Ginkgo Biloba and medications.
Ginkgo Biloba is in the Distil supplement database, evidence Grade B. The page below lists every medication we have explicitly assessed it against.
Ginkgo biloba, usually sold as the standardised EGb 761 extract, comes from the leaves of the maidenhair tree. Its flavone glycosides and terpene lactones support cerebral circulation, and the terpene lactones (ginkgolides) directly block platelet-activating factor. The Grade B evidence sits mainly in age-related cognitive decline and dementia: Le Bars 1997 and a 2015 meta-analysis found 240mg/day may support cognitive function, and there is reasonable evidence for anxiety. The honest limit is tinnitus, where recent reviews do not support a benefit, so it should not be recommended on that basis alone. The interaction angle is the main reason for care. Ginkgo is the most potent antiplatelet compound in the Distil database at standard doses, roughly 30 to 40 percent of low-dose aspirin at 240mg/day. It must be avoided or closely monitored with anticoagulants and antiplatelet drugs like aspirin and clopidogrel, and stopped at least six weeks before surgery. Worth checking with your GP if you take any blood thinner.
Below are the 15 documented pairs we have explicitly assessed for Ginkgo Biloba: 15 amber. The pairs cluster around 5 mechanisms: Additive antiplatelet effect, Additive CNS depression, CYP induction, CYP3A4 inhibition, and Additive seizure risk (lowered threshold). Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not listed here is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by medication, and the missing-item form at the bottom of the page routes any uncatalogued medication into our next curation pass.
Documented interactions
Last reviewed 15 June 2026. Each interaction below is assessed against PubMed-indexed evidence.
Additive antiplatelet effect
Amber Does interact with Acenocoumarol?
Ginkgo can reduce platelet stickiness, which adds to the blood-thinning effect of acenocoumarol and may raise the risk of bleeding. If you take acenocoumarol, discuss ginkgo with your anticoagulant clinic and watch for unusual bruising or bleeding.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Aspirin?
Both ginkgo and aspirin reduce platelet aggregation, so combining them increases bleeding risk additively. The combination is not catastrophic at typical doses but is worth stopping six weeks before any planned surgery or dental procedure.
Evidence: Supported by human study data.
Amber Does interact with Clopidogrel?
Both ginkgo and clopidogrel reduce platelet aggregation, so combining them increases bleeding risk additively. The combination is worth stopping six weeks before any planned surgery or dental procedure.
Evidence: Limited human data, based on case reports and a known mechanism.
Amber Does interact with Diclofenac sodium?
Both ginkgo and diclofenac can slow blood clotting. Used together for short periods at standard doses, the combined effect is usually mild. Used at high doses for long periods, the combined effect can mean more bleeding and bruising. Stop ginkgo at least two weeks before any planned surgery.
Evidence: Limited human data, based on case reports and a known mechanism.
Amber Does interact with Ibuprofen?
Both ginkgo and ibuprofen can slow blood clotting. Used together for short periods at standard doses, the combined effect is usually mild. Used at high doses for long periods, the combined effect can mean more bleeding and bruising. Stop ginkgo at least two weeks before any planned surgery.
Evidence: Limited human data, based on case reports and a known mechanism.
Amber Does interact with Naproxen?
Both ginkgo and naproxen can slow blood clotting. Used together for short periods at standard doses, the combined effect is usually mild. Used at high doses for long periods, the combined effect can mean more bleeding and bruising. Stop ginkgo at least two weeks before any planned surgery.
Evidence: Limited human data, based on case reports and a known mechanism.
Amber Does interact with Warfarin sodium?
Ginkgo biloba has a mild antiplatelet effect of its own. The clinical data on whether it meaningfully shifts INR is mixed, but bleeding events have been reported, so combining with warfarin is best done with INR monitoring rather than freely.
Evidence: Supported by human study data.
Additive CNS depression
Amber Does interact with Trazodone hydrochloride?
There is a report of an older person with Alzheimer's disease falling into a coma after taking ginkgo with a low dose of trazodone. The person recovered. If you take trazodone, it is safer not to add ginkgo without discussing it with your GP first, especially in older adults.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
CYP induction
Amber Does interact with Efavirenz?
Ginkgo may lower the level of the HIV medicine efavirenz in the blood, which could let the virus rebound. This has been reported in patients who were stable for years and then lost virus control after starting ginkgo. If you take efavirenz, it is best to avoid ginkgo, or only use it with your HIV team's knowledge and viral-load monitoring.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Esomeprazole?
Esomeprazole is closely related to omeprazole and is cleared by the same enzyme that ginkgo can speed up, so ginkgo may make esomeprazole work less well, mainly at higher ginkgo doses. If your reflux or ulcer symptoms are not well controlled while taking both, mention the ginkgo to your GP or pharmacist.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Omeprazole?
Ginkgo can speed up how the body clears omeprazole, which may make the omeprazole work less well. This tends to matter at higher ginkgo doses rather than the standard 120 to 240mg a day. If your reflux or ulcer symptoms are not well controlled while taking both, mention the ginkgo to your GP or pharmacist.
Evidence: Supported by human study data.
Amber Does interact with Phenytoin?
There is a report of seizures returning in a person on phenytoin and valproate who was also taking ginkgo, with low blood levels of both seizure medicines. Ginkgo may lower the levels of these medicines, and ginkgo seeds also contain a natural compound that can trigger seizures. If you take phenytoin for epilepsy, it is safer not to add ginkgo without discussing it with the team managing your epilepsy.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Sodium valproate?
There is a report of seizures returning in a person on valproate and phenytoin who was also taking ginkgo, with low blood levels of both seizure medicines. Ginkgo may lower the levels of these medicines, and ginkgo seeds also contain a natural compound that can trigger seizures. If you take valproate for epilepsy, it is safer not to add ginkgo without discussing it with the team managing your epilepsy.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
CYP3A4 inhibition
Amber Does interact with Nifedipine?
Ginkgo may raise blood levels of nifedipine in some people, which can mean more side effects such as headache, dizziness or flushing. If you take nifedipine and notice these symptoms after starting ginkgo, mention it to your GP or pharmacist.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive seizure risk (lowered threshold)
Amber Does interact with Bupropion?
Bupropion lowers the seizure threshold, more so at higher doses, and ginkgo seeds contain a natural compound that can trigger seizures. Combining them may add to the seizure risk, especially if you have had seizures, an eating disorder, or take other medicines that also lower the threshold. If you take bupropion, it is safer to discuss ginkgo with your prescriber before starting it.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope. Use the checker below to surface any medication, and submit a missing item if you take something we have not catalogued.
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