Ginkgo biloba interacts in the following cases:
If the medicinal product is taken concomitantly with anticoagulants (e.g. phenprocoumon and warfarin) or antiplatelet drugs (e.g. clopidogrel, acetylsalicylic acid and other non-steroidal antiinflammatory drugs), their effect may be influenced.
In patients with concomitant anticoagulant and antiplatelet treatment, the medicinal product should only be used after consultation with a doctor.
Caution is advised if combining Ginkgo biloba and dabigatran.
One interaction study has indicated that the Cmax of nifedipine may be increased by Ginkgo biloba. In some individuals, increases by up to 100% were observed resulting in dizziness and increased severity of hot flushes.
Available studies with warfarin do not indicate that there is an interaction between warfarin and Ginkgo biloba products, but adequate monitoring is advised when starting, when changing Ginkgo biloba dose, when ending Ginkgo biloba intake or if changing product.
In patients with a pathologically increased bleeding tendency (haemorrhagic diathesis), the medicinal product should only be used after consultation with a doctor.
In patients with epilepsy, onset of further seizures – promoted by intake of Ginkgo preparations – cannot be excluded.
An interaction study with talinolol indicates that Ginkgo biloba may inhibit P-glycoprotein at the intestinal level. This may give rise to increased exposure of drugs markedly affected by P-glycoprotein in the intestine such as dabigatran etexilate.
Ginkgo biloba extracts may impair the ability of platelets to aggregate. The tendency for bleeding may be increased. Animal studies are insufficient with respect to reproductive toxicity.
The use is contraindicated in pregnancy.
It is unknown whether Ginkgo biloba metabolites are excreted in human milk. A risk to the newborns/infants cannot be excluded.
In the absence of sufficient data, the use during lactation is not recommended.
No specific studies with Ginkgo biloba in humans have been conducted to evaluate effects on fertility. In a study in female mice effects on fertility were seen.
No adequate studies on the effect on the ability to drive and use machines have been performed.
Bleeding of individual organs has been reported (eye, nose, cerebral and gastrointestinal haemorrhage). The frequency is not known.
Very common: headache
Common: dizziness
Common: diarrhoea, abdominal pain, nausea, vomiting
Hypersensitivity reactions (allergic shock) may occur. The frequency is not known.
Allergic skin reactions (erythema, oedema, itching and rash) may also occur. The frequencies are not known.
If other adverse reactions not mentioned above occur, a doctor or a pharmacist should be consulted.
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