (EGb 761) on pancreatic beta-cell function in response to glucose loading in individuals with non-insulin-dependent diabetes mellitus. J Clin Pharmacol 2001;41:600-11.
- Potential Negative Interaction
Ginkgo
Chlorthalidone
One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic. Ginkgo was not proven to be the cause of this reaction.
ChlorthalidoneGinkgo- Shaw D et al. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17:342-56.
- Potential Negative Interaction
Ginkgo
Glimepiride
In a preliminary trial, administration of Ginkgo biloba extract (120 mg per day) for three months to patients with type 2 diabetes who were taking oral anti-diabetes medication resulted in a significant worsening of glucose tolerance. Ginkgo did not impair glucose tolerance in individuals whose diabetes was controlled by diet. Individuals taking oral anti-diabetes medication should consult a doctor before taking Ginkgo biloba.
GlimepirideGinkgo- Kudolo GB. The effect of 3-month ingestion of Ginkgo biloba extract (EGb 761) on pancreatic beta-cell function in response to glucose loading in individuals with non-insulin-dependent diabetes mellitus. J Clin Pharmacol 2001;41:600-11.
- Potential Negative Interaction
Ginkgo
Glyburide
In a preliminary trial, administration of Ginkgo biloba extract (120 mg per day) for three months to patients with type 2 diabetes who were taking oral anti-diabetes medication resulted in a significant worsening of glucose tolerance. Ginkgo did not impair glucose tolerance in individuals whose diabetes was controlled by diet. Individuals taking oral anti-diabetes medication should consult a doctor before taking Ginkgo biloba.
GlyburideGinkgo- Kudolo GB. The effect of 3-month ingestion of Ginkgo biloba extract (EGb 761) on pancreatic beta-cell function in response to glucose loading in individuals with non-insulin-dependent diabetes mellitus. J Clin Pharmacol 2001;41:600-11.
- Potential Negative Interaction
Ginkgo
Glyburide Micronized
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
In a preliminary trial, administration of Ginkgo biloba who were taking oral anti-diabetes medication resulted in a significant worsening of glucose tolerance. Ginkgo did not impair glucose tolerance in individuals whose diabetes was controlled by diet. Individuals taking oral anti-diabetes medication should consult a doctor before taking Ginkgo biloba.
Glyburide MicronizedGinkgo- Kudolo GB. The effect of 3-month ingestion of Ginkgo biloba extract (EGb 761) on pancreatic beta-cell function in response to glucose loading in individuals with non-insulin-dependent diabetes mellitus. J Clin Pharmacol 2001;41:600-11.
- Potential Negative Interaction
Ginkgo
Heparin
Ginkgo extracts may reduce the ability of platelets to stick together, possibly increasing the tendency toward bleeding. Standardized extracts of ginkgo have been associated with two cases of spontaneous bleeding, although the ginkgo extracts were not definitively shown to be the cause of the problem. People taking heparin should consult with a physician knowledgeable about botanical medicines if they are considering taking ginkgo.
HeparinGinkgo- Kleijnen J, Knipschild P. Ginkgo biloba. Lancet 1992;340:1136-9 [review].
- Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med 1997;336:1108 [letter].
- Matthews MK Jr. Association of Ginkgo biloba with intracerebral hemorrhage. Neurology 1998;50:1933-4 [letter].
- Potential Negative Interaction
Ginkgo
Hydrochlorothiazide
One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic. Ginkgo was not proven to be the cause of this reaction.
HydrochlorothiazideGinkgo- Shaw D et al. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17:342-56.
- Potential Negative Interaction
Ginkgo
Hydroflumethiazide
One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic. Ginkgo was not proven to be the cause of this reaction.
HydroflumethiazideGinkgo- Shaw D et al. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17:342-56.
- Potential Negative Interaction
Ginkgo
Ibuprofen
It has been argued that ginkgo has a blood-thinning effect and might therefore further increase the risk of bleeing when taken in combination with drugs (including ibuprofen) that thin the blood. However, the bulk of the evidence suggests that ginkgo does not, in fact, have a blood-thinning effect.IbuprofenGinkgo- Kellermann AJ, Kloft C. Is there a risk of bleeding associated with standardized Ginkgo biloba extract therapy? A systematic review and meta-analysis. Pharmacotherapy 2011;31:490-502.
- Potential Negative Interaction
Ginkgo
Indapamide
One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic. Ginkgo was not proven to be the cause of this reaction.
IndapamideGinkgo- Shaw D et al. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17:342-56.
- Potential Negative Interaction
Ginkgo
Metformin
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
In a preliminary trial, administration of Ginkgo biloba extract (120 mg per day) for three months to patients with type 2 diabetes who were taking oral anti-diabetes medication resulted in a significant worsening of glucose tolerance. Ginkgo did not impair glucose tolerance in individuals whose diabetes was controlled by diet. Individuals taking oral anti-diabetes medication should consult a doctor before taking Ginkgo biloba.
MetforminGinkgo- Kudolo GB. The effect of 3-month ingestion of Ginkgo biloba extract (EGb 761) on pancreatic beta-cell function in response to glucose loading in individuals with non-insulin-dependent diabetes mellitus. J Clin Pharmacol 2001;41:600-11.
- Potential Negative Interaction
Ginkgo
Methyclothiazide
One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic. Ginkgo was not proven to be the cause of this reaction.
MethyclothiazideGinkgo- Shaw D et al. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17:342-56.
- Potential Negative Interaction
Ginkgo
Metolazone
One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic. Ginkgo was not proven to be the cause of this reaction.
MetolazoneGinkgo- Shaw D et al. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17:342-56.
- Potential Negative Interaction
Ginkgo
Polythiazide
One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic. Ginkgo was not proven to be the cause of this reaction.
PolythiazideGinkgo- Shaw D et al. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17:342-56.
- Potential Negative Interaction
Ginkgo
Repaglinide
In a preliminary trial, administration of Ginkgo biloba extract (120 mg per day) for three months to patients with type 2 diabetes who were taking oral anti-diabetes medication resulted in a significant worsening of glucose tolerance. Ginkgo did not impair glucose tolerance in individuals whose diabetes was controlled by diet. Individuals taking oral anti-diabetes medication should consult a doctor before taking Ginkgo biloba.
RepaglinideGinkgo- Kudolo GB. The effect of 3-month ingestion of Ginkgo biloba extract (EGb 761) on pancreatic beta-cell function in response to glucose loading in individuals with non-insulin-dependent diabetes mellitus. J Clin Pharmacol 2001;41:600–11.
- Potential Negative Interaction
Ginkgo
Ticlopidine
Ginkgo extracts may reduce the ability of platelets to stick together, possibly increasing the tendency toward bleeding. In a rat study, a high intake of ginkgo increased the action of ticlopidine in a way that could prove dangerous if the same effect occurred in people. Standardized extracts of ginkgo have been associated with two cases of spontaneous bleeding, although the ginkgo extracts were not definitively shown to be the cause of the problem. People taking ticlopidine should use ginkgo extracts only under the supervision of a doctor.
TiclopidineGinkgo- Kleijnen J, Knipschild P. Ginkgo biloba. Lancet 1992;340:1136-9 [review].
- Kim YS, Pyo MK, Park KM. Antiplatelet and antithrombotic effects of a combination of ticlopidine and Ginkgo biloba ext (EGb 761). Thromb Res 1998;91:33-8.
- Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med 1997;336:1108 [letter].
- Rowin J, Lewis SL. Spontaneous bilateral subdural hematoma with chronic Ginkgo biloba ingestion. Neurology 1996;46:1775-6.
- Potential Negative Interaction
Ginkgo
Tolbutamide
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
In a preliminary trial, administration of Ginkgo biloba who were taking oral anti-diabetes medication resulted in a significant worsening of glucose tolerance. Ginkgo did not impair glucose tolerance in individuals whose diabetes was controlled by diet. Individuals taking oral anti-diabetes medication should consult a doctor before taking Ginkgo biloba.
TolbutamideGinkgo- Kudolo GB. The effect of 3-month ingestion of Ginkgo biloba extract (EGb 761) on pancreatic beta-cell function in response to glucose loading in individuals with non-insulin-dependent diabetes mellitus. J Clin Pharmacol 2001;41:600-11.
- Potential Negative Interaction
Ginkgo
Trazodone
There is one case report of an elderly patient with Alzheimer’s disease going into a coma while concurrently using trazodone and ginkgo. Until more is known, ginkgo should not be combined with trazodone except under supervision of a doctor.
TrazodoneGinkgo- Galluzzi S, Zanetti O, Binetti G, et al. Coma in a patient with Alzheimer's disease taking low dose trazodone and Ginkgo biloba. J Neurol Neurosurg Psychiatry 2000;68:679-80.
- Potential Negative Interaction
Ginkgo
Trichlormethiazide
One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic. Ginkgo was not proven to be the cause of this reaction.
TrichlormethiazideGinkgo- Shaw D et al. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17:342-56.
- Potential Negative Interaction
Ginkgo
Warfarin
Ginkgo extracts may reduce the ability of platelets to stick together, possibly increasing the tendency toward bleeding. Standardized extracts of ginkgo have been associated with two cases of spontaneous bleeding, although the ginkgo extracts were not definitively shown to be the cause of the problem. There are two case reports of people taking warfarin in whom bleeding occurred after the addition of ginkgo. People taking warfarin should consult with a physician knowledgeable about botanical medicines if they are considering taking ginkgo.
WarfarinGinkgo- Kleijnen J, Knipschild P. Ginkgo biloba. Lancet 1992;340:1136-9 [review].
- Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med 1997;336:1108 [letter].
- Rowin J, Lewis SL. Spontaneous bilateral subdural hematoma with chronic Ginkgo biloba ingestion. Neurology 1996;46:1775-6.
- Matthews MK Jr. Association of Ginkgo biloba with intracerebral hemorrhage. Neurology 1998;50:1933-4 [letter].
- Gilbert GJ. Ginkgo biloba. Lancet 1997;1137 [letter].
Supportive Interactions
8- Support Medicine
Ginkgo
Clozapine
In one study, treatment with 120 mg per day of Ginkgo biloba extract for 12 weeks enhanced the beneficial effect of clozapine on certain symptoms of schizophrenia in patients who had not responded adequately to clozapine by itself.ClozapineGinkgo- Doruk A, Uzun O, Ozsahin A. A placebo-controlled study of extract of ginkgo biloba added to clozapine in patients with treatment-resistant schizophrenia. Int Clin Psychopharmacol 2008;23:223-7.
- Reduce Side Effects
Ginkgo
Citalopram
Ginkgo biloba extract may reduce the side effects experienced by some persons taking SSRIs such as fluoxetine or sertraline. An open-label study with elderly, depressed persons found that 200–240 mg of ginkgo per day was effective in alleviating sexual side effects in both men and women taking SSRIs. One case study reported that 180 to 240 mg of GBE daily reduced genital anesthesia and sexual side effects secondary to fluoxetine use in a 37-year-old woman.
CitalopramGinkgo- Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998;24:139-45.
- Ellison JM, DeLuca P. Fluoxetine-induced genital anesthesia relieved by Ginkgo biloba extract. J Clin Psychiatry 1998;59:199-200.
- Reduce Side Effects
Ginkgo
Cyclosporine
Ginkgo was reported to protect liver cells from damage caused by cyclosporine in a test tube experiment. A Ginkgo biloba extract partially reversed cyclosporine-induced reduced kidney function in a study of isolated rat kidneys. Human trials have not studied the actions of ginkgo to prevent or reduce the side effects of cyclosporine.
CyclosporineGinkgo- Barth SA, Inselmann G, Engemann R, Heidemann HT. Influences of Ginkgo biloba on cyclosporine A included lipid peroxidation in human liver microsomes in comparison to vitamin E, glutathione and N-acetylcysteine. Biochem Pharmacol 1991;41:1521-6.
- Bagnis C, Deray G, Dubois M, et al. Prevention of cyclosporine nephrotoxicity with a platelet-activating factor (PAF) antagonist. Nephrol Dial Transplant 1996;11:507-13.
- Reduce Side Effects
Ginkgo
Fluoxetine
Ginkgo biloba extract (GBE) may reduce the side effects experienced by some persons taking SSRIs such as fluoxetine or sertraline. An open-label study with elderly, depressed persons found that 200–240 mg of GBE daily was effective in alleviating sexual side effects in both men and women taking SSRIs. One case study reported that 180–240 mg of GBE daily reduced genital anesthesia and sexual side effects secondary to fluoxetine use in a 37-year-old woman.
FluoxetineGinkgo- Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998;24:139-45.
- Ellison JM, DeLuca P. Fluoxetine-induced genital anesthesia relieved by Ginkgo biloba extract. J Clin Psychiatry 1998;59:199-200.
- Reduce Side Effects
Ginkgo
Fluvoxamine
Ginkgo biloba extract may reduce the side effects experienced by some persons taking SSRIs such as fluoxetine or sertraline. An open-label study with elderly, depressed persons found that 200 to 240 mg of ginkgo daily was effective in alleviating sexual side effects in both men and women taking SSRIs.
One case study reported that 180–240 mg of GBE daily reduced genital anesthesia and sexual side effects secondary to fluoxetine use in a 37-year-old woman.
FluvoxamineGinkgo- Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998;24:139-45.
- Ellison JM, DeLuca P. Fluoxetine-induced genital anesthesia relieved by Ginkgo biloba extract. J Clin Psychiatry 1998;59:199-200.
- Reduce Side Effects
Ginkgo
Haloperidol
In a double-blind trial, supplementation of schizophrenic patients with Ginkgo biloba extract, in the amount of 250 mg per 2.2 pounds of body weight per day for 12 weeks, enhanced the effectiveness of haloperidol and also reduced the side effects of the drug.
HaloperidolGinkgo- Zhang XY, Zhou DF, Zhang PY, et al. A double-blind, placebo-controlled trial of extract of Ginkgo biloba added to haloperidol in treatment-resistant patients with schizophrenia. J Clin Psychiatry 2001;62:878-83.
- Reduce Side Effects
Ginkgo
Paroxetine
In three men and two women treated with fluoxetine or sertraline (SSRI drugs closely related to paroxetine) for depression who experienced sexual dysfunction, addition of Ginkgo biloba extract (GBE) in the amount of 240 mg per day effectively reversed the sexual dysfunction. This makes sense because ginkgo has been reported to help men with some forms of erectile dysfunction.
ParoxetineGinkgo- Cohen AJ. Long term safety and efficacy of Ginkgo biloba extract in the treatment of anti-depressant-induced sexual dysfunction. Psychiatry On-Line http://www.priory.com/ginkgo.html.
- Sohn M, Sikora R. Ginkgo biloba extract in the therapy of erectile dysfunction. J Sex Educ Ther 1991;17:53-61.
- Reduce Side Effects
Ginkgo
Sertraline
In three men and two women treated with fluoxetine or sertraline (SSRI drugs closely related to paroxetine) for depression who experienced sexual dysfunction, addition of Ginkgo biloba extract (GBE) in the amount of 240 mg per day effectively reversed the sexual dysfunction. This makes sense because ginkgo has been reported to help men with some forms of erectile dysfunction.
SertralineGinkgo- Cohen AJ. Long term safety and efficacy of Ginkgo biloba extract in the treatment of anti-depressant-induced sexual dysfunction. Psychiatry On-Line http://www.priory.com/ginkgo.html.
- Sohn M, Sikora R. Ginkgo biloba extract in the therapy of erectile dysfunction. J Sex Educ Ther 1991;17:53-61.