Interactions

Interactions with Drugs

Ginkgo may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Ginkgo may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

Ginkgo may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be altered in the blood, and may cause increased effects or potentially serious adverse reactions. People using any medications should check the package insert, and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

Tyramine/tryptophan containing foods may cause dangerously high blood pressure when taken at the same time as agents that have properties similar to monoamine oxidase inhibitor drugs (MAOIs). These include protein foods that have been aged/preserved. Specific examples of foods are anchovies, avocados, bananas, bean curd, beer (alcohol-free/reduced), caffeine (large amounts), caviar, champagne, cheeses (particularly aged, processed, or strong varieties), chocolate, dry sausage/salami/bologna, fava beans, figs, herring (pickled), liver (particularly chicken), meat tenderizers, papaya, protein extracts/powder, raisins, shrimp paste, sour cream, soy sauce, wine (particularly chianti), yeast extracts, and yogurt.

Ginkgo may cause altered blood pressure. Caution is advised in people taking drugs that lower blood pressure.

Ginkgo may also interact with agents eliminated by the kidney; agents for Alzheimer's, asthma, or cancer; agents for psychosis, seizures, tinnitus (ringing of ears) or vertigo (dizziness); agents for pain relief; agents for the brain, eyes, heart, or lungs; agents that increase urination such as thiazide; agents that may lower seizure threshold; agents that widen blood vessels; agents that reduce androgen or estrogen activity; antianxiety agents; anticholinergics (blocks acetylcholine); antidepressants such as monoamine oxidase inhibitors (MAOIs) or selective serotonin reuptake inhibitors (SSRIs); antihistamines; anti-inflammatories; cholesterol lowering agents; cilostazol; clozapine; cognitive agents; colchicine; efavirenz; exercise performance enhancement agents; hemorrhoid agents; hormonal agents; ibuprofen; impotence agents; iodine; lithium; nifedipine; olanzapine; prednisone; risperidone; rofecoxib; sexual performance agents; ticlopidine; trazodone.

Interactions with Herbs and Dietary Supplements

Ginkgo may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Ginkgo may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

Ginkgo may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may become altered in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.

Tyramine/tryptophan containing foods may cause dangerously high blood pressure when taken at the same time as agents that have properties similar to monoamine oxidase inhibitor drugs (MAOIs). These include protein foods that have been aged/preserved. Specific examples of foods are anchovies, avocados, bananas, bean curd, beer (alcohol-free/reduced), caffeine (large amounts), caviar, champagne, cheeses (particularly aged, processed, or strong varieties), chocolate, dry sausage/salami/bologna, fava beans, figs, herring (pickled), liver (particularly chicken), meat tenderizers, papaya, protein extracts/powder, raisins, shrimp paste, sour cream, soy sauce, wine (particularly chianti), yeast extracts, and yogurt.

Ginkgo may cause low blood pressure. Caution is advised in people taking herbs or supplements that lower blood pressure.

Ginkgo may also interact with androgen blocking herbs and supplements; antianxiety herbs and supplements; anticholinergics (blocks acetylcholine); antidepressants such as monoamine oxidase inhibitors (MAOIs) or selective serotonin reuptake inhibitors (SSRIs); antihistamines; anti-inflammatories; antioxidants; athletic performance enhancers; cholesterol lowering herbs and supplements; cognitive herbs and supplements; ginger; hemorrhoid herbs and supplements; herbs and supplements eliminated by the kidney; herbs and supplements for Alzheimer's, arthritis, asthma, or cancer; herbs and supplements for psychosis, seizures, tinnitus (ringing of ears), or vertigo (dizziness); herbs and supplements for sexual arousal; herbs and supplements for the brain, eyes, heart, and lungs; herbs and supplements that widen blood vessels; hormonal herbs and supplements or hormone replacement therapy; impotence herbs and supplements; iodine; herbs and supplements that increase urination; pain relief herbs and supplements; seizure threshold-lowering herbs and supplements; St. John's wort; yohimbe bark extract; yohimbine.

This evidence-based monograph was prepared by The Natural Standard Research Collaboration

www.naturalstandard.com