What are the implications of taking Ginkgo biloba concurrently with an antiplatelet?
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- Answered 15 Jun 2019 Conflict of interest declaration: None A 2008 study Potential interaction of Ginkgo biloba leaf with antiplatelet or anticoagulant drugs: what is the evidence?  reported: “Results from controlled studies consistently indicate that Ginkgo does not significantly impact haemostasis nor adversely affect the safety of coadministered aspirin or warfarin. Most of these studies were undertaken using EGb 761, a well-defined extract of Ginkgo biloba. In contrast, EGb 761 has not generally been implicated in the case reports. In general, the quality of these case reports is low. Nevertheless, the possibility of an idiosyncratic bleeding event due to Ginkgo use cannot be excluded on the basis of the available information. However, there is scant information from case reports or controlled trials to support the suggestion that Ginkgo potentiates the effects of anticoagulant or antiplatelet drugs.” A 2011 paper  concluded: “Although the combination of G. biloba extract with antiplatelet or anticoagulants showed insignificant correlation to the risk of hemorrhage, patients using ginkgo, particularly those with known bleeding risks and elderly, should take a particular attention to the possibility of increasing risk of bleeding.” The UK MI service answered the Q “Can a person on low dose aspirin take ginkgo?” reporting: “Pharmacodynamic studies suggest that ginkgo inhibits platelet aggregation. Spontaneous bleeding has been reported with the use of ginkgo alone. There may therefore be an increased risk of bleeding if ginkgo is combined with antiplatelet or anticoagulant drugs. A small number of studies have not shown that ginkgo biloba has an additive effect to the clinical effects of aspirin. There are, however, case reports of bleeding in patients taking ginkgo together with antiplatelet drugs. Ginkgo should be avoided or used cautiously in patients who are taking antiplatelet drugs such as low dose aspirin. Patients should be advised not to use ginkgo without medical supervision” General drug information sites, such as WebMD  have entries of Ginkgo and that includes side effects and interactions. Finally, you may be interested in this PLoS ONE paper “A Review of Potential Harmful Interactions between Anticoagulant/Antiplatelet Agents and Chinese Herbal Medicines”  References 1. https://www.ncbi.nlm.nih.gov/pubmed/18214851 2. https://www.ncbi.nlm.nih.gov/pubmed/21649517 3. https://www.sps.nhs.uk/wp-content/uploads/2014/09/SW_QA91_4_GinkgoAspirin_August2014.doc?UNLID=105103475120189618815 4. https://www.webmd.com/vitamins/ai/ingredientmono-333/ginkgo 5. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0064255