Meta Information
ID:ginkgo-biloba
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/class/anticoagulants-antiplatelets
Target name:
Anticoagulant and Antiplatelet Drugs
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Ginkgo inhibits platelet aggregation, and when combined with blood-thinning medications (e.g., warfarin, clopidogrel, apixaban, aspirin), it significantly increases the risk of serious, uncontrolled bleeding.
Actionable advice:
Ginkgo should not be taken with any anticoagulant or antiplatelet medication unless explicitly approved by a physician.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Major bleeding episodes were not more frequent among patients receiving aspirin plus warfarin than among those receiving warfarin alone, but the incidence of minor bleeding episodes was higher in the combined therapy group.
Label source:
Action type:
avoid
Target id:
/condition/seizure-disorder
Target name:
Seizure Disorder / Epilepsy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Ginkgo leaf extract contains ginkgotoxin, which can interfere with GABA neurotransmission and lower the seizure threshold, potentially triggering seizures in individuals with epilepsy.
Actionable advice:
Ginkgo should not be taken with a history of seizures or epilepsy.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The neurotoxicity of gingko nuts, particularly their convulsion-inducing effect, should be recognized.
Label source:
PubMed: Generalized convulsions after consuming a large amount of gingko nuts. (PMID 11240603)
Action type:
avoid
Target id:
/procedure/surgery-elective
Target name:
Elective Surgery
Severity:
major
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
336
Hours after target:
48
Description:
Ginkgo's significant antiplatelet effect increases the risk of excessive and difficult-to-control bleeding during and after surgical or dental procedures.
Actionable advice:
Ginkgo should be stopped at least 14 days before any scheduled surgery and not resumed until cleared by a surgeon.
Validation status:
validated_via_clinical_guidance
Evidence tier:
tier_b
Evidence basis:
clinical_guidance_verbatim
Evidence anchors:
Exact phrase from label:
the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) recommend stopping herbal medications 1–2 weeks before elective surgical procedures. Potential adverse drug effects related to preoperative use of herbal medications involve the coagulation system (e.g., increasing the risk of perioperative bleeding)
Label source:
Clinical guidance: ASA — perioperative herbal medication management
Action type:
informational_none
Target id:
/class/maois
Target name:
Monoamine Oxidase Inhibitors (MAOIs)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Ginkgo may have weak MAO-inhibiting activity, which could dangerously potentiate the effects of prescribed MAOI medications, leading to a hypertensive crisis or serotonin syndrome.
Actionable advice:
Ginkgo should not be taken while using an MAOI medication.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Ginkgo biloba leaf extract was shown to produce in-vitro inhibition of rat brain MAO-A and -B. The Ginkgo biloba extract was chromatographed on a reverse-phase HPLC system and two of the components isolated were shown to be MAO inhibitors (MAOIs).
Label source:
PubMed: The Journal of pharmacy and pharmacology (2000)
Source url:
Exact phrase from label:
Extracts of Ginkgo biloba leaves produce reversible inhibition of rat brain monoamine (MAO). Both MAO-A and -B types were inhibited to a similar extent.
Label source:
PubMed: Life sciences (1996)
Source url:
Exact phrase from label:
Extracts of Ginkgo biloba have been reported to reversibly inhibit both monoamine oxidase (MAO) A and B in rat brain in vitro leading to speculation that MAO inhibition may contribute to some of its central nervous system effects. Here we have used positron emission tomography (PET) to measure the effects of Ginkgo biloba on human brain MAO A and B in 10 subjects treated for 1 month with 120 mg/day of the Ginkgo biloba extract EGb 761, using [11C]clorgyline and [11C]L-deprenyl-D2 to measure MAO A and B respectively.
Label source:
PubMed: Life sciences (2000)
Action type:
avoid
Target id:
/intervention/trazodone
Target name:
Trazodone
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
A case report documented a coma in a patient taking both Ginkgo and trazodone, suggesting a potentially severe interaction that enhances sedative effects.
Actionable advice:
Ginkgo should not be combined with trazodone due to the risk of severe central nervous system depression.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
5.6 Priapism Cases of priapism (painful erections greater than 6 hours in duration) have been reported in men receiving trazodone hydrochloride tablets.
Label source:
Action type:
avoid
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Due to its effects on blood clotting and a lack of safety data, Ginkgo poses a risk of increased bleeding during delivery and its effects on the fetus are unknown.
Actionable advice:
Ginkgo should be avoided completely during pregnancy.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
If you are older, have a bleeding condition, or are pregnant, don't take ginkgo. The supplement might raise the risk of bleeding.
Label source:
Anecdotal: Mayo Clinic
Action type:
avoid
Target id:
/intervention/efavirenz
Target name:
Efavirenz
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Ginkgo has been shown to significantly reduce blood levels of efavirenz, an antiretroviral medication for HIV, which can lead to loss of virologic control and treatment failure.
Actionable advice:
Ginkgo should not be taken during treatment for HIV with efavirenz.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
We report a case in which a potential drug-herb interaction may have led to virological breakthrough in a patient that was maintained on the same regimen for 10 years.
Label source:
PubMed: A potential drug-herbal interaction between Ginkgo biloba and efavirenz. (PMID 22323244)
Action type:
avoid
Target id:
/dietary/ginkgo-seeds
Target name:
Raw or Roasted Ginkgo Seeds
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Unlike standardized leaf extracts, ginkgo seeds contain high concentrations of ginkgotoxin and can cause severe poisoning, leading to seizures, loss of consciousness, or death.
Actionable advice:
Ginkgo seeds should never be consumed; only standardized leaf extract supplements should be used.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Although reported cases of ginkgo seed poisoning usually involve children who exhibit repetitive seizures that can be fatal, prompt administration of pyridoxal phosphate (2 mg/kg) may have prevented additional seizures.
Label source:
PubMed: Ginkgo seed poisoning. (PMID 11826216)
Action type:
informational_none
Target id:
/class/nsaids
Target name:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Like prescription blood thinners, NSAIDs (e.g., ibuprofen, naproxen) also have antiplatelet effects. Combining them with Ginkgo increases the risk of gastrointestinal bleeding and bruising.
Actionable advice:
Extreme caution is warranted, and it is important to talk to a doctor before combining Ginkgo with regular NSAID use.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Ibuprofen Or Naproxen (PRECISION) was conducted to assess the relative
cardiovascular thrombotic risk of a COX-2 inhibitor, celecoxib, compared to the non-selective
NSAIDs naproxen and ibuprofen.
Label source:
Action type:
informational_none
Target id:
/class/antidiabetic-medications
Target name:
Diabetes Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Ginkgo may unpredictably affect blood glucose levels and insulin secretion, potentially interfering with the action of diabetes medications and leading to poor glycemic control.
Actionable advice:
If you have diabetes, monitor blood sugar very closely and consult your doctor before using Ginkgo.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
12 CLINICAL PHARMACOLOGY 12.1 Mechanism of Action Metformin is an antihyperglycemic agent which improves glucose tolerance in patients with type 2 diabetes mellitus, lowering both basal and postprandial plasma glucose.
Label source:
Action type:
monitor
Target id:
/class/ssris-snris
Target name:
SSRI & SNRI Antidepressants
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Combining Ginkgo with SSRIs or SNRIs increases the risk of bleeding, as both agents affect platelet function. A theoretical risk of serotonin syndrome also exists, though it is very rare.
Actionable advice:
It is important to talk to a physician before combining Ginkgo with SSRI or SNRI antidepressants due to increased bleeding risk.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
Ginkgo biloba may increase your risk of bleeding if you take it with... Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft)
Label source:
Primary literature: https://www.goodrx.com/well-being/supplements-herbs/ginkgo-biloba-interactions
Action type:
informational_none
Target id:
/class/cyp2c19-substrates
Target name:
CYP2C19 Substrates
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Ginkgo can induce (speed up) the CYP2C19 enzyme, which accelerates the breakdown of certain drugs (like omeprazole, clopidogrel), reducing their blood levels and effectiveness.
Actionable advice:
It is a good idea to consult a pharmacist when taking medications metabolized by CYP2C19, as their dose may need adjustment.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
For current labeling information, please visit https://www.fda.gov/drugsatfda
12.5 Pharmacogenomics CYP2C19, a polymorphic enzyme, is involved in the metabolism of omeprazole.
Label source:
Action type:
adjust_with_prescriber
Target id:
/class/cyp2c9-substrates
Target name:
Drugs Metabolized by CYP2C9
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Ginkgo may inhibit (slow down) the CYP2C9 enzyme, which can increase the levels of certain drugs (like ibuprofen, losartan), raising the risk of toxicity and side effects.
Actionable advice:
Caution is warranted when combining Ginkgo with drugs metabolized by CYP2C9, especially those with a narrow therapeutic window.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Examples of inhibitors and inducers of CYP2C9, 1A2, and 3A4 are below in Table 2; however, this list should not be considered all-inclusive.
Label source:
Action type:
informational_none
Target id:
/class/anticonvulsants
Target name:
Anticonvulsant Medications
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
By lowering the seizure threshold, Ginkgo may work against the action of anticonvulsant drugs (e.g., valproic acid, carbamazepine), reducing their effectiveness in preventing seizures.
Actionable advice:
Ginkgo is best avoided when taking medication to control seizures.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
John's wortb, sucralfate, theophylline Drugs that may either increase or decrease phenytoin serum levels Antiepileptic drugs Phenobarbital, valproate sodiumc, valproic acidc a Antacids may affect absorption of phenytoin.
Label source:
Action type:
avoid
Target id:
/class/herbal-anticoagulants
Target name:
Other Blood-Thinning Supplements
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Combining Ginkgo with other supplements that have blood-thinning properties (e.g., high-dose fish oil, garlic, ginger, vitamin E) can have an additive effect, increasing the overall risk of bleeding.
Actionable advice:
Ginkgo is best not combined with other supplements known to thin the blood.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Herbal products that may potentially increase the risk of bleeding or potentiate the effects of warfarin therapy include angelica root, arnica flower, anise, asafoetida, bogbean, borage seed oil, bromelain, capsicum, celery, chamomile, clove, fenugreek, feverfew, garlic, ginger ginkgo, horse chestnut, licorice root, lovage root, meadowsweet, onion, parsley, passionflower herb, poplar, quassia, red clover, rue, sweet clover, turmeric, and willow bark.
Label source:
PubMed: Potential interactions between alternative therapies and warfarin. (PMID 10902065)
Action type:
avoid
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
It is not known if components of Ginkgo are excreted in breast milk or what effects they may have on a nursing infant.
Actionable advice:
Ginkgo is best avoided while breastfeeding due to the lack of safety information.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
It is not known if ginkgo passes into breast milk.
Label source:
Anecdotal: WebMD
Action type:
avoid
Target id:
/class/cyp3a4-substrates
Target name:
CYP3A4 Substrates
Severity:
minor
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Some evidence suggests Ginkgo may induce the CYP3A4 enzyme, potentially accelerating the metabolism of a wide range of medications and slightly reducing their effectiveness.
Actionable advice:
Ginkgo could slightly reduce the effectiveness of medications metabolized by CYP3A4.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Blood pressure should be closely
monitored when Amlodipine is co-administered with CYP3A4 inducers.
Label source:
Action type:
informational_none
Target id:
/class/cyp1a2-substrates
Target name:
CYP1A2 Substrates
Severity:
minor
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Ginkgo may weakly induce the CYP1A2 enzyme, which could slightly increase the metabolism of substrates like caffeine or theophylline, potentially reducing their effects.
Actionable advice:
It is worth watching out for any minor changes in the effects of medications or substances like caffeine that are metabolized by CYP1A2.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The results showed that pretreatment of rats with GBE resulted in an increase in the total clearance of theophylline of about 30% (GBE 10 mg/kg, P<0.05) and 70% (GBE 100 mg/kg, P<0.01) compared with the control group after intravenous administration of theophylline (10 mg/kg).
Label source:
PubMed: Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association (2007)
Source url:
Exact phrase from label:
CYP1A1, 1A2, 2B1/2, and 3A1 activities and gene expression in the rat liver were significantly increased in a dose-dependent manner by pretreatment with EGb 761.
Label source:
PubMed: Current drug metabolism (2006)
Source url:
Exact phrase from label:
EGb 761® has no relevant effect on the in vivo activity of the major CYP enzymes in humans and therefore has no relevant potential to cause respective metabolic drug-drug interactions.
Label source:
PubMed: European journal of clinical pharmacology (2012)
Action type:
monitor
Target id:
/class/p-glycoprotein-substrates
Target name:
P-glycoprotein Substrates
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Ginkgo may alter the function of the P-glycoprotein drug transporter, which could unpredictably change the absorption and concentration of certain medications like digoxin.
Actionable advice:
P-glycoprotein substrate drugs may have altered effects when Ginkgo is taken.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Digoxin absorption may also be affected by various concomitant
therapy modulating gastric pH and P-glycoprotein [see Drug Interactions (7)].
Label source:
Action type:
informational_none