Ginkgo Interactions

Ginkgo biloba inhibits platelet-activating factor and can prolong bleeding time, adding an antiplatelet effect on top of warfarin's vitamin-K-antagonist anticoagulation. A 2025 PLOS One analysis of 2,647 prescriptions found ginkgo co-prescription was associated with a significantly higher rate of bleeding adverse events (hazard ratio ~1.38) and abnormal coagulation profiles.

Ginkgo biloba induces CYP2C19, the primary enzyme responsible for phenytoin metabolism. A published case report described a fatal breakthrough seizure in a patient on phenytoin and valproate whose autopsy revealed subtherapeutic anticonvulsant levels and self-administration of ginkgo biloba. Ginkgo also has independent pro-convulsant potential at high doses and through ginkgotoxin contamination.

Ibuprofen inhibits platelet aggregation through COX-1, and Ginkgo biloba inhibits platelet-activating factor through ginkgolide B. Combining them increases the risk of bleeding, with case reports of fatal intracerebral hemorrhage.

Ginkgo biloba has antiplatelet properties and may theoretically add to the bleeding risk of rivaroxaban, although a controlled pharmacokinetic study with EGb 761 found no change in rivaroxaban plasma levels or anti-Factor Xa activity. The risk is primarily additive rather than pharmacokinetic.

Ginkgo biloba can inhibit platelet-activating factor (PAF) and platelet aggregation, which can add to aspirin's irreversible inhibition of cyclooxygenase-1 and thromboxane A2. The combination may modestly increase minor bleeding events, with case reports of more serious bleeds in vulnerable patients.

Ginkgo biloba inhibits platelet-activating factor and may add to clopidogrel's blockade of the platelet P2Y12 ADP receptor. While a healthy-volunteer study did not detect additive platelet inhibition, observational and case-report data link the combination to increased bleeding, including intracranial hemorrhage.

Ginkgo biloba improves cerebral blood flow and has antioxidant effects; complexing it with phosphatidylserine substantially enhances absorption of its active terpene lactones and flavone glycosides. The Virtiva complex (ginkgo + phosphatidylserine) showed improved secondary memory and faster memory task performance versus ginkgo alone in a placebo-controlled crossover trial.