Ginkgo Biloba (Herb/Suppl)

Brand and Other Names:Eun-haeng, fossil tree, more...ginko biloba, ginkyo, icho, ityo, Japanese silver apricot, kew tree, maidenhair tree, salisburia, silver apricot
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Suggested Dosing

Altitude Sickness, Prevention

Leaf extract: 80 mg PO BID

Cognitive Function

Leaf extract: 120-600 mg/d PO BID

Dementia

Leaf extract: 120-240 mg/d PO div BID-TID

Intermittent Claudication

Leaf extract: 120-240 mg/d PO div BID-TID

Premenstrual Syndrome

Leaf extract: 80 mg PO BID; start on day 16 and continue until day 5 of next cycle

SSRI-induced Sexual Dysfunction

Leaf extract: 60-240 mg PO BID

Vertigo/tinnitus

Leaf extract: 120-160 mg/d PO div BID-TID

Raynaud's Disease

Leaf extract: 360 mg/d PO div TID

Normal Tension Glaucoma

Leaf extract: 40 mg PO TID x 4 weeks

Other Information

Standardized to 24% flavonoids, 6% terpenes

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Suggested Uses

Altitude sickness (prevention), cerebral vascular insufficiency, cognitive disorders, dementia, dizziness/vertigo, intermittent claudication, macular degeneration/glaucoma, memory loss, premenstrual syndrome, SSRI-induced sexual dysfunction, vasodilator

Efficacy

Documented incr in cerbral blood flow (greater effect in patients >50 years old)

Documented increase in peripheral blood flow in diabetes, intermittent claudication, hearing loss

Studies underway for SSRI-induced erectile dysfunction; initial results positive

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Interactions

Interaction Checker

and Ginkgo Biloba

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      Serious - Use Alternative

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            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (72)

                • aceclofenac

                  aceclofenac and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • acemetacin

                  acemetacin and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • agrimony

                  agrimony and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • alfalfa

                  alfalfa and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • alteplase

                  alteplase and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • American ginseng

                  American ginseng and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • antithrombin alfa

                  antithrombin alfa and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • antithrombin III

                  antithrombin III and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • argatroban

                  argatroban and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • aspirin

                  aspirin and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • aspirin rectal

                  aspirin rectal and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • aspirin/citric acid/sodium bicarbonate

                  aspirin/citric acid/sodium bicarbonate and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • bemiparin

                  bemiparin and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • bivalirudin

                  bivalirudin and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • celecoxib

                  celecoxib and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • choline magnesium trisalicylate

                  choline magnesium trisalicylate and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • cinnamon

                  cinnamon and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • cordyceps

                  cordyceps and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • dabigatran

                  dabigatran and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • dalteparin

                  dalteparin and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • diclofenac

                  diclofenac and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • diflunisal

                  diflunisal and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • dong quai

                  dong quai and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • enoxaparin

                  enoxaparin and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • epoprostenol

                  epoprostenol and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • etodolac

                  etodolac and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • fennel

                  fennel and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • fenoprofen

                  fenoprofen and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • feverfew

                  feverfew and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • flibanserin

                  ginkgo biloba will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

                • flurbiprofen

                  flurbiprofen and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • fondaparinux

                  fondaparinux and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • forskolin

                  forskolin and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • garlic

                  garlic and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • ginger

                  ginger and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • heparin

                  heparin and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • horse chestnut seed

                  ginkgo biloba and horse chestnut seed both increase anticoagulation. Use Caution/Monitor.

                • ibuprofen

                  ibuprofen and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • ibuprofen IV

                  ibuprofen IV and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • indomethacin

                  indomethacin and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • ketoprofen

                  ketoprofen and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • ketorolac

                  ketorolac and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • ketorolac intranasal

                  ketorolac intranasal and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • lomitapide

                  ginkgo biloba increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

                • lornoxicam

                  lornoxicam and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • meclofenamate

                  meclofenamate and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • mefenamic acid

                  mefenamic acid and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • meloxicam

                  meloxicam and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • mistletoe

                  ginkgo biloba increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • nabumetone

                  nabumetone and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • naproxen

                  naproxen and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • nettle

                  ginkgo biloba increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • oxaprozin

                  oxaprozin and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • panax ginseng

                  ginkgo biloba and panax ginseng both increase anticoagulation. Use Caution/Monitor.

                • parecoxib

                  parecoxib and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • pau d'arco

                  ginkgo biloba and pau d'arco both increase anticoagulation. Use Caution/Monitor.

                • phenindione

                  phenindione and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • phytoestrogens

                  ginkgo biloba and phytoestrogens both increase anticoagulation. Use Caution/Monitor.

                • piroxicam

                  piroxicam and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • protamine

                  protamine and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • reishi

                  ginkgo biloba and reishi both increase anticoagulation. Use Caution/Monitor.

                • reteplase

                  reteplase and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • salicylates (non-asa)

                  salicylates (non-asa) and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • salsalate

                  salsalate and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • Siberian ginseng

                  ginkgo biloba and Siberian ginseng both increase anticoagulation. Use Caution/Monitor.

                • sulfasalazine

                  sulfasalazine and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • sulindac

                  sulindac and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • tenecteplase

                  tenecteplase and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                • tolfenamic acid

                  tolfenamic acid and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • tolmetin

                  tolmetin and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

                • vitamin K1 (phytonadione)

                  ginkgo biloba increases and vitamin K1 (phytonadione) decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                • warfarin

                  warfarin and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

                Minor (13)

                • abciximab

                  ginkgo biloba, abciximab. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence.ÿ Use with caution.

                • anagrelide

                  ginkgo biloba, anagrelide. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence.ÿ Use with caution.

                • anamu

                  anamu and ginkgo biloba both increase anticoagulation. Minor/Significance Unknown.

                • cilostazol

                  ginkgo biloba, cilostazol. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence.ÿ Use with caution.

                • clopidogrel

                  ginkgo biloba, clopidogrel. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.

                • danshen

                  danshen and ginkgo biloba both increase anticoagulation. Minor/Significance Unknown.

                • devil's claw

                  devil's claw and ginkgo biloba both increase anticoagulation. Minor/Significance Unknown.

                • dipyridamole

                  ginkgo biloba, dipyridamole. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence.ÿ Use with caution.

                • eptifibatide

                  ginkgo biloba, eptifibatide. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.

                • green tea

                  green tea, ginkgo biloba. Other (see comment). Minor/Significance Unknown. Comment: Use caution when combining green tea with herbs that exhibit antiplatelet effects or anticoagulant activity.

                • prasugrel

                  ginkgo biloba, prasugrel. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence.ÿ Use with caution.

                • ticlopidine

                  ginkgo biloba, ticlopidine. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.

                • tirofiban

                  ginkgo biloba, tirofiban. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.

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                Adverse Effects

                Frequency Not Defined

                Allergic skin reactions

                Bleeding disorders

                Constipation

                Contact dermatitis (topical use)

                Diarrhea

                Dizziness

                Impaired fertility

                GI upset

                Headache

                Nausea/vomiting

                Palpitations

                Restlessness

                Seizures

                Subdural hematoma

                Weakness

                Vertigo (rare)

                Case reports of sponataneous bleeding from iris when used with aspirin

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                Warnings

                Contraindications

                Hypersensitivity

                Avoid prior to surgery: may cause bleeding

                Attempting conception

                Cautions

                Bleeding disorders, concurrent seizure threshold lowering drugs, diabetes mellitus, seizure disorder

                WARNING: seeds & fruit pulp are toxic

                May modulate some CYP 450 enzymes but clinical significance unknown, monitor when using concomitant substrates (eg, CYP3A4)

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                Pregnancy & Lactation

                Pregnancy Category: N/A

                Lactation: N/A

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Metabolism: N/A

                Excretion: N/A

                Mechanism of Action

                Ginkgoflavone glycosides: reduce capillary fragility, act as antioxidants

                Ginkgolides: inhib. platelet activating factor

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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.