Ginkgo

• What other names is Ginkgo known by?
• What is Ginkgo?
• Is Ginkgo effective?
• How does Ginkgo work?
• Are there safety concerns?
• Are there any interactions with medications?

What other names is Ginkgo known by?

Adiantifolia, Bai Guo Ye, Baiguo, Fossil Tree, Ginkgo biloba, Ginkgo Extract, Ginkgo Folium, Ginkgo Leaf Extact, Ginkgo Seed, Herba Ginkgo Biloba, Japanese Silver Apricot, Kew Tree, Maidenhair Tree, Salisburia Adiantifolia, Yinhsing.

What is Ginkgo?

Ginkgo is an herb. The leaves are generally used to make medicine. However, a few medicines are made from the seed, but these are not well studied.

Is Ginkgo effective?

There is some scientific evidence that ginkgo can slow the loss of memory and social skills in people with Alzheimer’s disease. Ginkgo might also help normal memory loss in older people and can possibly sharpen the thinking skills of younger people.

Ginkgo might also help people who experience leg pain when they walk due to poor bloodflow. Ginkgo seems to be able to help people with this condition walk farther before the pain starts. It might also help people with balance problems, ease some of the symptoms of premenstrual syndrome (PMS) (especially breast tenderness), improve distance vision in people with macular degeneration, improve color vision in people with diabetes, and reverse the sexual side effects of certain medications for depression (such as Prozac, Paxil, Zoloft, etc.).

There isn’t enough information to know if ginkgo leaf is effective for the other conditions people use it for, including: attention deficit-hyperactivity disorder (ADHD), blood clots, heart disease, high cholesterol, “hardening” of the arteries, depression, mountain sickness, and others.

Possibly Effective for...

• Alzheimer's disease and other forms of dementia.
• Improving thinking problems caused by old age.
• Improving thinking in young people.
• Raynaud's syndrome (a painful response to cold especially in the fingers and toes).
• Leg pain when walking due to poor blood flow (claudication).
• Vertigo and dizziness.
• Premenstrual syndrome (PMS).
• Improving color vision in people with diabetes.
• Treating some kinds of eye diseases (glaucoma and eye damage caused by diabetes).

Possibly Ineffective for...

• Ringing in the ears (tinnitus).
• Winter depression in people with seasonal affective disorder (SAD).
• Sexual problems related to antidepressant medicines.
• Sexual problems in women.
• Preventing symptoms of mountain or altitude sickness in climbers.

Insufficient Evidence to Rate Effectiveness for...

• Age-related macular degeneration (AMD), anxiety, attention deficit-hyperactivity disorder (ADHD), blood clots, heart disease, stroke, high cholesterol, "hardening" of the arteries (atherosclerosis), colorectal cancer, ovarian cancer, hearing loss, schizophrenia, and other conditions when the extract is used.
• Coughs, asthma, bronchitis, urinary problems, cognitive problems related to Lyme disease, digestion disorders, chronic fatigue syndrome (CFS), scabies, and skin sores when the seeds are used.

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).

How does Ginkgo work?

Ginkgo seems to improve blood circulation, which might help the brain, eyes, ears, and legs function better. It may slow down Alzheimer's disease by interfering with the changes in the brain that interfere with thinking.

Ginkgo seeds contain substances that might kill bacteria and fungi which cause infections in the body. The seeds also contain a toxin that can cause side effects like seizure and loss of consciousness.

Are there safety concerns?

Ginkgo is safe for most people when used appropriately. It can cause some minor side effects such as stomach upset, headache, dizziness, constipation, forceful heartbeat, and allergic skin reactions.

There is some concern that ginkgo might increase the risk of bruising and bleeding. Ginkgo thins the blood and decreases its ability to form clots. A few people taking ginkgo have had bleeding into the eye and into the brain, and excessive bleeding following surgery.

Some research suggests that a specific combination of ginkgo leaf extract plus American ginseng might be safe in children when used short-term.

Ginkgo seeds might not be safe. Long-term use or use of medicinal amounts can cause serious side effects including stomachache, nausea, diarrhea, vomiting, restlessness, difficulty breathing, weak pulse, shock, seizures, loss of consciousness, and death.

Do not take ginkgo if:

• You are pregnant or breast-feeding.
• You are scheduled for surgery in the next two weeks. It might increase the risk of bleeding.
• You have a bleeding problem.
• You have seizures, convulsions, or epilepsy.
• You are trying to get pregnant or father a child.

Are there any interactions with medications?

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Ibuprofen
Interaction Rating: Major Do not take this combination.

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

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Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)
Interaction Rating: Major Do not take this combination.

Ginkgo can 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.

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Warfarin (Coumadin)
Interaction Rating: Major Do not take this combination.

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.

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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.

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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

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

Taking ginkgo along with St. John's wort, other herbs, 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).

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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.

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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.

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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 change 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 this 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.

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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 change 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.

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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.

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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.

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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.

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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.

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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).

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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.

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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.