April 29, 2016

Ginkgo

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Are there any interactions with medications?



Efavirenz (Sustiva)
Interaction Rating: Major Do not take this combination.

Efavirenz (Sustiva) is used to treat HIV infection. Taking efavirenz (Sustiva) along with ginkgo extract might decrease the effects of efavirenz (Sustiva). Before taking ginkgo, talk to your healthcare provider if you take medications for HIV.



Talinolol
Interaction Rating: Major Do not take this combination.

Taking ginkgo leaf extract multiple times per day might increase levels of talinolol. In theory, this might increase the effects and side effects of talinolol. However, taking a single dose of ginkgo does not seem to affect talinolol levels.



Alprazolam (Xanax)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Taking ginkgo along with alprazolam might decrease the effects of alprazolam in some people.



Atorvastatin
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

The body breaks down atorvastatin to get rid of it. Ginkgo might increase how quickly the body gets rid of atorvastatin. However, it's not clear if this is a big concern. Ginkgo does not appear to influence the effects of atorvastatin on cholesterol levels. Until more is known, use cautiously.



Buspirone (BuSpar)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Ginkgo seems to affect the brain. Buspirone (BuSpar) also affects the brain. One person felt hyper and overexcited when taking ginkgo, buspirone (BuSpar), and other medications. It is unclear if this interaction was caused by ginkgo or the other medications.



Fluoxetine (Prozac)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Taking ginkgo along with buspirone (BuSpar), St. John's wort, melatonin, and fluoxetine (Prozac) might cause you to feel irritated, nervous, jittery, and excited. This is called hypomania. It's not known if this is a concern when just ginkgo is taken with fluoxetine (Prozac).



Ibuprofen
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Ginkgo might slow blood clotting. Ibuprofen can also slow blood clotting. Taking ginkgo with ibuprofen might slow blood clotting too much and increase the chance of bruising and bleeding.



Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Ginkgo might decrease how quickly the liver breaks down some medications. Taking ginkgo along with some medications that are changed by the liver might increase the effects and side effects of some medications. Before taking ginkgo, talk to your healthcare provider if you take any medications that are changed by the liver.

Some of these medications that are changed by the liver include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others.



Medications changed by the liver (Cytochrome P450 2C19 (CYP2C19) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Ginkgo might increase how quickly the liver breaks down some medications. Taking ginkgo with these medications might decrease how well the medication works. Before taking ginkgo, talk to your healthcare provider if you take any medications that are changed by the liver.

Some of these medications that are changed by the liver include amitriptyline (Elavil), carisoprodol (Soma), citalopram (Celexa), diazepam (Valium), lansoprazole (Prevacid), omeprazole (Prilosec), phenytoin (Dilantin), warfarin (Coumadin), and many others.



Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Ginkgo might decrease how quickly the liver breaks down some medications. Taking ginkgo along with these medications that are changed by the liver might increase the effects and side effects of your medication. Before taking ginkgo, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include amitriptyline (Elavil), diazepam (Valium), zileuton (Zyflo), celecoxib (Celebrex), diclofenac (Voltaren), fluvastatin (Lescol), glipizide (Glucotrol), ibuprofen (Advil, Motrin), irbesartan (Avapro), losartan (Cozaar), phenytoin (Dilantin), piroxicam (Feldene), tamoxifen (Nolvadex), tolbutamide (Tolinase), torsemide (Demadex), warfarin (Coumadin), and others.



Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Ginkgo might decrease how quickly the liver breaks down some medications. Taking ginkgo along with some medications that are changed by the liver can increase the effects and side effects of your medication. Before taking ginkgo, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include amitriptyline (Elavil), clozapine (Clozaril), codeine, desipramine (Norpramin), donepezil (Aricept), fentanyl (Duragesic), flecainide (Tambocor), fluoxetine (Prozac), meperidine (Demerol), methadone (Dolophine), metoprolol (Lopressor, Toprol XL), olanzapine (Zyprexa), ondansetron (Zofran), tramadol (Ultram), trazodone (Desyrel), and others.



Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Ginkgo might affect how quickly the liver breaks down some medications, and lead to a variety of effects and side effects. Before taking ginkgo, talk to your healthcare provider if you are taking any medications that are changed by the liver.

Some medications changed by the liver include lovastatin (Mevacor), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), diltiazem (Cardizem), estrogens, indinavir (Crixivan), triazolam (Halcion), and others.



Medications for depression (Antidepressant drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Ginkgo might decrease a brain chemical called serotonin. Some medications for depression increase serotonin. Taking ginkgo along with these medications for depression might decrease their effectiveness.

Some of these medications for depression include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and others; and tricyclic and atypical antidepressants such as amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Tofranil), and others.



Medications for diabetes (Antidiabetes drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Diabetes medications are used to lower blood sugar. Ginkgo might increase or decrease insulin and blood sugar in people with type 2 diabetes. Taking ginkgo along with diabetes medications might decrease how well your medication works. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.

Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.



Medications that increase the chance of having a seizure (Seizure threshold lowering drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications increase the chance of having a seizure. Taking ginkgo might cause seizures in some people. If this combination is taken, it might greatly increase the chance of having a seizure. Do not take ginkgo with medications that increase the chance of having a seizure.

Some medications that increase the chance of having a seizure include anesthesia (propofol, others), antiarrhythmics (mexiletine), antibiotics (amphotericin, penicillin, cephalosporins, imipenem), antidepressants (bupropion, others), antihistamines (cyproheptadine, others), immunosuppressants (cyclosporine), narcotics (fentanyl, others), stimulants (methylphenidate), theophylline, and others.



Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Ginkgo might slow blood clotting. Taking ginkgo along with medications that also slow clotting might increase the chances of bruising and bleeding.

Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, indomethacin (Indocin), ticlopidine (Ticlid), warfarin (Coumadin), and others.



Medications used to prevent seizures (Anticonvulsants)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Medications used to prevent seizures affect chemicals in the brain. Ginkgo can also affect chemicals in the brain in a way that might possibly decrease the effectiveness of medications used to prevent seizures.

Some medications used to prevent seizures include phenobarbital, primidone (Mysoline), valproic acid (Depakene), gabapentin (Neurontin), carbamazepine (Tegretol), phenytoin (Dilantin), and others.



Risperidone (Risperdal)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Ginkgo might decrease how quickly the liver breaks down some medications, including risperidone, which might increase the risk of side effects. Before taking ginkgo, talk to your healthcare provider if you are taking risperidone.



Simvastatin (Zocor)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

The body breaks down simvastatin (Zocor) to get rid of it. Ginkgo might increase how quickly the body gets rid of simvastatin (Zocor). However, it's not clear if this is a big concern as it does not appear to reduce the drug's effect on cholesterol levels. Until more is known, use cautiously.



Trazodone (Desyrel)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Trazodone (Desyrel) affects chemicals in the brain. Ginkgo can also affect chemicals in the brain. Taking trazodone (Desyrel) along with ginkgo might cause serious side effects in the brain. One person taking trazodone and ginkgo went into a coma. Do not take ginkgo if you are taking trazodone (Desyrel).



Warfarin (Coumadin)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Warfarin (Coumadin) is used to slow blood clotting. Ginkgo might also slow blood clotting. Taking ginkgo along with warfarin (Coumadin) might increase the chances of bruising and bleeding. Be sure to have your blood checked regularly. The dose of your warfarin (Coumadin) might need to be changed.



Hydrochlorothiazide
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Hydrochlorothiazide is used to help decrease swelling and control blood pressure. Taking hydrochlorothiazide along with ginkgo might increase blood pressure. Before taking ginkgo, talk to your healthcare provider if you take medications for high blood pressure.



Nifedipine
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Taking both ginkgo and nifedipine by mouth might increase nifedipine levels in the body. This might cause increased side effects, including headaches, dizziness, and hot flushes. However, taking nifedipine intravenously (by IV) while taking ginkgo by mouth does not seem to have the same effect.



Omeprazole (Prilosec)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Omeprazole (Prilosec) is changed and broken down by the liver. Ginkgo might increase how fast the liver breaks down omeprazole (Prilosec). Taking ginkgo with omeprazole (Prilosec) might decrease how well omeprazole (Prilosec) works.

Dosing considerations for Ginkgo.

The following doses have been studied in scientific research:

BY MOUTH:
  • For anxiety: 80 mg or 160 mg of a ginkgo leaf extract called EGb 761 has been taken three times per day for 4 weeks.
  • For dementia: a dosage of 120-240 mg per day of ginkgo leaf extract (EGb 761), divided in two or three doses.
  • For retinal damage caused by diabetes: 120 mg of a ginkgo leaf extract called EGb 761 has been taken daily for 6 months.
  • For improving mental function: single doses of 240-600 mg of ginkgo extract have been used. A ginkgo extract called EGb 761 has been taken in a dosage of 120-240 mg per day for 4 weeks to 4 months. A ginkgo leaf extract called LI 1370 has been taken in a dosage of 120-300 mg for two days. Also, a combination product containing ginkgo extract and Panax ginseng (Ginkoba M/E) has been taken in a dosage of 60-360 mg for 12 weeks.
  • For walking pain due to poor circulation (claudication, peripheral vascular disease): a dosage of 120-240 mg per day of ginkgo leaf extract (EGb 761), divided into two or three doses, has been used for up to 6.1 years. The higher dose may be more effective.
  • For vertigo: 160 mg of a ginkgo leaf extract called EGb 761 has been taken once daily or in two divided doses daily for 3 months.
  • For premenstrual syndrome (PMS): 80 mg of a ginkgo leaf extract called EGb 761 has been taken twice daily, starting on the sixteenth day of the menstrual cycle until the fifth day of the next cycle. Also 40 mg of a ginkgo leaf extract called Ginko T.D. has been taken three times daily starting on the sixteenth day of the menstrual cycle until the fifth day of the next cycle.
  • For the treatment of glaucoma: 120 to 160 mg of ginkgo leaf extract has been taken in two or three divided doses per day for up to 12.3 years.
  • For schizophrenia: 120-360 mg of a ginkgo leaf extract called EGb 761 (Yi Kang Ning, Yang Zi Jiang Pharmaceuticals Ltd., Jiangsu, China) has been used daily for 8-16 weeks.
  • For tardive dyskinesia: 80 mg of a ginkgo leaf extract called EGb 761, three times daily for 12 weeks, has been used.
For all uses, start at a lower dose of not more than 120 mg per day to avoid gastrointestinal (GI) side effects. Increase to higher doses indicated as needed. Dosing may vary depending on the specific formulation used. Most researchers used specific standardized Ginkgo biloba leaf extracts. Some people take 0.5 mL of a standard 1:5 tincture of the crude ginkgo leaf three times daily.

You should avoid crude ginkgo plant parts. These can contain dangerous levels of the toxic chemicals found in the seed of the plant and elsewhere. These chemicals can cause severe allergic reactions.


Therapeutic Research Faculty copyright

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