Warnings/PrecautionsThe use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider qualified in the field of botanical medicine.
GBE is considered to be safe, and side effects are rare. In a few cases, gastrointestinal upset, headaches, skin reactions, and dizziness were reported.
Because gingko decreases platelet aggregation (stickiness), there is some concern that it may increase risk of intracranial (brain) hemorrhage. In fact, there have been several reports of bleeding complications associated with ginkgo use. However, it is not clear whether ginkgo or another factor (such as the combination of ginkgo and blood-thinning medications including aspirin and non-steroidal anti-inflammatory agents such as ibuprofen) caused the bleeding complications. One human study found that a ginkgo extract significantly prolonged bleeding time when given along with cilostazol (Pletal), a commonly used medication that inhibits platelet aggregation.
Pregnant and breastfeeding women should avoid using ginkgo preparations. In addition, ginkgo use should be discontinued at least 36 hours prior to surgery due to the risk of bleeding complications.
Do not ingest Ginkgo biloba fruit or seed.
Possible Interactions:
Ginkgo may alter the metabolism and effectiveness of some prescription and non-prescription medications. If you are being treated with any of the following medications, you should not use ginkgo without first talking to your health care provider:
Anticonvulsant medications -- High doses of ginkgo could decrease the effectiveness of anticonvulsant therapy, such as carbamazepine (Tegretol) or valproic acid (Depakote), in controlling seizures.
Antidepressant medications -- Taking ginkgo along with selective serotonin reuptake inhibitor (SSRIs) antidepressants -- including fluoxetin (Prozac), sertraline (Zoloft), paroxetine (Paxil), and escitalopram (Lexapro) -- may cause serotonin syndrome. This condition is characterized by rigidity, tachycardia (fast heart rate), hyperthermia (high body temperature), restlessness, and diaphoresis (sweating). Ginkgo may enhance the effects (both good and bad) of antidepressant medications known as MAOIs, such as phenelzine (Nardil).
Antihypertensive medications -- Ginkgo may decrease blood pressure, so use of ginkgo along with prescription antihypertensive medications should be monitored by a health care provider. There has been a report of an interaction between ginkgo and nifedipine (Procardia), a calcium channel blocking drug used for blood pressure and arrhythmias.
Blood-thinning medications -- Ginkgo has blood-thinning properties and therefore should not be used if you are taking anticoagulant (blood-thinning) medications, such as aspirin, clopidogrel (Plavix), dipyridamole (Persantine), heparin, ticlopidine (Ticlid), or warfarin (Coumadin). There has been bleeding in the brain reported when using a ginkgo product and ibuprofen (Advil), a non-steroidal antiinflammatory drug (NSAID).
Blood sugar lowering medications -- Ginkgo was reported to increase insulin levels in healthy subjects and to decrease insulin levels in diabetic patients. Use ginkgo supplements under the supervision of a health care provider if you are diabetic and taking insulin or oral blood sugar lowering drugs.
Cylosporine -- Ginkgo biloba may help protect the cells of the body during treatment with the immunosuppressive (decreases immunity) drug cyclosporine.
Thiazide diuretics -- Although there has been one literature report of increased blood pressure associated with the use of ginkgo during treatment with thiazide diuretics, this interaction has not been verified by clinical trials. Nevertheless, you should consult with your health care provider before using ginkgo if you are taking thiazide diuretics.
Trazodone -- There has been a report of an adverse interaction between ginkgo and trazodone (Desyrel), an antidepressant medication that resulted in an elderly patient going into a coma.
