Basic Information
ID DDInter819 and DDInter104
Interaction Ginkgo may potentiate the risk of bleeding associated with anticoagulants, platelet inhibitors, and thrombolytic agents. Ginkgolide B, a component of ginkgo, inhibits platelet-activating factor by displacing it from its receptor-binding site, resulting in reduced platelet aggregation.
Management Patients should consult a healthcare provider before taking any herbal or alternative medicine. In general, consumption of ginkgo should be avoided during use of coagulation-modifying agents and at least two weeks prior to surgery. In patients who have used this herb extensively prior to receiving anticoagulation, antiplatelet or thrombolytic therapy, the potential for an interaction should be considered. Close clinical and laboratory observation for hematologic complications is recommended. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.
References [1] Benjamin J, Muir T, Briggs K, Pentland B "A case of cerebral haemorrhage - can Ginkgo biloba be implicated?." Postgrad Med J 77 (2001): 112-3 [2] Jayasekera N, Moghal A, Kashif F, Karalliedde L "Herbal medicines and postoperative haemorrhage." Anaesthesia 60 (2005): 725-6 [3] Evans V "Herbs and the brain: friend or foe? The effects of ginkgo and garlic on warfarin use." J Neurosci Nurs 32 (2000): 229-32 [4] Jiang X, Williams KM, Liauw WS, et al. "Effect of ginkgo and ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects." Br J Clin Pharmacol 59 (2005): 425-32 [5] Rowin J, Lewis SL "Spontaneous bilateral subdural hematomas associated with chronic Gingko biloba ingestion." Neurology 46 (1996): 1775-6 [6] Cupp MJ "Herbal remedies: adverse effects and drug interactions." Am Fam Physician 59 (1999): 1239-45 [7] Engelsen J, Nielsen JD, Winther K "Effect of coenzyme Q10 and Ginkgo biloba on warfarin dosage in stable, long-term warfarin treated outpatients. A randomised, double blind, placebo-crossover trial." Thromb Haemost 87 (2002): 1075-6 [8] Matthews MK Jr "Association of Ginko biloba with intracerebral hemorrhage." Neurology 50 (1998): 1933-4 [9] Sierpina VS, Wollschlaeger B, Blumenthal M "Ginkgo biloba." Am Fam Physician 68 (2003): 923-6 [10] Fugh-Berman A "Herb-drug interactions." Lancet 355 (2000): 134-8 [11] Vaes LP, Chyka PA "Interactions of warfarin with garlic, ginger, or ginseng: nature of evidence." Ann Pharmacother 34 (2000): 1478-82 [12] Chung KF, McCusker M, Page CP, Dent G, Guinot P, Barnes PJ "Effect of ginkgolide mixture (BN 52063) in antagonising skin and platelet responses to platelet acitivating factor in man." Lancet 1 (1987): 248-51 [13] Rosenblatt M, Mindel J "Spontaneous hyphema associated with ingestion of Ginkgo biloba extract." N Engl J Med 336 (1997): 1108 [14] Heck AM, DeWitt BA, Lukes AL "Potential interactions between alternative therapies and warfarin." Am J Health Syst Pharm 57 (2000): 1221-7; quiz 1228-30 [15] Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11 [16] Fessenden JM, Wittenborn W, Clarke L "Gingko biloba: A case report of herbal medicine and bleeding postoperatively from a laparoscopic cholecystectomy." Am Surg 67 (2001): 33-5 [17] Fong KC, Kinnear PE "Retrobulbar haemorrhage associated with chronic Gingko biloba ingestion." Postgrad Med J 79 (2003): 531-2 [18] Izzo AA, Ernst E "Interactions between herbal medicines and prescribed drugs: a systematic review." Drugs 61 (2001): 2163-75
Alternative for Ginkgo biloba N06D
Memantine Rivastigmine Donepezil Galantamine Aducanumab Tacrine
Alternative for Antithrombin Alfa -
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.