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 are proposed to act on blood flow, and the terpene lactones (ginkgolides) directly block platelet-activating factor. Those are mechanisms rather than measured outcomes, and the circulation claim in particular is worth stating plainly, because it is the one most often made for ginkgo. The Cochrane review we hold on ginkgo for intermittent claudication pooled fourteen trials in 739 people and found no significant effect on walking distance, and its authors concluded that there is no evidence of a clinically significant benefit in peripheral arterial disease. We make no circulation recommendation on that basis. The Grade B evidence in our records is for cognition, and it is worth knowing where it came from: every trial we cite behind it enrolled people with diagnosed dementia rather than people ageing normally. Le Bars 1997 studied outpatients with Alzheimer's disease or multi-infarct dementia, and the 2015 meta-analysis we cite pooled dementia trials. A result measured in dementia is not a description of what a well person should expect. There are two honest limits. Tinnitus is one, where recent reviews do not support a benefit, so it should not be recommended on that basis alone. Anxiety is the other. We do not recommend ginkgo for anxiety or mood. There is one genuinely positive trial, by Woelk in 2007, in 107 people with a diagnosed anxiety disorder over four weeks, but it has never been independently repeated and it was co-authored by the research arm of the company that makes the EGb 761 extract. A single unrepeated trial does not meet our bar for a graded recommendation, and this is the most potent antiplatelet compound in our database, so we do not think that trade is a fair one to offer. 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 two weeks before planned surgery, with your surgical or dental team told you take it. Worth checking with your GP if you take any blood thinner.
Below are the 20 documented pairs we have explicitly assessed for Ginkgo Biloba: 20 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 28 August 2026. Each interaction below lists the evidence its assessment drew on: some rest on studies of the exact pair, others on mechanism evidence, where a citation may support one part of the reasoning rather than the exact combination. The evidence line on each entry says which.
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, from small studies or case reports, alongside a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Apixaban?
Ginkgo may add to apixaban's bleeding risk, so we would not start it alongside apixaban without your prescriber agreeing, and there is no INR blood test on apixaban to pick up a problem early the way there is on warfarin. Trials in people have not measured a change in clotting from ginkgo at the 120 to 240mg doses sold in the UK, so the caution rests on published reports of bleeding in ginkgo users rather than on a proven blood-thinning effect. If you and your prescriber decide to continue both, watch for unusual bruising, nosebleeds, or black or bloody stools, and stop the ginkgo at least two weeks before any planned surgery or dental work.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
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, and it is worth stopping ginkgo at least two weeks before any planned surgery or dental procedure and telling the team you take it.
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 at least two weeks before any planned surgery or dental procedure, and worth telling the team about.
Evidence: Limited human data, from small studies or case reports, alongside a known mechanism.
Amber Does interact with Dabigatran etexilate?
Ginkgo may add to dabigatran's bleeding risk, and dabigatran is the blood thinner in this group where that matters most, so we would not start ginkgo alongside it without your prescriber agreeing. Dabigatran relies almost entirely on one gut transporter that ginkgo appears to slow, and in a study of nearly 50,000 people with an irregular heartbeat, medicines that block that transporter raised bleeding on dabigatran while leaving apixaban and rivaroxaban unchanged. Trials in people have not measured a change in clotting from ginkgo itself, so the concern here is about drug levels rather than a proven blood-thinning effect, and there is no INR blood test on dabigatran to catch a rise early. If you and your prescriber continue both, watch for unusual bruising, nosebleeds or black stools, and stop the ginkgo at least two weeks before planned surgery or dental work.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
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, from small studies or case reports, alongside a known mechanism.
Amber Does interact with Edoxaban?
Ginkgo may add to edoxaban's bleeding risk, so we would not start it alongside edoxaban without your prescriber agreeing, and there is no INR blood test on edoxaban to pick up a problem early the way there is on warfarin. Edoxaban depends heavily on one gut transporter that ginkgo appears to slow, and edoxaban's own prescribing information already tells doctors to reduce the dose when another medicine blocks that transporter, so this is a route the drug is known to be sensitive to. Trials in people have not measured a change in clotting from ginkgo itself at UK supplement doses, so if you and your prescriber continue both, watch for unusual bruising, nosebleeds or black stools and stop the ginkgo at least two weeks before planned surgery or dental work.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
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, from small studies or case reports, alongside 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, from small studies or case reports, alongside a known mechanism.
Amber Does interact with Rivaroxaban?
Ginkgo may add to rivaroxaban's bleeding risk, so we would not start it alongside rivaroxaban without your prescriber agreeing, and there is no INR blood test on rivaroxaban to pick up a problem early the way there is on warfarin. Rivaroxaban is usually taken once a day with food, which gives a higher peak level than a twice-daily tablet, so anything that nudges absorption upward lands on an already higher peak. Trials in people have not measured a change in clotting from ginkgo at the 120 to 240mg doses sold in the UK, so the caution rests on published reports of bleeding in ginkgo users, and if you continue both you should watch for unusual bruising, nosebleeds or black stools and stop the ginkgo at least two weeks before planned surgery or dental work.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Ticagrelor?
Ginkgo and ticagrelor both act on platelets, the cells that start a clot, so taking them together may raise bleeding risk, and we would not start ginkgo alongside ticagrelor without your cardiology team agreeing. Never stop ticagrelor on your own, particularly in the first year after a stent, because stopping it carries a serious risk of its own: the ginkgo is the thing to stop, ideally at least two weeks before any planned surgery or dental work. Trials in people have not measured a change in clotting from ginkgo at the 120 to 240mg doses sold in the UK, so the caution rests on published reports of bleeding in ginkgo users and on the shared mechanism rather than on a measured effect alongside ticagrelor.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
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 published report of an older person with Alzheimer's disease falling into a coma after taking ginkgo with a low dose of trazodone. 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, from small studies or case reports, alongside 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, from small studies or case reports, alongside 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, from small studies or case reports, alongside 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, from small studies or case reports, alongside 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, from small studies or case reports, alongside 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, from small studies or case reports, alongside 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, from small studies or case reports, alongside 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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