Ginkgo may alter the metabolism and effectiveness of some prescription and non-prescription medications. If you are being treated with any of the following medications, you should not use ginkgo without first talking to your health care provider:
Anticonvulsant medications -- High doses of ginkgo could decrease the effectiveness of anticonvulsant therapy, such as carbamazepine (Tegretol) or valproic acid (Depakote), in controlling seizures.
Antidepressant medications -- Taking ginkgo along with selective serotonin reuptake inhibitor (SSRIs) antidepressants -- including fluoxetin (Prozac), sertraline (Zoloft), paroxetine (Paxil), and escitalopram (Lexapro) -- may cause serotonin syndrome. This condition is characterized by rigidity, tachycardia (fast heart rate), hyperthermia (high body temperature), restlessness, and diaphoresis (sweating). Ginkgo may enhance the effects (both good and bad) of antidepressant medications known as MAOIs, such as phenelzine (Nardil).
Antihypertensive medications -- Ginkgo may decrease blood pressure, so use of ginkgo along with prescription antihypertensive medications should be monitored by a health care provider. There has been a report of an interaction between ginkgo and nifedipine (Procardia), a calcium channel blocking drug used for blood pressure and arrhythmias.
Blood-thinning medications -- Ginkgo has blood-thinning properties and therefore should not be used if you are taking anticoagulant (blood-thinning) medications, such as aspirin, clopidogrel (Plavix), dipyridamole (Persantine), heparin, ticlopidine (Ticlid), or warfarin (Coumadin). There has been bleeding in the brain reported when using a ginkgo product and ibuprofen (Advil), a non-steroidal antiinflammatory drug (NSAID).
Blood sugar lowering medications -- Ginkgo was reported to increase insulin levels in healthy subjects and to decrease insulin levels in diabetic patients. Use ginkgo supplements under the supervision of a health care provider if you are diabetic and taking insulin or oral blood sugar lowering drugs.
Cylosporine -- Ginkgo biloba may help protect the cells of the body during treatment with the immunosuppressive (decreases immunity) drug cyclosporine.
Thiazide diuretics -- Although there has been one literature report of increased blood pressure associated with the use of ginkgo during treatment with thiazide diuretics, this interaction has not been verified by clinical trials. Nevertheless, you should consult with your health care provider before using ginkgo if you are taking thiazide diuretics.
Trazodone -- There has been a report of an adverse interaction between ginkgo and trazodone (Desyrel), an antidepressant medication that resulted in an elderly patient going into a coma.
ADAM Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network (1/26/2007).